To the Editor:
Medical schools are increasingly revamping curricula to introduce students to clinical environments earlier in their training.1 Students are trained to sequentially move through a tried and true list of questions, gleaning information about chief complaints to construct differential diagnoses and treatment plans. Depending on the scenario, students’ plans tend to consist of medications, referrals, and/or lifestyle changes. Less frequently do their plans consider the role of health economics and policy. This is problematic since health outcomes can be influenced by patient finances.
Considering the rising costs of health care, patients’ insurance plans are important for outcome and compliance. Analysis of 2015 National Immunization Survey-Teen data revealed a significant negative correlation between vaccination rates and lack of insurance amongst adolescents.2 Additionally, a study on the relationship between cost of care and quality of life in cancer patients found increased financial burden to be the strongest independent predictor of a poor quality of life in survivors.3 These examples illustrate that high-quality care encompasses more than an accurate diagnosis and availability of technology and medications; it necessitates an intentional conversation between the provider and patient on how finances may guide patients’ decisions.4
The Trump administration’s change to the Supplemental Nutrition Assistance Program, which addresses food insecurity, also reflects how policy and economics intertwine with health outcomes. Although the administration claims the new 20-hour per week work requirement will save an estimated $5 billion, there are health-related ramifications.5 Food insecurity in nonsenior adults, the age group impacted, is correlated with higher risk of diabetes, hypertension, and mental health issues.6 An increase in these conditions would create additional hurdles within an already struggling health care system. However, a physician-in-training with knowledge of how such policy changes can impact health outcomes would be better equipped to address patient concerns.
Successfully advocating for patients entails delving beyond the patient as an individual and acknowledging external systems. Encouragement from medical educators to inquire about insurance and relevant barriers to access during a patient history will train medical students to think critically about cost-effective treatment options, understand factors impacting continuity of care, and embrace a more proactive role in the health care system.
1. Skochelak SE, Stack SJ. Creating the medical schools of the future. Acad Med. 2017;92:16–19.
2. Lu PJ, Yankey D, Jeyarajah J, et al. Association of health insurance status and vaccination coverage among adolescents 13-17 years of age. J Pediatr. 2018;195:256–262.
3. Fenn KM, Evans SB, McCorkle R, et al. Impact of financial burden of cancer on survivors’ quality of life. J Oncol Pract. 2014;10:332–338.
4. Meropol NJ, Schrag D, Smith TJ, et al.; American Society of Clinical Oncology. American Society of Clinical Oncology guidance statement: The cost of cancer care. J Clin Oncol. 2009;27:3868–3874.
5. Fessler P, Treisman R. Nearly 700,000 SNAP recipients could lose benefits under new Trump rule. All Things Considered. https://www.npr.org/2019/12/04/784732180/nearly-700-000-snap-recipients-could-lose-benefits-under-new-trump-rule
. Posted December 4, 2019. Accessed September 25, 2020.
6. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff (Millwood). 2015;34:1830–1839.