U.S. Internists' Perspectives on Discussing Cost of Care With Patients: Structured Interviews and a Survey

Rising out-of-pocket costs are creating a need for cost conversations between patients and physicians.

To understand the factors that influence physicians to discuss and consider cost during a patient encounter.

Mixed-methods study using semistructured interviews and a survey.

United States.

20 internal medicine physicians were interviewed; 621 internal medicine physician members of the American College of Physicians completed the survey.

Interviews were analyzed by using thematic analysis, and surveys were analyzed by using descriptive statistics.

From the interviews, 4 themes were identified: Physicians are 1) aware that patients are struggling to afford medical care; 2) relying on clues from patients that hint at their cost sensitivity; 3) relying on experience to anticipate potentially high-cost treatments; and 4) aware that patients are making financial trade-offs to afford their care. Three quarters (n = 466) of survey respondents stated that they consider out-of-pocket costs when making most clinical decisions. For 31% (n = 191) of participants, there were times in the past year that they wanted to discuss out-of-pocket prescription drug costs with patients but did not. The most influential factors for ordering a test are the desire to be as thorough as possible (71% [n = 422]) and insurance coverage for the test (68% [n = 422]).

Findings are self-reported, the sample is limited to a single specialty, the survey response rate was low, information on the patient population was limited, and the survey instrument is not validated.

Physicians are attuned to the burden of health care costs and are willing to consider alternative options based on a patient's cost sensitivity.

Robert Wood Johnson Foundation.