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Do out-of-pocket costs discourage care?
Higher medical expenses increased financial anxiety and reduced willingness to schedule recommended procedures in 3 studies, with stronger effects among financially stressed participants.
Clinical Scorecard: Do out-of-pocket costs discourage care?
At a Glance
Category
Detail
Condition
Patient responses to out-of-pocket costs for recommended medical procedures
Key Mechanisms
Higher stated costs were associated with greater financial discomfort (pain of paying) and procedure-related financial anxiety; these responses were linked to lower scheduling intentions in some analyses.
Target Population
1,028 English-speaking US adults recruited online who considered hypothetical routine blood draws, endoscopies, or nerve conduction procedures
Care Setting
Hypothetical procedure-scheduling decisions in an online experimental study; actual care use and clinical outcomes were not assessed
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.
