Study: Primary care physicians consider patients’ health care costs

Primary care physicians consider the out-of-pocket expenses their patients face more than other medical specialists, according to a study published in the April 9 Archives of Internal Medicine . The authors examined physician behavior in three situations—when prescribing drugs, choosing inpatient or outpatient care settings, and selecting diagnostic tests—also taking into consideration a physician’s practice type and practice characteristics.

Overall, 78 percent of physicians reported routinely considering out-of-pocket costs when prescribing drugs, 51.2 percent reported considering costs when selecting care settings and 40.2 percent when selecting diagnostic tests. Primary care physicians reported heightened sensitivity than other physicians, with 85.3 percent always or usually considering costs when choosing prescription drugs, 53.9 percent when choosing care settings and 46.3 percent when choosing diagnostic tests.

Physicians who provide more than 10 hours of charity care are also more likely to consider a patient’s out-of-pocket costs. When choosing diagnostic testing, 40.7 percent of these physicians report considering the cost to the patient and 51.4 percent when making care-setting decisions.

The study used data from the 2004-2005 Community Tracking Study Physician Survey, which surveyed more than 6,500 physicians nationally. The authors offered a few reasons why primary care physicians might be more sensitive to the patient’s pocketbook, starting with the perception of a medical home. Patients may feel more comfortable discussing finances with a primary care physician due to an established physician-patient relationship. The authors also said specialists may not have a wide selection of diagnostic tests available when treating more complex cases.