key: cord-0021658-8yyd278g authors: Bassett, Hannah K.; Beck, Jimmy; Coller, Ryan J.; Flaherty, Brian; Tiedt, Kristin A.; Hummel, Kevin; Tchou, Michael J.; Kapphahn, Kristopher; Walker, Lauren; Schroeder, Alan R. title: Parent Preferences for Transparency of Their Child’s Hospitalization Costs date: 2021-09-21 journal: JAMA Netw Open DOI: 10.1001/jamanetworkopen.2021.26083 sha: 9b78f5dfc5737a8a481d4e3b9cec186fc7cde5ef doc_id: 21658 cord_uid: 8yyd278g IMPORTANCE: Health care in the US is often expensive for families; however, there is little transparency in the cost of medical services. The extent to which parents want cost transparency in their children’s care is not well characterized. OBJECTIVE: To explore the preferences and experiences of parents of hospitalized children regarding the discussion and consideration of health care costs in the inpatient care of their children. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional multicenter survey study included 6 geographically diverse university-affiliated US children’s hospitals from November 3, 2017, to November 8, 2018. Participants included a convenience sample of English- and Spanish-speaking parents of hospitalized children nearing hospital discharge. Data were analyzed from January 1, 2020, to June 25, 2021. MAIN OUTCOMES AND MEASURES: Parents’ preferences and experiences regarding transparency of their child’s health care costs. Multivariable linear regression examined associations between clinical and sociodemographic variables with parents’ preferences for knowing, discussing, and considering costs in the clinical setting. Factors included family financial difficulties, child’s level of chronic disease, insurance payer, deductible, family poverty level, race, ethnicity, parental educational level, and study site. RESULTS: Of 644 invited participants, 526 (82%) were enrolled (290 [55%] male), of whom 362 (69%) were White individuals, 400 (76%) were non-Hispanic/Latino individuals, and 274 (52%) had children with private insurance. Overall, 397 families (75%) wanted to discuss their child’s medical costs, but only 36 (7%) reported having a cost conversation. If cost discussions were to occur, 294 families (56%) would prefer to speak to a financial counselor. Ninety-eight families (19%) worried discussing costs would hurt the quality of their child’s care. Families with a medical financial burden unrelated to their hospitalized child had higher mean agreement that their child’s physician should consider the family’s costs in medical decision-making than families without a medical financial burden (effect size, 0.55 [95% CI, 0.18-0.92]). No variables were consistently associated with cost transparency preferences. CONCLUSIONS AND RELEVANCE: Most parents want to discuss their child’s costs during an acute hospitalization. Discussions of health care costs may be an important, relatively unexplored component of family-centered care. However, these discussions rarely occur, indicating a tremendous opportunity to engage and support families in this issue. For this survey: all questions refer to your child who is currently in the hospital -"hospital employee" could be a healthcare professional (for example, a doctor or nurse), a social worker, a financial counselor, or other administrator -"tests and treatments" refers to any medical service that your child might receive while in the hospital The following questions will ask about your thoughts about the healthcare costs of your child. There are no right or wrong answers. These questions are for research purposes only. Your answers will have no impact on your child's current hospitalization or care. Your answers will not result in immediate changes in the way hospital employees share information about healthcare costs, but might change how they talk about costs with parents in the future. Please rate how much you agree or disagree with the next statements. 1 On the stair steps below, mark how satisfied you are with your present financial situation. The "1" at the bottom of the steps represents complete dissatisfaction. The "10" at the top if the steps represents complete satisfaction. The more dissatisfied you are, the lower the number you should mark. The more satisfied you are, the higher the number you should mark. A hospital employee should talk to me about the costs society (the insurance company, government) will have to pay for my child's tests and treatments. 1 When choosing a test or treatment for my child, my child's doctor should consider the amount of money it will cost society (the insurance company, government). I think about how much it will cost society (the insurance company, government) when I make a decision about my child's tests and treatments. 2 How concerned are you about how much your child's hospitalization will cost you? De novo During your child's hospitalization, have there been times when you wanted to talk about the costs of your child's tests and treatments with a hospital employee? 3 Did you talk about the costs of your child's tests and treatments with a hospital employee? De novo Did you know that this hospital has financial counselors? Did you ask to speak with a financial counselor during your child's hospitalization? Why did you ask to speak with a financial counselor? A hospital that charges more than another hospital for the same test or treatment is probably providing higher quality care. A hospital that charges less than another hospital for the same test or treatment is probably providing lower quality care Treatments that work better usually cost more than treatments that don't work as well. Treatments that do not work as well usually cost less than treatments that don't work as well. Tests that are more accurate usually cost more than tests that are less accurate. Tests that are less accurate usually cost less than tests that are more accurate. Do you or your spouse/partner (if applicable) have any current financial burden from medical care? Financial burden could include: difficulty paying or inability to pay medical bills, using personal savings to pay medical bills, difficulty paying for food, gas, or rent because of medical bills, declaring bankruptcy because of medical bills, etc. Patient experience and attitudes toward addressing the cost of breast cancer care Understanding patient's attitudes toward communication about the cost of cancer care Patient-physician communication about out-of-pocket costs Most Americans do not believe that there is an association between health care prices and quality of care. Health affairs Nearly half of families in high-deductible health plans whose members have chronic conditions face substantial financial burden InCharge Financial Distress/Financial Well-being Scale: Development, administration, and score interpretation How much will it cost? How Americans use prices in healthcare. Public Agenda