In the United States, millions of individuals are forced to navigate the complex healthcare systems with minimal guidance or support. Medical debt and the unpaid bills that result present serious challenges to the healthcare system. A March 2022 report determined the estimated total medical debt in the US was $111 billion in 2021. Given that healthcare is not a guaranteed right, it comes as no surprise that Americans struggle to access healthcare providers with reasonable payment plans and expectations. Those who struggle with paying medical bills often rely on non-profit healthcare organizations to offer reduced-cost care.

These organizations, which receive large-scale tax exemptions and significant funding for their services, are supposed to fill gaps within the healthcare system by providing reduced-price or free care to those who are uninsured or unable to pay. However, various non-profits healthcare organizations have come under fire for refusing care and, in some cases, for suing patients. Not only does this pose dangerous implications for those seeking healthcare, but it also places HCPs in murky waters as they must balance their professional code of ethics with the financial sustainability of their employer.

What Does This Mean for Patients?

Although not immediate, the effects of healthcare refusal significantly impact a patient’s quality of life both physically and financially. Not only does this put an immediate strain on the patients to find a way to pay medical fees without their healthcare provider’s support, but their health will also inevitably decline further because they did not receive the proper care or treatment.

While their initial medical problem may resolve itself, there is no way to repair trust that patients lose in the healthcare system following refusal. This may prevent them from seeking further medical help. In addition to trust, there are other core psychological needs that influence how people engage with the healthcare system. Understanding what these core needs are and how this situation may violate them reveals critical sources of stress that can be addressed.

  • One core need is autonomy, the need to feel in control. In this instance, the healthcare system is deciding that patients can no longer receive care unless they find a way to reconcile their outstanding bills, which violates patients’ autonomy.
  • Another core need is fairness, the need to feel that we are being treated the same as others. When low-cost or no-cost healthcare services are taken away due to missed payments, patients are no longer able to receive fair treatment.
  • Patients also have a core need to feel a sense of security, the need to feel safe from anticipated harm. Being unable to receive proper care compromises patients’ sense of safety.
    What Does This Mean for HCPs?

The ethical and legal implications of healthcare refusal pose a dilemma for many health care providers, as it is legal to refuse treatment to patients on the basis of their inability to pay for medical services, but a doctor cannot refuse treatment if it will cause the patient immediate harm.

Data from our Mindset Engine, the Syneos Health proprietary intelligence platform, shows that 73% of HCPs seriously consider product price when choosing a medication. This suggests that doctors are aware of the weight put on patients regarding price, and do not wish to put more strain on their patients if it is within their control. Additional data shows that the majority of doctors are concerned with insurance payer demands. This suggests that HCPs are attentive to their patient's well-being, in a medical sense and otherwise. There is a discrepancy between what HCPs want to provide and what they can control.

What does this mean for pharma marketers?

The context of hospitals and healthcare organizations dictating when and to whom to provide care has lasting ramifications for both HCPs and patients. Telling those stories and sharing their audiences' real experiences brings awareness and perspective to these issues. We can better understand the realities that HCPs and patients are navigating. And we can't fully talk about issues of HCP burnout or patient non-adherence without appreciating the greater environment in which they're providing or receiving care.

Pharma marketers should better connect to their audience's needs to ensure content, products, and experiences mirror their lived realities, making them more resonant and therefore, more effective.

About the Author:

Kathy Moriarty, Director, Behavioral Strategy, has over 12 years of experience in the life science and marketing industries. Her career has spanned providing care directly to patients, to developing strategic marketing plans and deliverables, to applying behavioral science insights to address audiences’ needs and challenges.

Kathy’s therapeutic expertise includes oncology, chronic kidney disease, narcolepsy, obesity, type 1 and type 2 diabetes, and mental health conditions. She is experienced in supporting behavior change on both a micro and macro level, including defining key behavioral challenges and identifying evidence-based techniques to drive change. 

Kathy has an MSW from Loyola University Chicago. She has worked as a therapist at a community-based mental health clinic and at an employee assistance program. She has also worked in marketing and advertising at companies including at IQVIA and evoke micromass.