title: Focus groups highlight that many patients object to clinicians' focusing on costs.
abstract: Having patients weigh costs when making medical decisions has been proposed as a way to rein in health care spending. We convened twenty-two focus groups of people with insurance to examine their willingness to discuss health care costs with clinicians and consider costs when deciding among nearly comparable clinical options. We identified the following four barriers to patients' taking cost into account: a preference for what they perceive as the best care, regardless of expense; inexperience with making trade-offs between health and money; a lack of interest in costs borne by insurers and society as a whole; and noncooperative behavior characteristic of a "commons dilemma," in which people act in their own self-interest although they recognize that by doing so, they are depleting limited resources. Surmounting these barriers will require new research in patient education, comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients.
authors: Yale Law School, New Haven, Connecticut, USA.
authors: Roseanna
authors: R
authors: Sommers
authors: Susan Dorr
authors: SD
authors: Goold
authors: Elizabeth A
authors: EA
authors: McGlynn
authors: Steven D
authors: SD
authors: Pearson
authors: Marion
authors: M
authors: Danis
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003299:Cooperative Behavior; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000191:economics / Q000523:psychology; D057240:Patient Preference / Q000191:economics / Q000523:psychology; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000191:economics / Q000592:standards; D055815:Young Adult
references: Health Aff (Millwood). 2012 Mar;31(3):560-8
references: 22392666
references: N Engl J Med. 2012 May 24;366(21):1951-3
references: 22551108
references: J Clin Oncol. 2009 Aug 10;27(23):3868-74
references: 19581533
references: J Gen Intern Med. 2006 Nov;21(11):1138-43
references: 16836629
references: N Engl J Med. 2012 May 24;366(21):1949-51
references: 22551106
references: Health Expect. 2007 Sep;10(3):236-47
references: 17678512
references: Int J Technol Assess Health Care. 2010 Oct;26(4):398-404
references: 20942984
references: Science. 1968 Dec 13;162(3859):1243-8
references: 5699198
references: Ann Intern Med. 2011 Sep 20;155(6):386-8
references: 21930856
references: JAMA. 2012 May 2;307(17):1801-2
references: 22492759
references: N Engl J Med. 2012 Jul 12;367(2):99-101
references: 22784112
references: BMJ. 2003 Sep 27;327(7417):693-4
references: 14512450