Physician-Patient Cost Conversations in Rheumatoid Arthritis: The Patient Experience at the Intersection of High Cost and Health Policy

The out-of-pocket cost burden associated with healthcare in the United States imposes broad hardship on patients. One quarter of Americans struggle to pay their healthcare bills, and over half of personal bankruptcy filings in the United States cite healthcare expenses as a contributing factor. This study examined 268 transcripts of audio-recorded clinic encounters between rheumatoid arthritis patients and their rheumatologists to better understand the patient experience in the face of high cost and begin to inform high-impact areas for policy solutions moving forward. Qualitative analysis of the transcripts identified three themes – emotional response, difficulty managing complexity, and cost-induced non-adherence – that characterize the patient experience when dealing with high cost. Informed by these transcript findings, subject matter expert interviews directed the policy recommendations. In the future, policymakers should continue to leverage the patient experience to motivate policy changes that reduce the cost burden associated with expensive medical care.