Patient Financial Considerations and Humanistic Medicine
Should a patient worry about getting care because of financial implications, be it copays, deductibles, medical debt or medical bankruptcy, choosing between medical care or food or housing, or other consequences?
If one believes that health care is like any other good or service in life, like buying a new television or deciding on a vacation, then one can justify financial consequences, including possible avoidance of care or medicines and choosing inferior treatments. But if one believes that health care is special, like having food to eat or housing to live in or education to get, then one is likely to be persuaded that facing more than small financial consequences of seeking care violates the tenets of Humanistic Medicine. It is certainly a sobering experience for a patient seeking care when the first question asked by an intake clerk seeks to ascertain their insurance coverage. Even more sobering is receiving a huge and possibly unexpected bill for services that were unavoidable.
Some will object that financial consequences are important to moderate demand. Yet, financial consequences fall unevenly – those with low financial resources are often supported by Medicaid and those with high resources find paying for care easily affordable and the elderly have Medicare, so it is only the middle of the population that really is affected, which is itself unfair. In addition, the main culprits for high costs in health care are high prices in hospitals and in procedures, for drugs, and for administrative overhead, not high utilization. Out-patient utilization is a minor factor in health care costs, and asking patients to shop for prices for health care is nugatory. If you want to assert market pressure on prices by doing comparative shopping, the best way is not to have patients do it, but to have their doctors do it. Their doctors have the knowledge necessary to shop, which patients lack. So don’t put it on the patients.
Humanistic Medicine considerations thus demand that financial implications for health care be a minor issue for patients, and that medical decisions by families not have to take finances into account.
