Objective:

To examine whether out-of-pocket medical costs affect anticipated physical pain and willingness to schedule procedures, and whether financial discomfort and anxiety help explain these responses.

Approach:

• Design: Three randomized online experiments assigned 1,028 English-speaking US adults to hypothetical procedure scenarios with either the full out-of-pocket cost or no out-of-pocket expense.
• Procedures and measures: Scenarios involved a routine blood draw ($53), endoscopy ($787), or nerve conduction procedure ($1,120). Participants reported anticipated pain, scheduling intentions, pain of paying, and procedure-related financial anxiety.

Key Findings:

• For the endoscopy and nerve conduction scenarios, participants assigned the full cost reported lower willingness to schedule than those assigned no cost.
• Higher-cost groups reported greater pain of paying and financial anxiety across the studies.
• Anticipated physical pain was numerically higher in the higher-cost groups in studies 1 and 3, but neither overall difference was statistically significant.
• Serial mediation analyses found significant indirect pathways through pain of paying and financial anxiety for anticipated pain in studies 1 and 3, and for scheduling intentions in study 3. The corresponding overall serial indirect effect for scheduling in stu…
• In study 3, the association between cost-related financial anxiety and reduced scheduling intentions was stronger among participants with greater baseline financial stress.

Interpretation:

The authors reported that the pain of paying can affect behavioral intentions to make medical appointments. The experiments provided more consistent evidence for effects on scheduling intentions than for a direct effect on anticipated physical pain.

Limitations:

• The studies used hypothetical scenarios and self-reported expectations, not actual care decisions or experienced pain.
• Online US samples may not represent patients facing immediate medical needs or generalize beyond the US health care system.
• Prior procedure or physician experiences, insurance arrangements, and other contextual factors could influence responses.
• Mediation analyses do not independently establish the causal sequence between financial discomfort, anxiety, and anticipated pain.
• The studies did not test whether cost communication, financial counseling, or lower-cost alternatives affect attendance, adherence, or clinical outcomes.

Conclusion:

The experiments linked higher out-of-pocket costs with greater financial discomfort and anxiety, and with lower scheduling intentions in two procedure scenarios. They did not establish that higher costs directly increase physical pain.

Sources:

• Psychology & Marketing (source identified in article context; URL not provided)