title: Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients' Out-Of-Pocket Spending.
abstract: Some experts contend that requiring patients to pay out of pocket for a portion of their care will bring consumer discipline to health care markets. But are physicians prepared to help patients factor out-of-pocket expenses into medical decisions? In this qualitative study of audiorecorded clinical encounters, we identified physician behaviors that stand in the way of helping patients navigate out-of-pocket spending. Some behaviors reflected a failure to fully engage with patients' financial concerns, from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending. Many of these failures resulted from systemic barriers to health care spending conversations, such as a lack of price transparency. For consumer health care markets to work as intended, physicians need to be prepared to help patients navigate out-of-pocket expenses when financial concerns arise during clinical encounters.
authors.affiliation: Peter A. Ubel (peter.ubel@duke.edu) is a professor in the Sanford School of Public Policy, Fuqua School of Business, and School of Medicine, and faculty in the Duke-Margolis Center for Healthcare Policy, all at Duke University, in Durham, North Carolina.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.affiliation: Cecilia J. Zhang is a medical student in the School of Medicine, Duke University.
authors.forename: Cecilia J
authors.initials: CJ
authors.lastname: Zhang
authors.affiliation: Ashley Hesson is a student in the College of Human Medicine at Michigan State University, in Grand Rapids.
authors.forename: Ashley
authors.initials: A
authors.lastname: Hesson
authors.affiliation: J. Kelly Davis is a research associate in the Fuqua School of Business, Duke University.
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Davis
authors.affiliation: Christine Kirby is a research associate in the Fuqua School of Business, Duke University.
authors.forename: Christine
authors.initials: C
authors.lastname: Kirby
authors.affiliation: Jamison Barnett is chief technology officer and vice president of Verilogue Sound Insight, in Horsham, Pennsylvania.
authors.forename: Jamison
authors.initials: J
authors.lastname: Barnett
authors.affiliation: Wynn G. Hunter is a medical student in the School of Medicine, Duke University.
authors.forename: Wynn G
authors.initials: WG
authors.lastname: Hunter
mesh_terms: D000328:Adult; D003142:Communication; D017281:Cost of Illness; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D005102:Health Expenditures / Q000941:ethics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000191:economics*; D036301:Qualitative Research; D014481:United States
keywords: Cost of Health Care