Study: Increased Healthcare Costs Not The Result Of Patient Demands

By Christine Kern, contributing writer

Physicians often blame patient demands for escalating costs, but a study shows this sentiment may be misguided.

A study published by Ezekiel Emanuel, MD., PhD, by JAMA Oncology found that, while many physicians believe patients’ inappropriate demands or requests for medical tests or treatments prompt escalating healthcare costs, the rate at which these requests are satisfied is actually very low. That means it is not, in fact, patient demands that are pushing healthcare costs higher.

And while physicians increasingly feel compelled to perform tests and procedures as proactive measures to avoid medical malpractice suits, the study demonstrates malpractice and defensive medicine account only for a fraction of rising healthcare costs.

Patient Demands and Requests for Cancer Tests and Treatments assessed 5,050 patient-clinician encounters between 3,624 patients and 60 clinicians at 3 oncology clinics between October, 2013 and June, 2014 to assess how frequently patients actually push for particular tests or treatments, what types they demand, the clinical appropriateness of the requested tests, and the frequency of clinician acquiescence. According to Healthday, the clinicians included 34 oncologists, 11 oncology fellows, and 15 nurse practitioners.

“We decided to look specifically at cancer patients' demands because oncology is a setting where there are life-and-death stakes for patients and the drugs and tests can get very expensive,” Emanuel said in a release. “However, we found, contrary to expectations, that patient demands are low and cannot be a key driver of increasing health care costs.”

The data revealed that only 440 of the 5,050 encounters involved a patient demand, which clinicians deemed appropriate in all but 50 cases. And of the 50 inappropriate demands, physicians only complied with 7. That means they complied with inappropriate demands or requests in only 0.14 percent of the 5,050 total encounters. The 440 patient requests included 216 imaging studies, 68 palliative treatments (excluding chemotherapy or radiation), and 60 laboratory tests.

“We observed very few patient demands for inappropriate treatments, and it was even rarer that a physician complied with the demand,” said lead author Keerthi Gogineni, MD, MSHP. “In this age of unregulated consumer medical information on the Internet, it's encouraging to see that this hasn't translated to cancer patients requesting inappropriate – and often costly – tests and treatments.”

The findings show doctors “have to stop blaming patients for being demanding. In reality, it is hardly happening,” wrote Dr. Anthony Back in an editorial for JAMA. “The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and in our memories. And when we have calmed down enough to look up, we see that what is really happening between patients and physicians these days is something quite different.”

The study was confined to oncology encounters, and whether or not the findings can be extrapolated to other fields or healthcare in general is subject to further study.