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November 19, 2003

Incidence of Inflicted Traumatic Brain Injury in Infants—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(19):2543-2544. doi:10.1001/jama.290.19.2543-a

In Reply: Dr Bridges raises the question of whether our method overlooked constraints on resources such as time. The economic theory underlying differences between stated and revealed preferences in this setting suggests that patients and physicians have complete information on the value of the choices for discussion during the clinical encounter and that they rationally prioritize other topics more highly than out-of-pocket costs. Although this theory is plausible, our findings suggest that insufficient time is only one of several important barriers to better patient-physician communication about out-of-pocket costs. Other barriers identified by patients and physicians include discomfort in discussing costs, concerns about the impact of discussions on quality of care, beliefs that physicians have no viable solution to offer, and lack of physician habit (C.C.A., unpublished data, 2003). Nevertheless, we agree that the distinction between stated and revealed preferences, as well as the potential of conjoint analysis to explore the perceived value of discussions about out-of-pocket costs relative to other topics of discussion within the clinical encounter, offer important opportunities for future research on communication about out-of-pocket costs.

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