Out-of-pocket costs account for approximately one fifth of healthcare expenditures. Indeed, a recent report issued by The Commonwealth Fund found that as many as 18 million U.S. families spent more than 5% of their annual incomes on out-of-pocket medical expenses, not including health insurance premiums.

Little was known about how, or whether, patients and physicians ever discussed these rising costs. However, a new study published in the August 20, 2003 issue of the Journal of the American Medical Association set out to identify patient and physician beliefs and practices regarding discussion of out-of-pocket costs. The researchers found that while both physicians and patients agreed that discussions of patient out-of-pocket costs were important, they rarely took place. The researchers concluded that physician communication with patients about these costs may be a neglected aspect of current clinical practice.

About the study

Between March and November 2002, the researchers conducted paired surveys of 133 general internists and 484 of their outpatients. The patient surveys asked about the burden of their out-of-pocket costs, whether they wished to discuss these costs with their physicians, and past experiences with these discussions.

The physician surveys asked whether the physician was aware of each patient’s particular out-of-pocket cost burden, whether they had ever discussed these concerns with their patients, and whether they believed patients wanted to have these discussions.

The findings

Sixty-three percent of the patients surveyed expressed a desire to talk with their physicians about their out-of-pocket costs, and 79% of physicians believed that patients in general wanted to discuss these costs. And, while 90% of physicians thought they should consider discussing out-of-pocket costs with their patients, only 35% of physicians and 15% of patients reported ever actually having this conversation.

The researchers also found that these discussions were significantly more likely to occur with patients who were burdened by their out-of-pocket costs and with patients seen in a community practice. Physicians were substantially more likely to recognize this burden when a prior discussion regarding out-of-pocket costs had taken place.

How does this affect you?

These findings have important implications for patients, clinicians, and policymakers. For starters, patients should be encouraged to discuss their concerns regarding out-of-pocket costs with their physicians. One reason for this is that these discussions may facilitate a patient-physician partnership when it comes to making clinical decisions. For example, improved communication regarding out-of-pocket costs may improve a physician’s awareness of a particular patient’s situation and encourage them to choose more cost-effective medications.

These results also offer policymakers, and physicians, new insights into how out-of-pocket expenses impose a particular burden on those populations with the greatest health care expenditures (e.g., the uninsured, the elderly, and those with multiple chronic conditions).

In conclusion, the researchers determined that physician communication with patients about out-of-pocket costs is an important but neglected aspect of current clinical practice. They recommend further research be done to identify the prevalence of this problem, it’s causes, and the potential impact physician-patient conversations regarding out-of-pocket costs could have on patient satisfaction, utilization of care, and outcomes. In an economy where budgets are tight, and every expenditure is scrutinized, this may be one more area where improved communication can have a real impact on the quality of life for many patients.