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Asthma Patients to Docs: Can We Talk About Cost?

Perceived financial burden can lead to non-adherence

Asthma patients concerned about their ability to pay for medical care would like to talk about cost-related concerns with their physicians but often don’t get that opportunity, say researchers at the University of Michigan School of Public Health.

In a recent study published in the Annals of the American Thoracic Society, less than half of patients who expressed a preference for such discussions with their doctors reported having these conversations.

“Financial burden from out-of-pocket health care expenses poses significant safety concerns and risk of poor outcomes to patients and society when patients utilize risky strategies, such as nonadherence, to address these burdens,” said lead author Dr. Minal Patel.

“Patients need to communicate with health care providers in order to access affordable options, such as free samples, verification to access community assistance programs, to change a prescription, or to adjust treatment recommendations.”

The authors surveyed 422 African–American women with asthma and found that 52% perceived a financial burden from treatment. In addition, 72% reported a preference to discuss costs with their health care providers, and yet only 39% did so.

Patel said doctors may not be aware that patients need this kind of communication, or they may be hindered by “social distance,” which makes the subject difficult to approach.

Recent data from the National Health Interview Survey show that 20% of families in the U.S. have trouble paying for medical care. Often both the perception and the reality of a financial burden causes patients to skip treatments altogether or to cut back on dosages.

Cost-related non-adherence to medical treatment is prevalent among both high- and low-income patients and can even occur among people who appear to have resources, such as health insurance, a job, or a steady income, the authors note.

“Individuals with economic resources or whose situations suggest economic security may perceive or have actually experienced that their perceptions of burden were not taken seriously by their provider, since resources typically increase expectations to pay out-of-pocket,” Patel said.

According to the authors, additional research is needed to determine whether communication about the cost of therapy is associated with health outcomes.

The study was supported by the National Heart, Lung and Blood Institute.

Source: University of Michigan; November 10, 2014.

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