Culture shock: Consumer-directed health care slow to catch on

Defining patients as "consumers" is a concept many doctors have not embraced. Patients seem to agree, as health plans that give patients more first-dollar coverage are growing less quickly than expected.

By Emily Berry, AMNews staff. Dec. 24/31, 2007.

Family physician Don Gibson, MD, isn't too keen on talking about bills with patients. Usually, he said, if a patient asks about the price of a visit or a test, he refers them to "the people at the front desk," who manage the billing for his solo practice in Richland, Miss.

His hesitance to talk about the cost of care or a patient's bill is just the way he was trained, Dr. Gibson said. "I do have to talk about money more. I personally don't like to be a part of it, but at times I have to be a part of it."

The discussion about money is happening more often, in part because some patients now have high-deductible health plans paired with health spending or flexible spending accounts -- also known as consumer-directed health plans.

Advocates of such plans say that giving patients first-dollar coverage will get them more involved in their health care, and more involved in discussing the costs. But analysts say those plans are growing more slowly than expected because of a perceived taboo about patients and doctors discussing the cost of care.

"There's no question that there will be certain individuals who just don't feel comfortable having this discussion related to their financial situation, period," said Jacque Sokolov, MD, chair and senior partner at health care consulting firm SSB Solutions.

It appears many patients and physicians are having a difficult time turning health care into a consumer-retailer discussion.

"I'm only concerned about their medical problem," Dr. Gibson said. "I don't like that term, 'consumer,' even though I guess there's some truth to it. I've always considered them my patients, not consumers."