PRICE ALONE IS NOT ENOUGH: WE NEED EFFECTIVENESS INFORMATION TOO
By Jessie Gruman
April 2, 2014
The price of a drug, health care service or procedure is pretty much useless to me without also knowing about its effectiveness.
Think about it. If your clinician recommended the shingles vaccine, would you get it if it:
a) Is completely covered by your insurance
b) Requires a $25 insurance co-payment
c) Carries a $220 price-tag at your local Walgreens drugstore
Don’t you think your decision should include information that the vaccine is effective in about 50 percent of those who get it?
When price enters into examination room discussions, even straightforward recommendations get complicated. For example, different antidepressants work differently among individuals. Some are much more expensive than others. Your clinician recommends this one. Because it’s first on your insurance’s formulary list? Because it’s old and available as a generic? Because a handy sample is nearby? What about the overall effectiveness of the drug and the side effect profile? How about the characteristics of your depression? What about your age, sex, and personal and medical history?
How can you decide if the price of the pills is worth it if you don’t understand why your clinician recommended this particular drug?
With the exception of price, most of us blithely assume that all these other considerations constitute the basis of any clinician’s thoughtful recommendation to take a pill or undergo surgery for cancer or get a PSA examination – or not. Further, many of us are convinced that an action is only recommended if it is really recommended, i.e., it is not a tentative suggestion open to discussion. That’s why we sought advice of a professional, after all. If we wanted a discussion, we would have called our aunt.
Those of us who are well-insured are able to maintain the assumption of our clinician’s comprehensive good judgment with ease. We are protected from needing to weigh it against the price of our care. But more and more of us these days have high deductibles or limited health insurance coverage and find ourselves seeking price information as part of our decision-making. Of course, those without insurance coverage find price their central consideration whenever seeking care.
And so the price of the care our clinician provides and recommends should be a normal part of our conversations, right? After all, what we can afford is a topic about which we each have unique relevant expertise. In considering the price of any service or drug or procedure, our trust in our clinician’s advice, our tolerance for risk and our understanding of possible benefit are lined up against our available funds.
But how can we consider price when making a decision to go ahead with a treatment without an explicit discussion that allows us to weigh its potential effectiveness? Without understanding the relative risks and benefits of the drug or test or surgery, we have no idea what its value is to us, whether it is worth the money, the investment of time and inconvenience, and the potential time lost due to side effects or recovery, for example.
The integration of price and effectiveness into exam room discussions presents an open challenge to the time constraints experienced by both doctors and patients. Where in that average 20-minute visit will sorting through the implications of each recommendation fit?
Other barriers are familiar. Most clinicians don’t know much about the price of various treatments and certainly don’t know the details of each patient’s insurance. Some of us resist joining in discussions about the pros and cons of treatment relative to price because we don’t feel we have the expertise, lack the health literacy and numeracy skills, think it is our clinician’s job to recommend the best, or are just plain too upset to contemplate the risks and the price treatment entails.
Regardless, the price of our care is already a serious obstacle for too many. And signs point to it entering into more of our decisions about all aspects of our care. But once we are in that exam or hospital room, price alone should not and cannot ever be the sole consideration for our treatment choices. We simply cannot weigh our options – assuming we have some – without knowing the potential benefits and limitations of a treatment that might help us or those we love live long and well.
Original blog post by Jessie Gruman. Updated by the GW Cancer Institute June 2016.