Nancy Kressin, the author of a recent JAMA paper I blogged about earlier this week, wrote me to respond to some of readers’ comments on that post. She approved my sharing it with you.
It is not true that I could have learned the exact cost of the endoscopy for which I was being referred, in advance of having the procedure. I called my insurer, a major insurer covering federal employees, and learned that the exact cost to me could not be determined until AFTER a claim was submitted. However, I think this detail is somewhat of a distraction from the main point I was trying to make, which was that information on the relative cost of the proposed test was totally lacking from the discussion. If it had been a $5 blood test, that may have been one thing, but a procedure costing me several hundred dollars was what was at play. I think one of the key issues comes down to the value of the information to be gained from the diagnostic test, relative to the cost. Consumer Reports assesses information about consumer purchases of automobiles in this way (and is trying to lead discussions of health care in this direction), and I support that notion.
It is not clear what effect giving health care clinicians cost information might have. In a presentation at the 2012 Society of General Internal Medicine meeting, Daniel M. Horn and colleagues concluded that “Real time display of cost information can reduce ordering of high volume laboratory tests, and has no effect on physician ordering of lower volume, high cost tests.” (JGIM Volume 27, Issue 2 Supplement, July 2012; http://link.springer.com/journal/11606/27/2/suppl/page/1). However, this information was supplied to the clinicians and not directly to the patients, so the extent to which the information was discussed in the diagnostic decision making process is unknown.
If she wishes, she may continue the discussion in the comments, so feel free to speak your mind.