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Physician Consideration of Patients' Out-of-Pocket Costs in Making Common Clinical Decisions

April 9, 2007
Archives of Internal Medicine, Vol. 167
Hoangmai H. Pham, G. Caleb Alexander, Ann S. O'Malley

Patients face growing cost sharing through higher deductibles and other out-of-pocket costs, with uncertain effects on clinical decision making. The study found that while almost 80 percent of physicians consider patient costs when prescribing a generic over a brand-name drug, far fewer consider patient costs when deiding what diagnostic tests to recommend (51.2%) or deciding whether to hospitalize a patient when outpatient treatment is an option (40.2%). Cost-sharing arrangements targeting patients are likely to have limited effects in safely reducing health care spending because physicians do not routinely consider patients’ out-of-pocket costs when making decisions regarding more expensive medical services.

Free access to this article is available at the Archives of Internal Medicine Web site.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.