Doctors need to address patients’ worries about costs.
As we slowly move from the pandemic to the endemic phase of COVID-19, there has been much talk about patients who need preventive cancer screening. Some estimates suggest that millions of people are behind and continue to need breast, colon, and prostate cancer screening.
Even in the best of times patients were not getting screening tests as frequently as they should. For example, in 2020 only 30% of U.S. adults were up to date on their recommended colorectal cancer screenings. We all know that screening matters: localized colon cancer has a five-year survival rate of 91%, but this rate plummets to 14% when there is distant disease.
Primary care physicians are an important first line of defense in this struggle. Studies show that physicians are by far the most trusted resource that patients have when it comes to getting preventive care. PCPs are great at considering risk factors and personal preferences when having conversations about screening tests.
But there is another factor that doctors should consider when it comes to making recommendations: patient financial concerns.
Financial concerns around preventive care
It might not seem obvious with preventive care, but people still worry about the financial consequences of medical care. After all, preventive care such as an annual mammograms is generally covered at 100% by insurance, with no out-of-pocket cost to patients.
Why then should financial issues come up when we’re only talking about preventive tests? For starters, past experiences color future expectations. We’ve all had a patient who had an abnormal mammogram that required a follow-up ultrasound, and the patient complained that “insurance didn’t cover” the second test. While the first test was preventive, the second was diagnostic.
Diagnostic tests are subject to the same rules as other types of care, so there are usually some associated out-of-pocket costs. After a patient experiences this once, she expects it could happen again—and she no longer thinks of a “100% free” preventive test the same way.
Second, social determinants could be creating financial hardships. While the test itself might not have an associated cost, other hidden costs exist for patients: Transportation to and from the testing center can be a challenge. Finding childcare for a couple of hours while the test is being performed might be a burden. Being unable to work due to bowel prep or anesthesia might mean your patient has to take an unpaid sick day.
Finally, patients might struggle with a fear of the unknown. People avoid some kinds of medical care simply because they don’t know what to expect. But equally anxiety-provoking is the fear of the medical bill that comes after a visit to the doctor or a hospital stay.
It’s virtually impossible to know precisely what a service is going to cost in our health care system. This fear of an unexpected bill is a major barrier to getting important early care.
5 Ways to help patients prioritize early care
Trying to think through what we should do about our patients’ physical health is challenging, but it becomes even more complex when we layer on financial concerns. Fortunately, there are a few simple steps we can take to incorporate this important factor when helping our patients get care.
We owe it to our patients to help them access and understand screening tests — and encourage them to get those tests so small issues don’t become big problems. The next time you recommend screening tests to patients, take a few moments to talk about the financial side of care. Your patients will appreciate that extra bit of consideration, and they’ll be more likely to make preventive care a priority.