BACKGROUND: Though many patients and physicians believe that they should discuss out-of-pocket costs, research suggests that they infrequently do.

OBJECTIVE: To examine barriers preventing patient-physician communication about out-of-pocket costs among study subjects recalling a time when they wanted to discuss these costs but did not do so.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional surveys of 133 general internists and 484 of their patients from 3 academic and 18 community practices in a large midwestern metropolitan region.

MEASUREMENTS: Patient- and physician-reported barriers to discussing out-of-pocket costs.

MAIN RESULTS: Overall, 54 patients (11%) and 27 physicians (20%) were able to recall a specific time when they wanted to discuss out-of-pocket costs but did not do so. Among patients, a wide variety of barriers were reported including their own discomfort (19%), insufficient time (13%), a belief that their physician did not have a viable solution (11%), and concerns about the impact of discussions on quality of care (9%). Among physicians, the most common barriers reported were insufficient time (67%) and a belief that they did not have a solution to offer (19%).

CONCLUSIONS: Efforts to promote discussions of out-of-pocket costs should emphasize the legitimacy of patients’ concerns and brief actionable alternatives that physicians can take to address them.