Diabetes Self-Management Blog

Critics of the current American health insurance system, on both the left and the right, often lament the lack of transparent pricing for office visits and medical tests and procedures. Those on the left are likely to point out that hospitals and medical practices can and do overcharge in the absence of government cost controls, due to the relatively weak bargaining power of private insurance companies; while those on the right are likely to point out that when insurance covers nearly all medical expenses, consumers have little incentive to pay attention to the costs they are incurring. Yet both sides may be surprised by the results of a recent survey examining patients’ attitudes toward asking about costs.

Released last week, the Altarum Instutute Survey of Consumer Health Care Opinions (Fall 2013) was conducted online and resulted in a sample size of 1,974, all of whom were aged 25–65 and had private insurance. On the question of whether respondents asked about what the personal cost of their visit would be, only 32% said that they did, while 68% said that they did not ask. This lack of asking about cost appears not to be based on having excellent insurance or being financially well-off: 33% of respondents said they would be “extremely concerned” about their ability to pay bills not covered by insurance, while 31% said they would be “somewhat concerned” and 25% “a little concerned.” Most survey respondents wouldn’t admit, at least, that they were hesitant to ask about cost because it made them uncomfortable: 43% said they were “very comfortable” asking about costs, while 38% said they were “somewhat comfortable.” Yet if respondents were, in fact, so comfortable asking, it is very strange that so few of them did.

According to the survey, younger people were more likely than older people both to ask about cost and to look for doctor or provider quality ratings. While 37% of respondents aged 25–34 asked about cost within the last 12 months, only 23% of those aged 55–64 did. On quality ratings, the difference was even more dramatic: 51% of respondents aged 25–34 said they looked for ratings within the last 12 months, while only 23% of those aged 55–64 did. Yet whether checking ratings had any impact on doctor choices is unclear: 79% of respondents reported using “opinions from friends or relatives” to select their doctor, and 32% used “online ratings of a doctor’s bedside manner or waiting time,” while only 27% used “online ratings from experts about clinical quality” and 16% used “information comparing the cost of care.” It appears that most patients care far more about comfort than they do about cost or effectiveness.

Why do you think so few people ask about the cost of care ahead of time — do most people care far more about other aspects of the hospital or office visit, or is it still widely considered taboo to ask about cost? Does pride, or a desire not to seem financially insecure, play a role? Have you ever asked about the cost of a visit or procedure ahead of time? If not, why not? Can medical costs be brought under control even if patients aren’t willing to ask about prices or shop around? Leave a comment below!

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