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.

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