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Key Points Question What is the association between health insurance literacy and avoidance of health care services owing to cost? Findings In this US national survey study of 506 insured adults, 29.6% reported having delayed or foregone care because of cost. Higher health insurance literacy was associated with a lower likelihood of delayed or foregone care owing to cost for both preventive and nonpreventive care. Meaning These findings suggest that to improve appropriate use of recommended health care services, including preventive health services, clinicians and policymakers may need to adopt communication strategies that make health insurance concepts accessible to individuals regardless of health insurance literacy and improve consumers’ understanding of services exempt from out-of-pocket costs.

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Conflicts between physicians and families about end-of-life decisions create challenging and emotionally difficult situations. In this article, we propose a "differential diagnosis" of such conflicts, distinguishing and describing the characteristics of families, physicians, and organizations and society that contribute to the "etiology" of the situation, as well as strategies for "diagnosing" the dominant factors. As a medical model, the differential diagnosis can be a useful tool to help physicians understand and manage conflicts about end-of-life care.

Though trust is essential to relationships between people, including that between patient and clinician, its role in organizational ethics is largely unexplored. Nonetheless, trust is also ideally a part of the relationship between patient and health care institution, both because it is desirable in and of itself, and because it makes for better medical care.

Having patients weigh costs when making medical decisions has been proposed as a way to rein in health care spending. We convened twenty-two focus groups of people with insurance to examine their willingness to discuss health care costs with clinicians and consider costs when deciding among nearly comparable clinical options. We identified the following four barriers to patients’ taking cost into account: a preference for what they perceive as the best care, regardless of expense; inexperience with making trade-offs between health and money; a lack of interest in costs borne by insurers and society as a whole; and noncooperative behavior characteristic of a “commons dilemma,” in which people act in their own self-interest although they recognize that by doing so, they are depleting limited resources. Surmounting these barriers will require new research in patient education, comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients.

For over two decades, the "deliberative turn" has rooted itself in the fields of health policy and bioethics, producing a growing body of deliberation in action and associated academic scholarship. With this growing use and study of citizen deliberation processes in the health sector, we set out to map this dynamic field to highlight its diversity, interdisciplinarity, stated and implicit goals and early contributions. More specifically, we explored how public deliberation (PD) is being experimented with in real-world health settings, with a view to assessing how well it is meeting current definitions and common features of PD. Our review provides an informative and up-to-date set of reflections on the relatively short but rich history of public deliberation in the health sector. This emerging, interdisciplinary field is characterized by an active community of scholars and practitioners working diligently to address a range of bioethics and health policy challenges, guided by a common but loosely interpreted set of core features. Current definitions and conceptualizations of public deliberation's core features would benefit from expansion and refinement to both guide and respond to practice developments. Opportunities for more frequent cross-disciplinary and theory-practice exchange would also strengthen this field.