As far back as 2001, insurance companies began introducing high-deductible health care plans, increasing the amount patients pay for healthcare before their insurance benefits pick up costs. While many believed this would keep healthcare costs down by eliminating unwarranted visits to the doctor's office, it has resulted in complicating the patient-physician relationship.
A 2016 joint survey by the Kaiser Family Foundation and The New York Times found that about one-quarter of adults aged 18 to 64 said someone in their household had trouble paying medical bills in the previous 12 months. The report showed that among those who had insurance, 75 percent said that the amount they had to pay for the insurance copays, reach the deductible or pay in coinsurance was more than they could afford.
Physicians and their staff are now finding it necessary to dedicate additional time with patients to discuss insurance coverage and out-of-pocket costs.
According to Michael Munger, family physician, president-elect of the American Academy of Family Physicians (AAFP), high deductibles add to the complexity of a physician's relationship with patients and can present barriers to care, especially when patients delay important medical care or skip preventive services that are covered by their health plan without having to first meet the deductible or copay.
"When patients delay important medical care, this can result in the physician, especially primary [care] physicians, responding more reactively," said Munger, who practices in Overland Park, Kan.
However, Munger added, there is a positive side effect for the patient-physician relationship to these high-deductible health plans. "It is helping to open the lines of communication even wider, enabling physicians and patients to discuss the benefits of proactive care," he said.
Communication is paramount
Ken Ostermann, an OB/GYN at Beaver Dam Women's Health, a women’s health clinic located in Beaver Dam, Wisc., argued that insurers currently value only things that can be measured — not relationships. While high deductibles and copays might have an initial negative impact on the patient-physician relationship, Ostermann says he and his staff are able to connect with patients in new ways that add value to the relationship.
"Sometimes we serve as translators, helping patients understand exactly what their insurance policies cover," explained Ostermann. "In other ways, we serve as counselors when explaining options to the patients."
Communication between patients and physicians are being adjusted to discuss financial concerns. Ostermann adds, "While there are courses in medical school that deal with bedside manner when communicating with a patient, there are no courses focusing on communication when it comes to billing and collection etiquette."
Effective communication and cost transparency lead to shared decision making, according to Osterman. For example, patients might ask about a generic drug instead of using a name-brand drug.
Both Ostermann and Munger say open communication, which includes effective listening and cost transparency, is helping to cement the trust that already exists in the patient-physician relationship.
"Patients trust that physicians are on their side when it comes to medical costs," says Munger.
In a recent letter to President-Elect Donald Trump, the AAFP said it looked forward to working closely with the new administration and the 115th Congress to ensure that all Americans have access to high-quality, efficient health care. The AAFP also emphasized the need for policies that value primary medical care and protect patients from financial barriers to needed services, including the elimination of financial obstacles to securing primary and preventive care, especially those individuals who have high-deductible health plans.