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Physician awareness of diagnostic and nondrug therapeutic costs: A systematic review

Published online by Cambridge University Press:  09 April 2008

G. Michael Allan  and
Joel Lexchin
G. Michael Allan
Affiliation:
University of Alberta and Institute of Health Economics
Joel Lexchin
Affiliation:
York University and University Health Network
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Abstract

Objectives: The aim of this study was to investigate doctors' knowledge of the relative and absolute costs of diagnostic tests, medical consumables (e.g., syringes or intravenous tubing), and healthcare visits as well as to determine factors influencing awareness.

Methods: For this systematic review, we searched the Cochrane Library, EconoLit, EMBASE, and MEDLINE; reviewed reference lists; and had contact with authors. Studies were included if either doctors or trainees were surveyed, there were >10 survey respondents, costs of diagnostic or therapeutic items were estimated, results were expressed quantitatively, and a clear description was provided of how authors defined Accurate Estimates and determined True Cost. Two authors reviewed each article for eligibility and extracted data independently. Cost accuracy outcomes were summarized, but data were not combined due to extensive heterogeneity.

Results: Fourteen articles were included in the final analysis. Cost accuracy was low; 33 percent of estimates were within 20 percent or 25 percent of true cost and 50 percent were within 50 percent or in the 50–200 percent range of the true cost. Country, year of study, level of training, and specialty did not impact accuracy. The cost of items appears to have no impact on the accuracy (Fisher's exact test, p = .41) or pattern of estimation (binomial test, p = .92).

Conclusions: Doctors have a limited understanding of diagnostic and nondrug therapeutic costs, and we could not identify anything that impacts understanding of these costs. More focus is required in the education of physicians about costs and the access to cost information.

Keywords

Healthcare costsPhysician awarenessInvestigationsMedical careSystematic review
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 2 , April 2008 , pp. 158 - 165
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1. Allan, GM, Innes, G. Family practice residents' awareness of medical care costs in British Columbia. Fam Med. 2002;34:106–111.Google ScholarPubMed
2. Allan, GM, Innes, G. Do family physicians know the costs of medical care? Can Fam Physician. 2004;50:263–270.Google ScholarPubMed
3. Allan, GM, Lexchin, J, Wiebe, N. Physician awareness of drug cost: A systematic review. PLoS Med. 2007;4:e283.CrossRefGoogle ScholarPubMed
4. Bailey, CR, Ruggier, R, Cashman, JN. Anaesthesia: Cheap at twice the price? Staff awareness, cost comparisons and recommendations for economic savings. Anaesthesia. 1993;48:906–909.CrossRefGoogle ScholarPubMed
5. Barclay, S, Todd, C, Finlay, I, Grande, G, Wyatt, P. Not another questionnaire! Maximizing the response rate, predicting non-response and assessing non-response bias in postal questionnaire studies of GPs. Fam Pract. 2002;19:105–111.CrossRefGoogle ScholarPubMed
6. Bareford, D, Hayling, A. Inappropriate use of laboratory services: Long term combined approach to modify request patterns. BMJ. 1990;301:1305–1307.CrossRefGoogle ScholarPubMed
7. Beilby, JJ, Silagy, CA. Trials of providing costing information to GP's: A systematic review. Med J Aust. 1997;167:89–92.CrossRefGoogle Scholar
8. Black, WC, Welch, HG. Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy. N Engl J Med. 1993;328:1237–1243.CrossRefGoogle ScholarPubMed
9. Blackstone, ME, Miller, RS, Hodgson, AJ et al. , Lowering hospital charges in the trauma intensive care unit while maintaining quality of care by increasing resident and attending physician awareness. J Trauma. 1995;39:1041–1044.CrossRefGoogle ScholarPubMed
10. Boiver, PA, Martin, DP, Perneger, TV. Cost-consciousness among Swiss doctors: Cross-sectional survey. BMC Health Serv Res. 2005;5:72.CrossRefGoogle Scholar
11. Bowling, A. Mode of questionnaire administration can have serious effects on data quality. J Public Health. 2005;27:281–291.CrossRefGoogle ScholarPubMed
12. Conti, G, Dell'Utri, D, Pelaia, P et al. , Do we know the costs of what we prescribe? A study on awareness of the cost of drugs and devices among ICU staff. Intensive Care Med. 1998;24:1194–1198.CrossRefGoogle Scholar
13. Conyers, RAJ. Modifying the use of pathology services. Med J Aust. 1999;170:8–9.CrossRefGoogle ScholarPubMed
14. Dresnick, SJ, Roth, WI, Linn, BS, Pratt, TC, Blum, A. The physician's role in the cost-containment problem. JAMA. 1979;241:1606–1609.CrossRefGoogle ScholarPubMed
15. Esmail, N, Walker, M. How good is Canadian health care? An international comparison of health care systems. Vancouver: Fraser Institute; 2002.Google Scholar
16. Fairbass, MJ, Chaffe, AG. Staff awareness of cost of anaesthetic drugs, fluids, and disposables. BMJ. 1988;296:1040.CrossRefGoogle Scholar
17. Fisher, ES, Wennberg, DE, Stukel, TA et al. , The implications of regional variations in Medicare spending. Part 1: Health the content, quality and accessibility of care. Ann Intern Med. 2003;138:273–287.CrossRefGoogle ScholarPubMed
18. Fisher, ES, Wennberg, DE, Stukel, TA et al. , The implications of regional variations in Medicare spending. Part 2: Health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288–298.CrossRefGoogle ScholarPubMed
19. Gardner, MD, Henderson, AR. Test request patterns for clinical chemistry in a British and a Canadian renal dialysis unit. Clin Chem. 1983;29:1546–1548.CrossRefGoogle Scholar
20. Graat, ME, Kröner, A, Spronk, PE et al. , Elimination of daily routine chest radiographs in a mixed medical-surgical intensive care unit. Intensive Care Med. 2007;33:639–644.CrossRefGoogle Scholar
21. Innes, G, Grafstein, E, McGrogan, J. Do emergency physicians know the costs of medical care? CJEM. 2000;2:95–102.CrossRefGoogle ScholarPubMed
22. Jamtvedt, G, Young, JM, Kristoffersen, DT, O'Brien, MA, Oxman, AD. Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;2:CD000259.Google Scholar
23. Johnson, RK, Mortimer, AJ. Routine pre-operative blood testing: Is it necessary? Anaesthesia. 2002;57:914–917.CrossRefGoogle ScholarPubMed
24. Leurquin, P, Van Casteren, V, De Maeseneer, J. Use of blood tests in general practice: A collaborative study in eight European countries. Eurosentinel study group. Br J Gen Pract. 1995;45:21–25.Google ScholarPubMed
25. Mills, G, Chaffe, A. Is cost-awareness really improving? Health Trends. 1993;25:38–40.Google ScholarPubMed
26. Moher, D, Cook, DJ, Eastwood, S et al. , Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement. Lancet. 1999;354:1896–1900.CrossRefGoogle ScholarPubMed
27. Munro, J, Booth, A, Nicholl, J. Routine preoperative testing: A systematic review of the evidence. Health Technol Assess. 1997;1:i–iv, 1–62.CrossRefGoogle ScholarPubMed
28. Organization for Economic Cooperation and Development. Hospital services -% total expenditure on health, 2002. OECD health data 2006. Paris: OECD; 2006.Google Scholar
29. Perrine, TR. Physicians' knowledge of common outpatient medical costs in the Kanawha Valley-Charleston, West Virginia. W V Med J. 1982;78:90–97.Google ScholarPubMed
30. Prosser, H, Walley, T. A qualitative study of GP's and PCO stakeholders' views on the importance and influence of cost on prescribing. Soc Sci Med. 2005;60:1335–1346.CrossRefGoogle Scholar
31. Ringenberg, R. Cost awareness by family practice residents of commonly used laboratory tests, x-ray tests and medications. Indiana Med. 1988;81:136–141.Google ScholarPubMed
32. Sachdeva, RC, Jefferson, LS, Coss-Bu, J, et al. Effects of availability of patient-related charges on practice patterns and cost containment in the pediatric intensive care unit. Crit Care Med. 1996;24:501–506.CrossRefGoogle ScholarPubMed
33. Saunders, AF, Divine, GW, Weinberger, M. Physicians' awareness of mammography charges. Am J Prev Med. 1994;10:357–360.CrossRefGoogle ScholarPubMed
34. Schlunzen, L, Simonsen, MS, Spangsberg, NLM, Carlsson, P. Cost consciousness among anaesthetic staff. Acta Anaesthesiol Scand. 1999;43:202–205.CrossRefGoogle ScholarPubMed
35. Shrank, WH, Joseph, GJ, Choudhry, NK et al. , Physicians' perceptions of relevant prescription drug costs: Do costs the individual patient or to the population matter most? Am J Manag Care. 2006;12:545–551.Google ScholarPubMed
36. Skipper, JK Jr, Smith, G, Mulligan, JL, Garg, ML. Physicians' knowledge of cost: The case of diagnostic tests. Inquiry. 1976;13:194–198.Google ScholarPubMed
37. Smellie, WS, Murphy, MJ, Galloway, PJ et al. , Audit of an emergency biochemistry service. J Clin Pathol. 1995;48:1126–1129.CrossRefGoogle ScholarPubMed
38. Templeton, L, Deehan, A, Taylor, C, Drummond, C, Strang, J. Surveying general practitioners: Does a low response rate matter? Br J Gen Pract. 1997;47:91–94.Google ScholarPubMed
39. Wynick, D, Jessop, JH. A survey of cost awareness among hospital medical staff. Health Trends. 1985;17:24.Google ScholarPubMed
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