Cost a Deciding Factor in Whether Patients Will Accept a Diagnostic Test

In a study published in Academic Emergency Medicine, investigators sought to determine the level of risks, benefits, and costs of diagnostic testing within the emergency department.

“In the current health care market, costs are kind of opaque,” said senior author William Meurer, MD. “If people know their insurance will cover everything, then they tend to go with what their doctor is saying in terms of getting a test.

“We wanted to change the conversation to look at how much people are valuing these tests if they have to pay for them out of pocket.”

The investigators conducted a survey via Amazon Mechanical Turk to crowdsource 1000 participants aged 18 and older who met the requirements. Participants received $1 to complete the survey.

Survey respondents were given 2 hypothetical clinical scenarios: low-risk chest pain and minor traumatic brain injury. Each situation included 3 variables—benefit, risk, and cost—which were independently varied over 4 values. For benefit and risk, possible values were 0.1, 1, 5, and 10%, and $0, $100, $500, and $1000, for the personal cost of receiving the test.

Benefit was defined as the probability of finding traumatic intracranial hemorrhage or acute coronary syndrome, according to the study.

“We defined the benefit as the chance that the patient had a true-positive finding,” Dr Meurer said. “The risk was defined as the chance of developing cancer within the next 10 years due to radiation. And the cost was an additional out-of-pocket expense for the test.”

The results of the study showed that with an increased benefit from 0.1% to 10%, the percentage of respondents who accepted a diagnostic test rose from 28.4% to 53.1%. The number decreased from 53.1% to 28.5%, as risk increased from 0.1% to 10%.

Cost appeared to be the most influencing factor in the study, with increasing the cost from $0 to $1000 changed rates of test acceptance from 61.1% to 21.4%, respectively.

“We found that participants were more apt to get the diagnostic test if it was at a lesser cost,” Dr Meurer said. “It proved to us that people are potentially sensitive to getting an additional bill for diagnostic testing.

“In addition, if participants saw their chance of getting a disease was incredibly rare, they felt the sense that ‘I might not have this disease, so I’m not willing to spend extra on it because there’s not as much risk,’” Dr Meurer said. “When the risk exceeded the benefit, the number of participants interested went down at a remarkable rate.”

A limitation to the study was that surveyors were only in a hypothetical situation, rather than actually seeking medical care, and that emergency department care can have more of an influence on decision-making.

“Our study found cost to be a large factor in whether patients go through with a diagnostic test,” Dr Meurer concluded. “While there are sometimes risks to these tests, in other times the benefit can outweigh those risks. We don’t want to see those patients turning down a test that could help them because they cannot afford it.”