Financial Anxiety Makes Medical Procedures More Painful
/By Pat Anson
The high cost of healthcare is a big problem for many Americans. A KFF survey recently found that about one in four U.S. adults are “very worried” about paying for healthcare, and have skipped or postponed seeing a doctor in the last 12 months because of the cost.
But rising medical costs do more than damage a patient’s bank account. New research shows that financial anxiety about the cost of healthcare may cause more physical pain during medical procedures, driving many patients to skip appointments altogether.
The study, “Paying for Pain: How Healthcare Costs Influence Physical Pain Predictions,” found that financial distress spills over into sensory expectations. That discomfort leads the brain to anticipate significantly more physical pain from procedures ranging from simple blood draws to complex endoscopies.
"We found that the psychological pain of paying money doesn't stay separate from our physical expectations," said lead author Helen Colby, Assistant Professor of Marketing at The Tepper School of Business, Carnegie Mellon University.
"When a medical test costs more out of pocket, people mentally brace for a more painful physical experience. Financial anxiety changes how we construct the prospect of healthcare in our minds before we ever set foot in a doctor's office.”
Colby and her colleagues conducted three experiments to see if the anticipation of an out-of-pocket expense for a routine medical procedure would heighten pain.
Three hundred adult volunteers were recruited for an imaginary blood draw. About half were told that their insurance would fully pay for the procedure, while the other half were told there would be an out-of-pocket cost of $53.
Those who were told they’d have to pay reported significantly greater financial anxiety and anticipated physical pain than those who had zero out-of-pocket expenses.
In another experiment, 350 volunteers were told to imagine getting an endoscopy, a procedure that involves a thin flexible tube with a light and camera being inserted into the body to diagnose or treat a health issue. Half were told that insurance would pay for the endoscopy, while the other half were told there would be $787 in out-of-pocket costs.
The group that would have to pay for the procedure had significantly more financial anxiety. They were also less likely to schedule the endoscopy.
For the third experiment, 400 people were recruited to be evaluated for a nerve condition. Half would pay nothing for the procedure, while the other half were told they’d have to pay $1,120 in out-of-pocket expenses.
Once again, those who anticipated paying a high cost had significantly more financial anxiety and were less likely to schedule the procedure.
Since these were all “imaginary” procedures, we don’t know with certainty how physically painful they might have been in real life. But researchers say their experiments demonstrate that the cost of a procedure consistently predicts when patients have more financial anxiety, anticipate more pain, and are less likely to schedule appointments.
"Healthcare providers and marketers need to realize that price tags carry heavy emotional weight," Colby said. "Communicating lower-cost options, offering clear payment plans, or framing preventive care as low-cost can lower financial anxiety. By reducing the pain of payment, we can decrease expected physical discomfort and encourage patients to get the medical care they need.
Researchers say their findings suggest that pharmacies, vaccine makers, insurance companies, and public policymakers should market preventive care procedures like flu shots as being free or low cost. Consumers are less likely to seek treatment when procedures are more expensive, not only due to financial concerns, but also due to anticipated physical pain.
