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Pediatrics. 2019 Aug;144(2). pii: e20184029. doi: 10.1542/peds.2018-4029. Epub 2019 Jul 3.

Parent Attitudes and Preferences for Discussing Health Care Costs in the Inpatient Setting.

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Department of Pediatrics, University of Washington, Seattle, Washington;
Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington.
Department of Pediatrics, University of Washington, Seattle, Washington.
Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado.
Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.



To explore parent attitudes toward discussing their child's health care costs in the inpatient setting and to identify strategies for health care providers to engage in cost discussions with parents.


Using purposeful sampling, we conducted semistructured interviews between October 2017 and February 2018 with parents of children with and without chronic disease who received care at a tertiary academic children's hospital. Researchers coded the data using applied thematic analysis to identify salient themes and organized them into a conceptual model.


We interviewed 42 parents and identified 2 major domains. Categories in the first domain related to factors that influence the parent's desire to discuss health care costs in the inpatient setting, including responsibility for out-of-pocket expenses, understanding their child's insurance coverage, parent responses to financial stress, and their child's severity of illness on hospital presentation. Categories in the second domain related to parent preference regarding the execution of cost discussions. Parents felt these discussions should be optional and individualized to meet the unique values and preferences of families. They highlighted concerns regarding physician involvement in these discussions; their preference instead was to explore financial issues with a financial counselor or social worker.


Parents recommended that cost discussions in the inpatient setting should be optional and based on the needs of the family. Families expressed a desire for physicians to introduce rather than conduct cost discussions. Specific recommendations from parents for these discussions may be used to inform the initiation and improvement of cost discussions with families during inpatient encounters.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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