title: Barriers to patient-physician communication about out-of-pocket costs.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Patient- and physician-reported barriers to discussing out-of-pocket costs.
  
  
  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.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Chicago, IL 60637, USA. galexand@uchicago.edu
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Tseng
authors.forename: Diane
authors.initials: D
authors.lastname: McFadden
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003144:Communication Barriers; D005260:Female; D005382:Financing, Personal; D019538:Health Care Surveys; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010817:Physician-Patient Relations; D013997:Time Factors