In a recent Sermo poll, 63% of physicians said they consider the cost of care “all” or “most” of the time when deciding on treatment options.1 However, despite being acutely aware of the financial pressures facing patients, many feel they are unable to influence the nearly broken healthcare systems they work within.
As one Psychiatrist on Sermo puts it: “Although the cost of care is a huge barrier, usually physicians don’t have much control over it and insurance companies become the patient’s only resource.2“
The worldwide numbers give context to the situation. In high-income countries (for example, the cost of healthcare in America), annual healthcare spending usually ranges between $5,000 and $9,000 per person. In middle-income countries, it’s closer to $1,000 to $3,000, and in low-income nations, often less than $500.3 Throughout 2025, global healthcare spending overall is forecast to rise by 6%.4
As costs climb and increasing numbers of patients delay their care due to being unable to afford it, physicians continue to try and navigate an expensive system that pits financial reality against the ethics of healthcare.
So why is the cost of care such a central, but often unspoken, part of the clinical conversation? How do Sermo members balance financial concerns with patient needs, and what changes do physicians believe are necessary to make care more accessible?
This article draws on Sermo poll data and real-world physician insights to uncover how cost factors into treatment decisions and what needs to change to better support both patients and clinicians.
Do physicians consider cost in treatment decisions?
Physician awareness and impact on treatment plans
Cost is now an unavoidable factor in clinical decision-making. In a recent Sermo poll, 23% of physicians said they “always” and 40% said they “most of the time” consider the cost of care when determining treatment options. That’s more than 6 in 10 physicians routinely factoring affordability into their clinical judgement.
This awareness is driven by direct patient concerns. According to the same poll, 43% of physicians say their patients are “very” worried about care costs.1 These concerns play out daily in the clinic. One Internal Medicine physician on Sermo shared: “I try to be judicious with prescriptions, referrals, and follow-ups to limit unnecessary out-of-pocket costs.2”
Yet with fewer than 10% of physicians practicing in regions with universal coverage, avoiding cost considerations is nearly impossible.1 Even when insurance is available, deductibles, formularies and restricted networks often leave physicians concerned about how many people can’t afford healthcare.
Many clinicians want to help, but frequently lack the time, tools or institutional support to provide lower-cost alternatives without compromising the quality of care.
Patient refusal and resulting clinical risk
Physicians on Sermo are also witnessing the patient impact of these affordability concerns. In the same poll, 64% reported that their patients “occasionally” or “often” refuse treatment because they can’t afford it.1
These decisions affect all aspects of care, from skipping basic diagnostics to walking away from life-saving therapies. One Emergency Medicine physician commented: “I cannot deny that I am concerned that the high cost of medical care is leading many patients to postpone important treatments, putting their long-term health at risk.2”
The consequences are systemic. As patients delay care, their conditions often worsen, leading to more intensive and expensive interventions later on. An Oncologist on Sermo highlighted this dynamic, noting: “Immune therapies cost over $500K per year; pricing must align with actual benefits.2” By the time patients return for treatment, the opportunity for lower-cost options may have already passed.
As one General Practitioner put it: “Access to health care should be a fundamental right and not a privilege. High costs limit many people from receiving the care they need.2”
The implication is clear: short-term cost avoidance frequently leads to long-term clinical and financial risk. Physicians see this pattern and feel the pressure of trying to break it within systems that don’t make it easy to do so.
What are the barriers to talking about cost?
Despite the awareness and concern, conversations about cost don’t always happen. Only 31% of physicians said their patients feel “very” comfortable discussing financial concerns, meaning the vast majority of patients may be avoiding or downplaying the topic.1
Physicians say stigma, discomfort, and perceptions around value are all at play. One Sermo member shared: “Patients think expensive equals better care. It’s a hard perception to change.2”
This misalignment creates a communication gap. While physicians may try to reduce unnecessary spending, patients may hesitate to ask for more affordable alternatives, or may even assume that nothing cheaper exists. Meanwhile, time pressures and administrative complexity make it hard for clinicians to proactively address costs during routine consultations.
What tools are physicians using to help?
While many physicians try to support their patients, resources are limited and unevenly distributed. According to Sermo’s poll:
- 34% use patient assistance programs
- 14% recommend discount cards
- 13% turn to co-pay cards
- But 21% say they don’t use any cost-saving tools at all1
Much of this comes down to control. “Insurance controls most of this. We try to help, but the system is broken,2” wrote a Psychiatry resident on Sermo. Another Internal Medicine physician wrote: “One of my main concerns is to adjust treatments and diagnostic resources to those that match the patient’s preference and economic capabilities. Patients’ health and quality of life also depend on socioeconomic factors.2”
Still, some physicians try to empower themselves and their patients by staying informed of new treatments and adjusting care accordingly. “Being aware of alternatives for treatment. The latest and ‘best’ and usually most expensive is not always necessary,2” noted a Gynecologist.
However, without system-wide support, these efforts remain scattered and dependent on individual discretion. The result is a patchwork of solutions, with some patients benefiting from tailored, affordable care, while others fall through the cracks.
Until these tools are more accessible, integrated and encouraged, physicians will remain limited in how much they can meaningfully ease the burden of cost.
What do Sermo members believe needs to change?
Only 23% of physicians feel their organisation is doing enough to reduce cost burdens. Addressing this problem requires a shift in mindset, policy, and process.1
Transparency is a major opportunity. If patients and physicians alike had clearer insight into the true costs of treatment and the potential alternatives, they could work together to make more informed decisions.
Education also plays a role. “Maintaining health has a high price, but we need to educate on prevention to reduce costs,2” said one General Practice physician and Sermo member. Preventative care, lifestyle support and early intervention could all reduce long-term expenses, but they’re often under-resourced in fee-for-service models.
Finally, structural reform is needed. “The cost of health care is a reflection of a broken system,” wrote a Hematologist, “It’s time to rethink how it is funded.2”
Whether it’s through policy change, insurance innovation, creating the means for more affordable doctors, or new care models, physicians want to see a system that supports them in doing what they are trained to do: care for patients and not worry about the costs.
Your takeaway
Physicians on Sermo are clear about the role of cost in today’s care environment. They weigh it frequently, worry about its impact on patients and try, often with limited means, to soften its blow.
But concern alone isn’t enough. The insights from Sermo’s physician community reveal a deep need for better tools, open dialogue, and institutional support. Cost shouldn’t be the silent factor in care decisions. It should be part of an honest, empathetic, and actionable conversation; one that empowers both doctors and patients.
Join the conversation on Sermo
If you’re a physician facing similar challenges or want to learn how others are navigating cost-related decisions, join the Sermo community today.
Footnotes
- SERMO, 2024. Poll of the Week: Cost of Care [Poll]. SERMO Community. https://app.sermo.com/feed/for-you/post/1361375/expanded [Accessed 13 May 2025]
- SERMO member, 2024. Comment on Poll of the Week: Cost of Care [Poll]. SERMO Community. https://app.sermo.com/feed/for-you/post/1361375/expanded [Accessed 13 May 2025]
- World Population Review (2025) Health Care Costs by Country 2025. Available at: https://worldpopulationreview.com/country-rankings/health-care-costs-by-country (Accessed: 13 May 2025)
- Global Medical Trend Rate Projections 2025. Available at: https://ipmiglobal.com/in-focus/cost-containment/global-medical-trend-rate-projections-2025 [Accessed 13 May 2025]
