Costs rarely discussed

Both patients and doctors think it’s important to talk about out-of-pocket costs such as deductibles, co-payments and payment for services not covered by insurance that can become a financial burden -- yet the subject rarely comes up.

This particular medical communication gap hasn’t been studied, according to a first-of-its-kind report in the current issue of the Journal of the American Medical Assn. Researchers surveyed 133 doctors from three large Chicago-area internal medicine practices and 484 of their patients.

They found that 63% of the patients thought they needed to discuss these costs before tests or treatments, but only 15% reported having that conversation with their doctor.

Although 90% of the doctors thought they should consider their patients’ costs, and 80% believed their patients wanted to talk about costs, just 35% reported talking with them about it.

“We were surprised by the discrepancies between the respondents’ preferences and what they actually reported happening,” said lead investigator Dr. Caleb Alexander, an instructor in general internal medicine at the University of Chicago.

Costs arguably have an impact on whether patients follow through with recommended care, particularly when it comes to prescription medications. Out-of-pocket prescription costs account for almost half of all prescription spending. Studies and anecdotal experience have shown that many patients forgo prescriptions because they don’t have the money.

Although 90% of the surveyed patients had some prescription drug coverage, 25% described their costs as a burden and 16% reported skipping or stretching medicine in the previous year because of costs.

Alexander said in an interview that doctors might be able to ease some of the financial burden by prescribing cheaper generic versions of medications, recommending less-expensive over-the-counter drugs when possible or referring patients to pharmaceutical company discount programs.

Alexander said doctors might ask the patient if they have prescription coverage, inquire about out-of-pocket costs and whether those are burdensome, and then prescribe accordingly.

He and his colleagues attributed some of the communication gap to doctors feeling pressed for time. Patients cited discomfort discussing financial issues.

Yet when doctors and patients did talk about money, physicians became more aware of the burden their patients were shouldering and sometimes sought cheaper alternatives, the study found.