Barriers to patient-physician communication about out-of-pocket costs

G. Caleb Alexander, Lawrence P. Casalino, Chien Wen Tseng, Diane McFadden, David O. Meltzer

Research output: Contribution to journalArticlepeer-review


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. DESIGN, SETTING, AND PARTICIPANTS: 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. MEASUREMENTS: Patient- and physician-reported barriers to discussing out-of-pocket costs. MAIN 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.

Original languageEnglish (US)
Pages (from-to)856-860
Number of pages5
JournalJournal of general internal medicine
Issue number8
StatePublished - Aug 2004
Externally publishedYes


  • Out-of-pocket costs
  • Patient-physician communication

ASJC Scopus subject areas

  • Internal Medicine


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