This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (60)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Topic Collections  • Patient-Physician Communication  • Alert me on articles by topic

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

JAMA. 2003;290:953-958.

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 2002.

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.

Author Affiliations: Robert Wood Johnson Clinical Scholars Program (Drs Alexander and Meltzer), MacLean Center for Clinical Medical Ethics (Dr Alexander), Department of Health Studies (Dr Casalino), and Harris School of Public Policy (Dr Meltzer), University of Chicago, Chicago, Ill.

RELATED LETTER

Factors in Studying Patient-Physician Communication
John F. P. Bridges
JAMA. 2003;290(19):2543-2544.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Personal and economic burden of late-stage rheumatoid arthritis among patients treated with adalimumab: an evaluation from a patient's perspective
Mittendorf et al.
Rheumatology (Oxford) 2008;47:188-193.
ABSTRACT | FULL TEXT  

Talking With Patients About the Cost of Cancer Care
Anthony
J Oncol Pract 2007;3:122-123.
FULL TEXT  

Physician Consideration of Patients' Out-of-Pocket Costs in Making Common Clinical Decisions
Pham et al.
Arch Intern Med 2007;167:663-668.
ABSTRACT | FULL TEXT  

Changes in Financial Burdens for Health Care: National Estimates for the Population Younger Than 65 Years, 1996 to 2003
Banthin and Bernard
JAMA 2006;296:2712-2719.
ABSTRACT | FULL TEXT  

Falling into the Doughnut Hole: Drug Spending among Beneficiaries with End-Stage Renal Disease under Medicare Part D Plans
Patel and Davis
J. Am. Soc. Nephrol. 2006;17:2546-2553.
ABSTRACT | FULL TEXT  

Etanercept or Infliximab: The Patient's Considerations--Reply
DeWitt et al.
Arch Intern Med 2006;166:1418-1418.
FULL TEXT  

Medication access through patient assistance programs.
Chauncey et al.
Am J Health Syst Pharm 2006;63:1254-1259.
FULL TEXT  

The implications of choice: prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions.
Shrank et al.
Arch Intern Med 2006;166:332-337.
ABSTRACT | FULL TEXT  

A Call for Fairness in Formulary Decisions
Levinson and Laupacis
Arch Intern Med 2006;166:16-18.
FULL TEXT  

Academic Faculty Development: The Art and Practice of Effective Communication in Veterinary Medicine
Bonvicini and Keller
jvme 2006;33:50-57.
FULL TEXT  

Direct costs related to rheumatoid arthritis: the patient perspective
Hulsemann et al.
Ann Rheum Dis 2005;64:1456-1461.
ABSTRACT | FULL TEXT  

Physician Strategies to Reduce Patients' Out-of-pocket Prescription Costs
Alexander et al.
Arch Intern Med 2005;165:633-636.
ABSTRACT | FULL TEXT  

National Trends in Cyclooxygenase-2 Inhibitor Use Since Market Release: Nonselective Diffusion of a Selectively Cost-effective Innovation
Dai et al.
Arch Intern Med 2005;165:171-177.
ABSTRACT | FULL TEXT  

Mixed Dementia: Emerging Concepts and Therapeutic Implications
Langa et al.
JAMA 2004;292:2901-2908.
ABSTRACT | FULL TEXT  

Cost-Related Medication Underuse Among Chronically III Adults: the Treatments People Forgo, How Often, and Who Is at Risk
Piette et al.
Am. J. Public Health 2004;94:1782-1787.
ABSTRACT | FULL TEXT  

Don't Ask, Don't Tell: The Status of Doctor-Patient Communication About Health Care Costs
Federman
Arch Intern Med 2004;164:1723-1724.
FULL TEXT  

Glycemic self-monitoring and insurance coverage
Heisler
CMAJ 2004;171:48-49.
FULL TEXT  

Do Drug Benefits Help Medicare Beneficiaries Afford Prescribed Drugs?
Rector and Venus
Health Aff (Millwood) 2004;23:213-222.
ABSTRACT | FULL TEXT  

Factors in Studying Patient-Physician Communication
Bridges
JAMA 2003;290:2543-2544.
FULL TEXT