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June 2014

Overcoming Barriers to Discussing Out-of-Pocket Costs With Patients

Author Affiliations
  • 1Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland
  • 3Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
  • 4Fuqua School of Business, Duke University, Durham, North Carolina
  • 5Sanford School of Public Policy, Duke University, Durham, North Carolina
JAMA Intern Med. 2014;174(6):849-850. doi:10.1001/jamainternmed.2014.853

Increased cost sharing, in the forms of higher co-payments, deductibles, and yearly maximums, has been advocated to encourage patients to become smarter consumers and thus to reduce the overall cost of medical care. High out-of-pocket costs, however, can cause care to be delayed or foregone and can lead to financial distress and even bankruptcy. Some argue that physicians should be more cognizant of their patients’ out-of-pocket costs, not for the sake of society but for the sake of the patient.1 In our view, physicians have an ethical duty, at a minimum, to discuss out-of-pocket costs with patients in the same way that they would discuss the adverse effects of a treatment.2 But when physicians actually begin to consider out-of-pocket costs as part of clinical decision making, the challenges can seem overwhelming. We examine potential barriers to discussing out-of-pocket costs with patients and provide guidance on how physicians can overcome these barriers.

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