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Preventing the comorbidity of bankruptcy

By Bud Chumbley, MD, MBA

As physicians, it’s not uncommon to encounter a patient whom we know isn’t going to pick up a prescription or come in for a check-up because they don’t have insurance, it isn’t covered by insurance, or they can’t afford it. Studies have shown that anywhere from 10 percent to 30 percent of prescriptions are never filled, and one study showed a progressive relationship between drug cost and nonadherence, with an 11 percent increase in nonadherence between the cheapest and most expensive drugs. Patients with copayments on their prescriptions showed an even greater incidence of not filling prescriptions. Those with the maximum copays had a 63 percent increase in the rate of nonadherence compared with those who did not one. 1

What’s more, many patients don’t seek care because they fear the financial impact it may have on them or their families. According to studies of people filing for bankruptcy in the United States, 18 percent to 25 percent are due to medical expenses that make up over 50 percent of the debtor’s total unsecured debt or 50 percent of their annual income.2 For patients already experiencing financial issues, it is understandable that they would not seek medical care or fill prescriptions they feel they can’t afford or that might push them to the brink of financial ruin.

How can we help?
So what are we to do as physicians if our patients won’t or can’t fill prescriptions or come in to see us? I would argue that just as we take responsibility for their physical well-being, we also need to consider their mental and financial health in order to understand how best to heal them physically. We can be advocates for patients by discussing their health insurance coverage, procedures and prescriptions needed for their condition, and the options or resources available to them. While it is nearly impossible for us to know all aspects of every type of insurance coverage, we can open the conversation with patients so we know if they have insurance coverage or have concerns about the cost of their care. It’s important to encourage our patients to engage in their financial well-being by knowing their insurance plan and how it works—specifically what’s covered and what’s not—and to know who to contact for answers about their plan.

Often patients are afraid to ask about the cost of medications, procedures or tests, but they may be more willing to discuss those concerns, along with insurance issues, if you are the one to start that dialog. Once you understand their concerns, you may be able to help them find resources and options to help cover the cost of their care and prescriptions. Cost-cutting measures, such as online pharmacies, prescribing generic medications, calling in a 90-day supply, pill splitting, alternative care plans or alternative facilities are all options to consider for patients concerned about their financial and physical health.

We went into medicine to help our patients get better, and sometimes that means stepping outside our role of taking care of the physical and uncovering other issues that may be affecting them, including financial concerns. By addressing these concerns and providing resources and cost-saving measures where possible, we can help to ease our patients’ financial and mental stressors, and in turn, focus more on their physical well-being.


1 Vega C. Why Patients Won’t Fill Your Prescriptions. Medscape. Sept. 2, 2014.
https://www.medscape.com/viewarticle/830616. Accessed October 31, 2017.

2 Austin D. Medical Debt As A Cause of Consumer Bankruptcy. Maine L. Rev. 2015; 67(1).
http://www.mainelawreview.org/volume-67-no-1-2015/medical-debt-as-a-cause-of-consumer-bankruptcy/. Accessed October 31, 2017.

The views and opinions expressed in this blog are solely those of the author and do not necessarily represent the views of the Wisconsin Medical Society, Wisconsin Medial Society Holdings Corporation or its subsidiaries. Nothing in this blog should be construed as legal, financial or clinical advice.

Clyde “Bud” Chumbley, MD, MBA

Doctor Chumbley, the chief medical advisor for Wisconsin Medical Society Holdings, is a seasoned physician executive with 24 years of experience in complex multispecialty medical groups and integrated health care delivery systems. As a practicing OB/GYN and management consultant, he has worked for some of the largest health systems in the country, including Aspirus Network and Baylor Health Care System. He also has held leadership positions for organizations including the American Medical Association Regional Policy Board and the Wisconsin Collaborative for Healthcare Quality.

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