title: Office visit copayments: patient knowledge, response, and communication with providers.
abstract: BACKGROUND
  There is limited information on patients' knowledge about their cost-sharing requirements and how that influenced their care-seeking behavior.
  
  
  OBJECTIVE
  To examine patients' knowledge of their office visit copayments, their self-reported responses to perceived and actual copayments, and discussions with physicians about costs.
  
  
  METHODS
  Cross-sectional telephone interview study with a 71% response rate.
  
  
  METHODS
  Stratified random sample of 479 adult members of a prepaid, integrated delivery system: equal sample of members with and without a chronic disease.
  
  
  METHODS
  Perceived and actual office visit copayment amounts, patient self-reported behavioral responses to copayments, cost discussions with a physician, and patient attitudes about discussing costs.
  
  
  RESULTS
  Overall, 50% of respondents correctly reported their copayment amount, with 39% underestimating and 11% overestimating. Among respondents who reported having copayments, 27% reported delaying or avoiding a visit altogether, or talking to a physician/advice nurse instead of attending an in-person visit because of their copayment. Perceived office visit copayment amounts were significantly associated with self-reported behavior changes (OR, 1.47 per $10; 95% CI, 1.06-2.05). Only 4% of respondents reported talking with their physician about their costs, with 79% believing that their providers cannot help them with their costs, and 51% believing that it is inappropriate to discuss costs with their physician.
  
  
  CONCLUSIONS
  Patients have limited knowledge of their office visit copayment amounts, and are changing their care-seeking behavior in response to perceived costs. Moreover, most patients are making these changes without discussing their cost concerns with their physician.
authors: Center for Health Policy Studies and the Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94612, USA.
authors: Nancy J
authors: NJ
authors: Benedetti
authors: Vicki
authors: V
authors: Fung
authors: Mary
authors: M
authors: Reed
authors: Mary
authors: M
authors: Price
authors: Richard
authors: R
authors: Brand
authors: Joseph P
authors: JP
authors: Newhouse
authors: John
authors: J
authors: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D003669:Deductibles and Coinsurance / Q000191:economics*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics*; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors