Public Preferences: Cost of Care Discussions and Out-of-Pocket Imaging Costs Open Access

Abstract

Introduction: Higher insurance deductibles and rising out-of-pocket (OOP) healthcare costs can

lead to adverse financial outcomes and treatment non-adherence. Encouraging OOP cost

discussions with healthcare providers and increasing the availability of price transparency tools

are solutions that have been proposed to ameliorate the financial burden of healthcare. We

investigated public preferences regarding OOP cost discussions and price transparency tools.

Method: We recruited 1,025 volunteers using Amazon Mechanical MTurk. Participants

completed a 30-question survey that assessed their preferences about OOP cost discussions, OOP

cost delivery, and how they weigh cost versus quality (accuracy, doctor recommendation, and

online ratings) when choosing an imaging center for a back MRI in two different clinical

scenarios. Data was analyzed using average ranks and ordered logistic regressions of fractional

factorial models.

Results: A majority of participants wanted to know about OOP costs of imaging tests before their

receipt. Most wanted to have OOP cost discussions when scheduling imaging tests or during the

doctor visit when the test is recommended, and most preferred to have these discussions with the

doctor or provider ordering the test. For mild back pain, low-cost imaging was prioritized by

patients in all models when the effects of OOP costs and center quality were separated, but when

cost and quality data were presented together, high-quality, high-cost imaging was preferred over

low-cost, low-quality imaging. For severe back pain, high-quality imaging was prioritized by

patients in all models when the effects of OOP costs and center quality were separated, and this

trend remained consistent when cost and quality data were presented together. When given data

for cost and quality, the least preferred options were not knowing the cost of imaging or not

obtaining imaging tests, regardless of the severity of the back pain.

Conclusions: Quality metrics impact patients’ healthcare decisions. With the recent push towards

price transparency, price transparency tools should incorporate quality metrics to enable

healthcare consumers to make value-based decisions. Overall, transparency in medical care can

be promoted by providers (via OOP cost discussions) and institutions (via quality-based price

transparency tools), leading to decreased financial burden on healthcare consumers.

Table of Contents

Introduction ................................................................................................................................... 1

Cost-of-care discussions .............................................................................................................. 1

Price transparency and CMS mandate ........................................................................................ 2

Purpose ........................................................................................................................................ 4

Method ........................................................................................................................................... 4

Study population ......................................................................................................................... 4

Survey measurements .................................................................................................................. 4

Sociodemographic variables ....................................................................................................... 5

Statistical analysis ....................................................................................................................... 6

Results ............................................................................................................................................ 7

Study population ......................................................................................................................... 7

Preferences for OOP cost discussion delivery ............................................................................ 7

Participants’ stated preferences for imaging centers ................................................................... 8

Participants’ decisions: quality vs. cost in clinical scenarios ...................................................... 8

Discussion .................................................................................................................................... 10

Limitations ................................................................................................................................ 13

Future directions ........................................................................................................................ 14

Conclusion ................................................................................................................................. 14

References .................................................................................................................................... 16

Appendix A: Figures and Tables ............................................................................................... 21

Figure 1. Survey respondents .................................................................................................... 21

Table 1. Demographic characteristics of study participants ..................................................... 22

Table 2. Public preferences for OOP cost discussions .............................................................. 23

Table 3. Individual factors considered in imaging center selection .......................................... 24

Table 4. Cost and quality combinations considered in imaging center selection ..................... 25

Table 5. Ordered logistic regressions for mild and severe back pain ....................................... 26

Table 6. Relative importance of cost and quality ...................................................................... 27

Appendix B: Consent .................................................................................................................. 28

Appendix C. Survey .................................................................................................................... 29

About this Honors Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Emory College
Department	Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Biology, Biostatistics Health Sciences, Health Care Management Health Sciences, Radiology
Keyword	Out-of-pocket costs OOP costs Health economics Cost of care Quality of care Radiology Imaging
Committee Chair / Thesis Advisor	Sadigh, Gelareh, Emory University
Committee Members	Eisen, Arri, Emory University Duke, Marshall, Emory University

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