Tag: healthcare costs

Financial Toxicity

By Shauna Ayres MPH candidate 2017

CDC data estimates that 26.8% of families report significant financial burden due to medical costs (Cohen & Kirzinger, 2014) and this figure is expected to grow as insurance premiums, drug prices, medical procedures, and health facility overhead costs continue to rise each year. In addition, the aging US population is using more health services which drives everyone’s costs higher (Patton, 2015; Mitka, 2013).

Unfortunately, cancer is one of the most common and most expensive medical conditions. Cancer diagnosis, treatment, and rehabilitation are all lengthy, complex processes that require a variety of medical experts (Mitka, 2013). All of the visits, time, supplies, machines, therapies, medicines, personnel, etc. required adds to a patient’s out-of-pocket costs. (Zafar & Abernethy, 2013). However, there are not just monetary costs. Depending on the type and stage of cancer, thousands of dollars of lost wages can accumulate due to the time taken off from work to travel to appointments and receive treatments. This causes more financial stress on the patient because they are earning less income while their expenses are increasing (Zafar & Abernethy, 2013).

In the cancer community, the term financial toxicity has gained popularity. Financial toxicity refers to how the cost of a disease and its treatment impacts quality of life (University of Chicago, 2016), like how chemical toxicity effects health. Financial toxicity encompasses all aspects of wellness: physical, emotional, social, occupational, financial, and spiritual. Increased medical costs, and thus financial toxicity, is associated with decreased treatment adherence, worse patient outcomes, and lower self-reported quality of life (Shankaran & Ramsey, 2015; Zafar & Abernethy, 2013).

Financial toxicity should be treated as a symptom of cancer. Discussing personal finances in America is largely taboo, but this cultural norm should be challenged in the healthcare field. Doctor’s should assess the financial situations of their patients and use that information to help inform what the best mode of treatment will be (Shankaran & Ramsey, 2015). There are numerous ways to treat cancer and some are drastically more expensive than others. People may argue that the price tag of a treatment can never outweigh the price of life and that is valid; however, a health professionals must assess each patient’s priorities, both personally, medically, and financially to determine the healthiest individualized treatment path (Emanuel & Steinmetz, 2013; Shankaran & Ramsey, 2015). This does not necessarily mean that poor patients with receive cheaper and lower quality care. If a doctor is aware of a patient’s financial status, he/she can refer the patient to a hospital social worker who can assist in securing charitable funding or grant money to help pay for treatment (Shankaran & Ramsey, 2015). Until the issues of medical spending and insurance are solved, which will unfortunately not occur overnight, health professionals and patients must communicate more effectively to find the optimal comprehensive treatment to achieve the best overall quality of life for each individual (Emanuel & Steinmetz, 2013).


Cohen, R.A. & Kirzinger, W.K. (2014) Financial burden of medical care: A family perspective. NCHS data brief, no 142. Hyattsville, MD: National Center for Health Statistics.

Emanuel, E.J., & Steinmetz, A. (2013) Will Physicians Lead on Controlling Health Care Costs?. JAMA; 310(4):374-375.

Mitka, M. (2013). IOM Report: Aging US Population, Rising Costs, and Complexity of Cases Add Up to Crisis in Cancer Care. JAMA; 310(15):1549-1550.

Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., William Hollingworth, W., & Overstreet, K. (2013) Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff; 10.1377/hlthaff.2012.1263.

Shankaran, V. & Ramsey, S. (2015) Addressing the Financial Burden of Cancer treatment from Copay to Can’t Pay. JAMA Oncol; 1(3):273-274.

Shankaran, V., Jolly, S., Blough, D. & Ramsey, S. (2012). Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: A population-bases exploratory analysis. J Clinical Onclology; 14:1608-1614.

Zafar, S.Y. & Abernethy, A.P. (2013). Financial toxicity, part I: A new name for a growing problem. Oncology; 27(2):80-149.

University of Chicago (2016). Financial toxicity facts. Cost of Cancer Care. https://costofcancercare.uchicago.edu/page/financial-toxicity-facts

Patton, M. (2015, Jun 29) U.S. health care costs rise faster than inflation. Forbes. http://www.forbes.com/sites/mikepatton/2015/06/29/u-s-health-care-costs-rise-faster-than-inflation/#1226e08f6ad2

Hemostat holding money

Spending more for no better care

It is, perhaps, an American truism that the more you spend on something the better it will be.  We figure designer clothes are better than JC Penneys’…$200 jeans better than Wranglers…gourmet food better than Mom’s home cooking.

But none of those things is, necessarily, so, and with healthcare more and more evidence is showing that higher cost does not equal better care.  In fact, cost seems to have more to do with where you get your care than how good it is.  Quite a few studies have found that the average cost of a medical procedure varies geographically–getting lithotripsy in Cleveland, for instance, might cost twice as much as getting it in Kansas City (I’m making that up for an example but there are real examples from highly credible sources like the Institute of Medicine).  Now a study in the Journal of Trauma and Acute Care Surgery cited by Health Leaders Media shows that “the cost of treating trauma patients in the western United States is 33% higher than the cost for treating similarly injured patients in the Northeast.”

So your hospital might spend a third more to fix your injuries after a car wreck than a hospital in Maine, for instance, and you’d be no better off–or more likely to recover well.

Why should you care, if you don’t plan to have some sort of traumatic injury? (Which, of course, nobody does.) Because your insurance, if you have it, pays for other members’ costs, which increases your premiums…and if you pay taxes, other people’s injuries add to the cost we all pay to support Medicare and Medicaid.  And the study in Trauma and Acute Care Surgery found that “…trauma-related disorders are among the five most expensive medical conditions. …the average per-person cost in the Northeast [where care was cheaper] for trauma care for all five injury types combined was $14,022.”

These geographic disparities in healthcare costs have existed for decades, now, generally unaddressed.  Isn’t it time that changed?

Weekly round-up

Here are some stories we’ve been reading this week. Got something to add? Share it in the comments.