The Price of Healing: Confronting Financial Toxicity

May 20, 2024. By Avani Desai.

2023-24 NC Schweitzer Fellow Avani Desai
2023-24 NC Schweitzer Fellow Avani Desai

I entered the hospital to finally start bringing our project to life. As Albert Schweitzer Fellows, my co-fellow and I developed our project from the recognition of the gap between healthcare delivery and the broader needs that patients face. Hoping to bridge this divide for patients facing unmet needs after trauma surgery, our project aims to help these patients navigate barriers to recovery by providing social support, addressing food insecurity, and connecting to community resources.

Stepping into the first room, I began discussing the project with the patient. They confided in me about their battle to keep the lights on at home, the constant juggle between paying for utilities or buying groceries, and now, the daunting prospect of affording surgery.

This was not a unique narrative. As I moved from one room to the next, the echoes of similar stories formed a chorus of lived experiences. Each conversation peeled back layers of financial burdens, revealing the stark impact on recovery and well-being. These were not just patients recovering from surgery; they were individuals wrestling with the fear of how to heal when every resource was already stretched thin.

One in three Americans experiences financial burdens as a result of medical care. This financial strain is not confined to the uninsured; even those with insurance often find themselves unable to bear the costs, resorting to exhausting their savings or borrowing money to afford treatment. The medical community needs to take immediate action in the clinical setting and advocate for patients in the long-term to address this pressing issue.

Financial toxicity refers to the adverse impact that medical expenses, particularly out-of-pocket healthcare costs, have on the quality of patient care and patient outcomes. These costs then drive patients to delay, ration, or abandon care. A record-high 38% of Americans reported that they or a family member postponed medical treatment due to cost in 2022, according to a Gallup poll. A study of the financial toxicity of cancer patients found that in order to reduce costs, 20% of patients took less than the prescribed amount of medication, 19% filled only part of a prescription, and 24% avoided filling prescriptions at all to save money. Further, these strategies are not limited to patients who are uninsured – this financial toxicity also occurs for patients with health insurance.

Financial toxicity can increase the risk for readmission and longer hospital stays. Studies show that it is also associated with worse clinical outcomes and health-related quality of life. Plus, financial toxicity does not impact all patients equally. Patients identifying as black experience higher rates of financial toxicity, more commonly limiting care, experiencing debt, and having a significantly lower health-related quality of life due to healthcare costs.

It is clear that financial toxicity is increasingly poisoning the health of Americans. The medical community must address this threat with a multifaceted approach to ensure accessible, high-quality care and improve patient outcomes. There must be advocacy for policy changes to promote innovative payment models and curb exorbitant drug prices. However, realistically, any policy intervention directed at payers or industry is unlikely to be implemented soon. As such, there also must be focus on actionable interventions.

Continued research efforts are needed to characterize the extent of financial toxicity across health conditions, as well as how financial toxicity specifically impacts patient decision-making and long-term health outcomes. Investigators should explore strategies to tackle mitigating costs and improving outcomes, building a foundation for patient advocacy efforts and evidence-based recommendations for providers.

Physician engagement is also critical to combatting financial toxicity. Encouraging discussions on costs, once considered offensive, is now recognized as an essential facet of patient-centered care by professional organizations such as the American Society of Clinical Oncology. Many patients also want to discuss costs but worry about receiving lower quality care if they bring up costs. Bridging this gap requires educating physicians and providing them with tools to encourage and navigate these discussions, direct patients to financial resources, and advocate for patients to payers.

Financial toxicity has relentlessly plagued healthcare for too long. It has reached a tipping point, demanding immediate, concerted action. Through collaboration among policymakers, industry, hospitals, physicians, and patients, we can dismantle these barriers, forging a path towards greater health equity.

Avani Desai

2023-24 NC Schweitzer Fellow

UNC School of Medicine, Class of 2026