Context Out-of-pocket costs account for approximately one fifth of health care
expenditures and are increasing. Previous research suggests that these costs
are associated with medication nonadherence and considerable economic burden
among some patients. Little is known about patient-physician communication
regarding these costs.
Objective To identify patients' and physicians' beliefs and practices regarding
discussions of out-of-pocket costs.
Design, Setting, and Participants Cross-sectional paired surveys of 133 general internists and 484 of
their outpatients, aged 18 years or older, in 3 academic and 18 community
general medicine practices in the Chicago metropolitan area, March-November
Main Outcome Measures Patient and physician beliefs regarding discussions of out-of-pocket
costs, frequency and predictors of discussions, and physician recognition
of patient burden from out-of-pocket costs.
Results Sixty-three percent of patients reported a desire to talk with their
physician about their out-of-pocket costs, and 79% of physicians believed
that patients in general want to discuss these costs. By contrast, only 35%
of physicians and 15% of patients reported ever having discussed the study
patient's out-of-pocket costs. Multivariate analysis indicated that discussions
were significantly more likely to occur with patients burdened by their out-of-pocket
costs (prevalence ratio [PR], 2.55; 95% confidence intervals [CI], 1.62-3.76)
and with those patients seen in a community practice (PR, 5.19; CI, 1.86-8.93).
Among patients burdened by out-of-pocket costs, physicians were substantially
more likely to recognize this burden when a prior discussion regarding out-of-pocket
costs had taken place (80% vs 51%).
Conclusions Among respondents, both patients and physicians believed that discussions
of out-of-pocket costs were important, yet these discussions occurred infrequently.
Physician communication with patients about out-of-pocket costs may be an
important yet neglected aspect of current clinical practice. Further research
should identify the prevalence of this problem in broader populations, investigate
its causes, and evaluate the impact of enhanced communication about out-of-pocket
costs on patient satisfaction, utilization of care, and outcomes.