What role do clinicians play in the cost of health care?
Health care clinicians may not consider themselves a major factor in the cost of health care, they do feel they have a role in addressing the issue.
A new survey from the University of Utah Health and NEJM Catalyst points a finger at pharmaceutical and biotech companies as the biggest cost drivers in the high price of health care, followed by payers. Doctors? Not so much. At least according to doctors.
The survey of health care clinicians, clinical leaders and executives found that 87 percent lay the blame at pharma/biotech’s feet, while 81 percent think health plans, health maintenance organizations and insurers are a top driver. Just 28 percent say individual clinicians have a major effect on costs.
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While they may work in the health care industry, respondents don’t understand its workings any better than your average patient–90 percent of respondents say that the current payer environment is too confusing, and 86 percent say that doctors aren’t trained to talk about those costs anyway—yet more than 60 percent say that physicians are responsible for educating patients about costs. Meanwhile, 94 percent say out-of-pocket expenses are “extremely important” or “very important” to patients.
In fact, the survey finds a disconnect on the matter of cost, saying, “Physicians feel responsible for the cost of care to a patient, but not accountable for it.” While 76 percent of respondents say the cost to the practice/system is considered in clinical decisions at their organization, 72 percent said they consider out-of-pocket costs for the patient in those decisions and 68 percent said the same about total cost of care.
“The physicians don’t get into the detail of the individual payers, but they do understand there’s not consistency and there are pain points patients might be under,” says Dennis Jolley, vice president of institutional advancement for Gillette Children’s Specialty Healthcare.
Nearly half of respondents say they believe physicians should not be held accountable for that cost of care. More clinicians (53 percent) than clinical leaders (44 percent) and executives (32 percent) feel this way.
Though they don’t consider themselves a major factor in the cost of health care, clinicians do feel they have a role in addressing the issue. The report quotes Robert Glasgow, M.D., vice chair of clinical and quality operations for University of Utah Health’s department of surgery and chief value officer for the department of surgery in Salt Lake City: The doctor-patient relationship should never be seen as a business transaction. We need to train physicians to give patients enough cost data. That’s the starting block of high-value care.”
“The people who are paying for health care, delivering health care and receiving health care should have more power,” he adds. “They should be the ones to start the discussion and begin to influence the cost structure.”