Journal of General Internal Medicine

, Volume 19, Issue 8, pp 856–860 | Cite as

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

  • G. Caleb Alexander
  • Lawrence P. Casalino
  • Chien-Wen Tseng
  • Diane McFadden
  • David O. Meltzer
Original Articles


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.

Key words

patient-physician communication out-of-pocket costs 


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Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • G. Caleb Alexander
    • 7
    • 1
  • Lawrence P. Casalino
    • 7
    • 2
  • Chien-Wen Tseng
    • 5
    • 6
  • Diane McFadden
    • 3
  • David O. Meltzer
    • 7
    • 4
  1. 1.MacLean Center for Clinical Medical EthicsUniversity of ChicagoChicago
  2. 2.Department of Health StudiesUniversity of ChicagoChicago
  3. 3.Biological Sciences Collegiate DivisionUniversity of ChicagoChicago
  4. 4.Harris School of Public PolicyUniversity of ChicagoChicago
  5. 5.Pacific Health Research InstituteJohn A. Burns School of Medicine, University of HawaiiHonolulu
  6. 6.Department of Family Practice and Community HealthJohn A. Burns School of Medicine, University of HawaiiHonolulu
  7. 7.RWJ Clinical Scholars ProgramThe University of ChicagoChicago

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