When a doctor prescribes a medication, most of us don’t ask how much it’ll cost. It makes sense: for a lot of people – both doctors and patients – talking about the cost of care is a totally foreign concept.
Peter Ubel is the perfect person to explain why that is. He’s a physician who now teaches at Duke University, specializing in the overlap of ethics, behavioral economics and medicine.
“Not that long ago, if a person had insurance, they had really good insurance that covered the vast majority of the expenses,” Ubel says. “So there really wasn’t much to talk about when it came to money.”
But these days there’s a lot more to talk about. The Kaiser Family Foundation says last year, 80 percent of people who got insurance through their job still faced an annual deductible that could run as high as $3,000 or more.
That means we all have skin in the game now, Ubel says.
“When the doctor recommends one medication to us, we might have reason now to ask whether another medicine would be almost as good and a lot cheaper,” he explains.
That type of conversation is still rare, but it is happening in at least one medical field.
At Mohawk Alley Animal Hospital in Los Angeles, Dr. Diane Tang examines the mouth of a huge black and white cat named Melvin.
“Tell me a little about what’s going on with Melvin today,” Dr. Tang says to Melvin’s owner, Morgan Bradley. Bradley replies that she’s concerned about a bump on the cat’s face.
Tang lays out testing and treatment options for Melvin.
Tang examines Melvin. (Rebecca Plevin/KPCC)
Then, Kayla Wilkinson, a technician assistant at the hospital, enters the exam room and says something rarely said in a doctor’s office for people: “We have two estimates here,” Wilkinson says, as she walks Bradley through the different options.
Regarding one treatment plan, she adds, “it is most definitely not going to ever get higher than the high point, but just to prepare you, we like to give you a pillow for what to expect.”
Bradley says she appreciates getting this information upfront.
“It always helps in knowing what to prepare for and how much money I’m going to have to scrounge for,” Bradley says.
Dr. Reshma Gupta, an internal medicine physician at UCLA, says the veterinarian model is a good one for the human health care system, but there’s a caveat.
She says doctors and patients can — and should — discuss different treatment options, just as veterinarians do.
“I think where it works is that, when you’re trying to make shared decisions with patients, you come up with all the options that are available for the patient,” Gupta says.
The problem, she says, is doctors who treat people have no way of knowing what those options will cost.
Doctors “do not have access to costs of medications, or commonly ordered labs, or radiology when they’re face to face with a patient,” Gupta says. “And so they don’t have the ability to actually offer that information to patients.”
Ubel, the Duke University professor, says it comes down to one word: insurance.
“We all have different insurance plans, and so we all face different costs, and it’s almost impossible for a physician to figure out what any given patient has to pay,” Ubel says.
Ubel is optimistic that this situation will change. In the long run, he believes improved and innovative technology will make these prices more readily available. But for now, he says some information is better than none.
“We know that the old fashioned, generic antibiotic is going to be cheap and the brand new, high-powered antibiotic is going to be expensive,” he says. “And how expensive it is might vary from patient to patient, but just knowing the gist of the cost should be enough for doctors and patients to get somewhere in deciding what to do.”
But when deciding what to do, Ubel says there’s another more nuanced difference between pets and people: we’re just not comfortable talking about the costs of our own care.
But Ubel says, if we do, we might find that, like Melvin the cat, we have more options than we realize.
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