Lots of factors are at play when it comes to high healthcare costs. But doctors are sure of one thing: They aren’t to blame.
The health system surveyed members of the NEJM Catalyst Insights Council, which includes clinicians, clinical leaders and healthcare executives. Most of the 571 respondents, said pharmaceutical/biotech companies have the biggest impact on the cost of healthcare (87%), followed by health plans/HMOs/insurers (81%) and hospitals/health systems/physician organizations (75%).
Only 30% of the respondents (72% of whom are physicians) said clinicians have a strong impact on costs. Patients had the smallest effect.
“Physicians don’t set up pricing for insurance and we can’t determine the price of a drug or new technology. So, it’s easy to feel powerless when it comes to impacting costs,” said Robert Glasgow, M.D., a surgeon with the University of Utah Health.
Doctors have shouldered part of the blame for inflated U.S. healthcare costs for making expensive recommendations or overtreating patients to protect themsevles in a litigious society.
But the survey showed doctors do care about medical costs and are sensitive to those costs when treating patients, Glasgow said in an interview with FierceHealthcare. The survey found that 73% of respondents indicated that out-of-pocket costs to patients enter into their clinical decisions. But only 30% of physicians said they should be held accountable for the cost of care.
“The doctor-patient relationship can’t be a business transaction,” said Glasgow, but physicians need training in order to talk to patients about costs.
Glasgow, who has been in practice for 18 years, said costs do come into play when treating patients. While people consider costs when looking at just about everything else in life, when they step into a hospital, most don’t think about cost, he said.
But cost does matter. For instance, Glasgow recently treated a patient—a business owner who had health insurance—but decided to prescribe a different drug for treatment of symptoms before performing surgery to remove an adrenal gland tumor.
The patient simply couldn’t afford the co-pay for the drug typically used to treat symptoms such as high blood pressure prior to surgery. The alternative medication worked fine and the patient’s surgery was a success, he said, but he worries about costs becoming a barrier to providing care.
Doctors want to have a seat at the table when it comes to discussing healthcare and how to influence the cost structure, he said.
The survey found 86% of respondents agreed that physicians aren’t trained to discuss the cost of care and 78% said the tools necessary to estimate costs to the patient are not available. Many doctors don’t know what a particular drug will cost until they hear from a patient who has had to pay the bill, Glasgow said.