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MDs often fail to consider patients' out-of-pocket fees

Hospitalist Leadership Connection, April 25, 2007

Only four in 10 physicians routinely consider their patients out-of-pocket costs when they recommend expensive medical care, according to a study by researchers at the Washington, D.C.-based Center for Studying Health System Change (HSC) and the University of Chicago Hospitals. The study was published in the April 9 Archives of Internal Medicine.

Roughly 80% of physicians surveyed for the study consider patient costs when prescribing a generic medication over a brand-name drug, and 40% consider patient costs when deciding what diagnostic tests to recommend. Meanwhile, 51% consider patient costs in deciding whether to hospitalize a patient when outpatient treatment is an option, the study found.

Hoangmai H. Pham, MD, MPH, the study's lead author and a senior health researcher at HSC, is quoted in an April 9 HSC press release as saying, "Because physicians consider patient costs less frequently in making decisions about more expensive services, it's likely that increased patient cost sharing will be limited as an effective cost-control tool."

The study, which collected information from 6,628 practicing physicians, also found the following:

• PCPs are more likely than specialists to consider patients' costs in choosing prescription drugs (85.3% vs. 74.5%), care settings (53.9% vs. 43.1%), and diagnostic tests (46.3% vs. 29.9%).
• Physicians in large groups/HMOs are more likely to consider out-of-pocket costs in prescribing generic drugs than those in solo/small practices. 

Access the study's abstract at http://archinte.ama-assn.org/cgi/content/short/167/7/663.

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