Racial and ethnic differences in cost-of-care conversations among older adults

ABSTRACT

Background

The rapidly growing racially diverse ageing population in the United States presents unique challenges for the country’s social, economic, and healthcare systems. Rising health care costs, increased patient cost-sharing, and limited financial resources make this generation of older Americans susceptible to large medical bills or debt, which disproportionally impacts older adults who are from racial/ethnic minority communities. Cost of care (CoC) conversations between patients and healthcare providers is one recommended approach for containing healthcare costs and alleviating patients’ financial burden of care.

Method

The current study used focus group methods to qualitatively explore the contextual factors that influence CoC conversations in a diverse sample of older adults (N = 27). Three focus groups were held with non-Hispanic White (n = 10), Black/African American (n = 9), and Hispanic (n = 8) participants. Thematic analysis yielded four broad themes.

Results

The results suggest that CoC conversations do not occur with physicians. The facilitators of CoC conversations included positive provider affect, rapport/relationship building, and communication. Barriers included lack of physician training, wait time, lack of focus on the patient, language, provider preferences, fear of physicians, and religion. There were significant differences in the facilitators and barriers across racial/ethnic groups.

Conclusions

It is critical for physicians to have the tools and training to successfully discuss CoC with older patients. Cultural competency training and provider awareness of patient preferences and expectations may be important when it comes to enhancing rapport and increase the likelihood of these important conversations within racial/ethnic minority communities.

KEYWORDS:

• Healthcare costs
• aging
• ethnic groups
• communication barriers

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by an internal award from the College of Public Health at the University of South Florida. No disclosures

Notes on contributors

Kyaien O. Conner

Kyaien O. Conner, Associate Professor in the College of Behavioral and Community Sciences at USF; researches factors that influence disparities in health service utilization/treatment outcomes for racial/ethnic minorities.

Jacqueline Wiltshire

Jacqueline Wiltshire, Assistant Professor in the College of Public Health at the USF; research examines health communication and the impact of cost of care on health outcomes.

Edlin Colato Garcia

Edlin Colato Garcia, doctoral student in the Department of Applied Health at Indiana University Bloomington; research examines mental health literacy, self-care, and help-seeking behaviors among young adults.

Barbara Langland-Orban

Barbara Langland-Orban, Professor in the College of Public Health at USF; research examines quality and performance improvement and health services management.

Erica Anderson

Erica Anderson, doctoral student in the College of Behavioral and Community Sciences at USF; research examines cultural adaptations to evidence-based interventions.

Iraida Carrion

Iraida Carrion, Associate Professor in the School of Social Work at the University of South Florida and is recognized as a Fellow of the Gerontological Society of America’s Cancer.

Amber Goodman

Amber Goodman, Pharmacist and master’s in public health student at Robert Stempel College of Public Health & Social Work, FIU.

Ashley Goodman

Ashley Goodman, Pharmacist and master’s in public health student at Robert Stempel College of Public Health & Social Work, FIU.