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    Most Patients and Doctors Don't Know Out-of-Pocket Costs

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    How Much Does Health Care Truly Cost?

    Aug. 19, 2003 -- If you were buying a car, you'd certainly weigh the price of different options, yet a new study shows that patients and doctors rarely weigh the costs of medical treatment -- which can leave people with a large, unexpected bill.

    Most Want to But Few Do

    Certainly, caring for your health is more important than buying a car. Still, a sizeable 63% of patients and 79% of doctors said they felt the need to discuss cost but only 15% of patients and 35% of doctors reported that the talks actually happened.

    The research shows that only one in three doctors talked about the health-care costs of a procedure or medication with their patients. 'The difference between what physicians reported they should do and what they actually do, is striking,' says researcher Caleb Alexander, MD, of the MacLean Center for Clinical Medical Ethics at the University of Chicago, in a news release.

    Patients who were seen in a community practice -- who had more limited incomes -- did discuss health-care cost more, but not a lot. Still 75% of those patients did not have that conversation.

    For the study, researchers surveyed 130 general internists and 490 of their adult patients. The group came from three academic and 18 community general medicine practices in Chicago. Doctors and patients were interviewed after each visit. The findings appear in the August 20 issue of The Journal of the American Medical Association.

    Most Doctors Just Don't Know

    The researchers say high health care costs create a burden that causes many patients to forgo prescribed medications. Although 90% of the volunteers in the study had insurance that covered at least part of prescription drug costs, 25% complained that out-of-pocket costs were a burden, and 16% reported that they had skipped or stretched a medicine during the previous year because it was too expensive.

    Researchers say that only 21% of doctors actually reported knowing how much health-care services actually cost the patient. So, when doctors actually did discuss out-of-pocket expense with patients, it made doctors more aware of the burden the cost may have.

    'Although national changes in health care financing are needed, there are also things that individual physicians can do right now to help patients burdened by their out-of-pocket costs, such as using generic or less expensive medicines whenever possible. But that process has to begin with a conversation,' says Alexander.

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