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This weeks blog is brought to you by: Professor Sir Muir Gray, Founding Director.

Authors conclusion

Cost-conversation practice certainly will not make us perfect, given the logistical and informational barriers that exist. However, it will move us closer to the kind of patient-centered care that characterizes the ideals of our profession.


Text from the paper chosen by 3VH (this may, or may not be the ‘conclusion’)

Out-of-pocket expenditures have increased rapidly in the United States over the past decade. In 2018, 29% of people with private insurance were enrolled in high-deductible health plans, compared with just 4% in 2006. Out-of-pocket costs are high for many publicly insured people, too. Medicare beneficiaries with cancer who do not have supplemental insurance, for instance, face average out-of-pocket costs of $8115 per year, equivalent to 24% of their household income. As a result, more than one quarter of Americans have trouble paying their medical bills. Increased out-of-pocket expenses are associated with lower adherence, delayed or forgone care, and higher mortality. One survey published in this supplement reports that 86% to 95% of a representative sample of internists are aware of patients in their panel going without medical care because of cost. Given these financial burdens, and the impact they have on people’s medical care, health care providers need to talk to their patients about out-of-pocket costs. The 8 studies published in this supplement provide early evidence for best practices and have inspired us to propose 7 (preliminary) habits of what we hope will be highly effective cost-of-care conversations.

  1. You won’t know if you don’t ask
  2. Discuss the cost prognosis
  3. You can anticipate many, if not all, costs
  4. Be systematic: make explorations of out-of-pocket costs routine
  5. Integrate cost conversations into your workflow in a way that works for you
  6. Enlist your ancillary staff
  7. It gets easier, and better


3VH – Implications for value

Next time someone says that health insurance would make health better and clinical practice easier show them this article. One of the key resources that a physician has is time and just imagine how much time is taken up with this type of discussion. As if clinicians and patients did not have enough to think about in a consultation already, for example about the risks and benefits of a knee replacement operation or, an increasing time consumer, the meaning of a polyvalent risk score, ordered by some other keen clinician or bought by the patient himself.

The introduction of insurance and co-payment schemes would not, on the evidence of this article increase value for either individuals or the population