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Barriers to patient-physician communication about out-of-pocket costs

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Abstract

BACKGROUND: Though many patients and physicians believe that they should discuss out-of-pocket costs, research suggests that they infrequently do.

OBJECTIVE: To examine barriers preventing patient-physician communication about out-of-pocket costs among study subjects recalling a time when they wanted to discuss these costs but did not do so.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional surveys of 133 general internists and 484 of their patients from 3 academic and 18 community practices in a large midwestern metropolitan region.

MEASUREMENTS: Patient- and physician-reported barriers to discussing out-of-pocket costs.

MAIN RESULTS: Overall, 54 patients (11%) and 27 physicians (20%) were able to recall a specific time when they wanted to discuss out-of-pocket costs but did not do so. Among patients, a wide variety of barriers were reported including their own discomfort (19%), insufficient time (13%), a belief that their physician did not have a viable solution (11%), and concerns about the impact of discussions on quality of care (9%). Among physicians, the most common barriers reported were insufficient time (67%) and a belief that they did not have a solution to offer (19%).

CONCLUSIONS: Efforts to promote discussions of out-of-pocket costs should emphasize the legitimacy of patients’ concerns and brief actionable alternatives that physicians can take to address them.

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Author information

Authors and Affiliations

  1. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Ill

    G. Caleb Alexander MD, MS

  2. Department of Health Studies, University of Chicago, Chicago, Ill

    Lawrence P. Casalino MD, PhD

  3. Biological Sciences Collegiate Division, University of Chicago, Chicago, Ill

    Diane McFadden BA

  4. Harris School of Public Policy, University of Chicago, Chicago, Ill

    David O. Meltzer MD, PhD

  5. Pacific Health Research Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii

    Chien-Wen Tseng MD, MPH

  6. Department of Family Practice and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii

    Chien-Wen Tseng MD, MPH

  7. RWJ Clinical Scholars Program, The University of Chicago, 5841 S. Maryland, MC 2007, 60637, Chicago, IL

    G. Caleb Alexander MD, MS, Lawrence P. Casalino MD, PhD & David O. Meltzer MD, PhD

Authors
  1. G. Caleb Alexander MD, MS
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  2. Lawrence P. Casalino MD, PhD
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  3. Chien-Wen Tseng MD, MPH
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  4. Diane McFadden BA
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  5. David O. Meltzer MD, PhD
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Corresponding author

Correspondence to G. Caleb Alexander MD, MS.

Additional information

This work was supported by funding from the Robert Wood Johnson Foundation Clinical Scholars Program. The content of this publication does not necessarily reflect the views or policies of the Robert Wood Johnson Foundation.

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Alexander, G.C., Casalino, L.P., Tseng, CW. et al. Barriers to patient-physician communication about out-of-pocket costs. J GEN INTERN MED 19, 856–860 (2004). https://doi.org/10.1111/j.1525-1497.2004.30249.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30249.x

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