Clinical Scorecard: Do out-of-pocket costs discourage care?

At a Glance

Key Highlights

• Across three randomized online experiments, participants assigned full out-of-pocket costs reported lower willingness to schedule endoscopy and nerve conduction procedures than those assigned no cost.
• Higher-cost conditions produced greater financial discomfort and financial anxiety across the procedure scenarios.
• Anticipated physical pain was numerically higher in higher-cost groups in the blood draw and nerve conduction studies, but neither overall comparison was statistically significant.
• Serial mediation analyses found indirect pathways through financial discomfort and anxiety for anticipated pain in studies 1 and 3, and for scheduling intentions in study 3; the corresponding serial indirect effect for endoscopy scheduling did not reach conventional statistical significance.
• In study 3, the association between cost-related financial anxiety and reduced scheduling intentions was stronger among participants reporting greater baseline financial stress.

Guideline-Based Recommendations

Diagnosis

Management

• The authors noted that cost communication, financial counseling, and access to lower-cost alternatives could potentially address financial anxiety; these approaches were not tested for effectiveness.

Monitoring & Follow-up

Risks

• The authors raised the possibility that presenting high prices without affordable options could heighten financial distress.
• The studies used hypothetical scenarios and self-reported expectations, so they did not establish effects on actual appointment attendance, treatment adherence, or clinical outcomes.

Patient & Prescribing Data

Participants were 1,028 English-speaking US adults recruited through Prolific, assigned to hypothetical procedure scenarios with either the full stated out-of-pocket cost or no out-of-pocket expense.

Full-cost assignments were associated with lower scheduling intentions for endoscopy ($787: mean 2.87 vs. 4.26) and nerve conduction procedures ($1,120: mean 4.19 vs. 5.66), on 7-point scales. These were experimental intentions, not observed care decisions.

Clinical Best Practices

• Interpret the findings as evidence about stated intentions and emotional responses to hypothetical costs, not actual procedure uptake or clinical outcomes.
• The authors suggested considering cost communication, financial counseling, and lower-cost alternatives, while noting that these strategies were not evaluated in the studies.
• Do not infer that higher out-of-pocket costs directly increase physical pain; overall anticipated-pain comparisons were not statistically significant.

Related Resources & Content

• Psychology & Marketing study described in the supplied article; source URL not provided