Is Money Spent, Money Earned in Healthcare?

Appropriate Placement of Financial Responsibility

If patients accepted more financial responsibility and possibly complained to a greater extent, more effort would be to reduce costs and not pay over-priced treatments or procedures. Focusing on the charge itself, market-based and consumer-driven transactions can only exist if patients know the costs of care. Typically, competition and comparison expectation to modulate price in a market, like other markets, would contribute to setting the price. However, when medical-only discussions, rather than financial, are present, it will not suffice. The burden placed on HCP’s for disclosure before treatment is unmanageable. Negotiations of rate by the payers typically, and not well known or publicized, pay lower than the uninsured, and the higher burden is placed on patients, at the full or chargemaster price. Lastly, for HCP’s, knowing the negotiated rate again is beyond reasonable expectations (Hall, 2014).

Informing and Disclosing.

Today, patients are the deciding factor on what care they accept to receive. Advising patients on costs has been historically away from patients until after treatment. It is now more in line with the current policy to include the price with the informed consent disclosure of out of pocket (OOP) before the patient receives care. Currently, the burden remains with the patient, the more valuable player. Too difficult to mandate and not appropriately placed with physician-patient encounters, the financial discussion of OOP must find a place because it cannot be separated from the medical discussion. Also, what is determined to be a benefit cannot be specified by the physician; this would not be objective. By informing patients of treatment options and financial risk, understanding the side effects, and the financial burden, a more shared decision gives more information to decide. A bill after the fact can have negative health impacts as well. (Hall, 2014).

The morality of disclosure to assign accountability.

Our moral obligation to include disclosure of cost, the question of objections to care, where risk is strictly medical, not financial, moral obligation to disclose is even more important. The impetus is to focus on the economic and practical, not moral, even if it is the strongest argument. If universal state-funded healthcare did occur, we would be giving up the idea of morality to do what would be more advantageous, healthcare for all in our efficient and cost-effective US Healthcare system.
But in this case of our current situation, the sacrifice is preserving the expensive, complicated, and over-managed system which excludes people. Therefore, according to Hall (2014), our situation has both moral and financial working on the same vector. If the absurdity of not mandating disclosure with informed consent, which would not be informed, then how can reform be made on an unsubstantiated market that would do truly little to control rising costs? Desperately needed are specifics about actual costs and require changes to the payment system (Hall, 2014). Real cost transparency may do more to lower prices than healthcare reform, especially one that does not contain cost for healthcare services. Clear and straightforward pricing, perhaps moving away from Fee-for-Service (FFS) payment system to streamlined bundled or capitation to make disclosure easier.

Expose the expensive system.

Cost-containment is not the reason for disclosure; however, it must be done and exemplifies most harm to the most vulnerable patients. Medical and financial factors end up being interconnected, where lack of disclosure is damaging to both health and finances. Disclosure should be simple and stand alone as the standard. In the US, confronting costs that come from disclosure is necessary and will expose the inequality in care. Put another way the moral justification does not disappear by moving questions about cost out of the clinic. By weighing the consequences, disclosing OOP may encourage providers to consider the new expensive treatment actual cost versus the significant improvements in more affordable and already available options. Although the belief is physicians would not be discussing but instead designate office personnel, if the discussion were commonplace, physicians would be able to anticipate problems (Hall, 2014). Providers could work out solutions, much like proprietors of business. In consumer-based care and a market-based healthcare system, some customers would not get particular care, due to not being in the market.