Physicians and patients rarely discuss costs

about out-of-pocket costs before receiving a test or treatment, yet 85 percent said they had never discussed these costs with the doctors in this study.

Although 90 percent of study patients had insurance that covered at least part of the costs of prescription drugs, 25 percent complained that out-of-pocket costs were a burden, and 16 percent reported that they had skipped or stretched a medicine during the previous 12 months due to costs.

Patients seen in a community practice were slightly more likely to have discussed costs than were those seen in academic setting. But even in the most likely circumstances, 75 percent of patients reported that they did not discuss medical expenses.

When doctors and patients did talk it made a difference. Discussing out-of-pocket costs made physicians more aware of the burden on patients and may have enabled them to seek less expensive alternatives.

Patients should be encouraged to raise their concerns about out-of-pocket cost with their doctors, said Alexander. "Our findings suggest that although physicians may not frequently discuss these costs, that they are sensitive to the issue and concerned about patients' burden."

Physicians, on the other hand, should be aware of the risk factors that suggest patients may be burdened by out-of-pocket costs, note the study authors, such as low income, advanced age, and multiple health problems.


Contact: John Easton
University of Chicago Medical Center

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