Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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viable solution to offer, and lack of physician habit (C.C.A., unpublished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.
Alexander CC, Meltzer DO, Casalino LP. Incidence of Inflicted Traumatic Brain Injury in Infants—Reply. JAMA. 2003;290(19):2543–2544. doi:10.1001/jama.290.19.2543-a
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