Should Patient Responsibility for Costs Change the Doctor-Patient Relationship?

Abstract

Copays, deductibles, coinsurance, and reference prices all now expose patients to increasingly larger shares of the costs of health care. Extant research on cost sharing has primarily focused on its impact on patients, their health care spending, and their health outcomes. Scholars have paid much less attention to the question of how patient exposure to health care costs may impact physicians and their relationships with their patients. This Essay is given on the occasion of a symposium motivated by two recent books by David Schenck, Larry Churchill, and Joseph Fanning that highlight the relational aspects of health care ethics. Accordingly, this Essay explores the impact of cost sharing on the doctor-patient relationship, specifically and argues that the patient’s exposure to cost should be understood as an essential part of that relationship. This insight implies changes in the ways that doctors establish their relationships with patients (making price more salient), in the ways they communicate with patients (affirmatively disclosing cost information to secure informed consent), and ultimately in the substance of their treatment recommendations for patients (broadening the considerations applicable to the legal standard of care for medical malpractice).

Keywords: cost-sharing, medical malpractice, informed consent, health insurance, copays, deductibles, biomedical ethics