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Jakovljevic M, Vukovic M, Chen CC, Antunovic M, Dragojevic-Simic V, Velickovic-Radovanovic R, Djendji MS, Jankovic N, Rankovic A, Kovacevic A, Antunovic M, Milovanovic O, Markovic V, Dasari BNS, Yamada T. Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans. Balkan Med J 2016; 33:8-17. [PMID: 26966613 DOI: 10.5152/balkanmedj.2015.15869] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/28/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Serbia, as the largest market of the Western Balkans, has entered socioeconomic transition with substantial delay compared to most of Eastern Europe. Its health system reform efforts were bold during the past 15 years, but their results were inconsistent in various areas. The two waves of global recession that hit Balkan economies ultimately reflected to the financial situation of healthcare. Serious difficulties in providing accessible medical care to the citizens became a reality. A large part of the unbearable expenses actually belongs to the overt prescription of pharmaceuticals and various laboratory and imaging diagnostic procedures requested by physicians. Therefore, a broad national survey was conducted at all levels of the healthcare system hierarchy to distinguish the ability of cost containment strategies to reshape clinician's mindsets and decision-making in practice. AIMS Assessment of healthcare professionals' judgment on economic consequences of prescribed medical interventions and evaluation of responsiveness of healthcare professionals to policy measures targeted at increasing cost-consciousness. STUDY DESIGN Cross-sectional study. METHODS A nationwide cross-sectional survey was conducted through a hierarchy of medical facilities across diverse geographical regions before and after policy action, from January 2010 to April 2013. In the middle of the observed period, the National Health Insurance Fund (RFZO) adopted severe cost-containment measures. Independently, pharmacoeconomic guidelines targeted at prescribers were disseminated. Administration in large hospitals and community pharmacies was forced to restrict access to high budget-impact medical care. Economic Awareness of Healthcare Professionals Questionnaire-29 (EAHPQ-29), developed in Serbian language, was used in face-to-face interviews. The questionnaire documented clinician's attitudes on: Clinical-Decision-Making-between-Alternative-Interventions (CDMAI), Quality-of-Health-Care (QHC), and Cost-Containment-Policy (CCP). The authors randomly and anonymously recruited 2000 healthcare experts, with a total of 1487 responding; after eliminating incomplete surveys, 649 participants were considered before and 651 after policy intervention. RESULTS Dentists (1.195±0.560) had a higher mean CDMAI score compared to physicians (1.017±0.453). The surgical group compared to the internist group had a higher total EAHPQ-29 score, CCP score and CDMAI score. Policy intervention had a statistically significant negative impact on the QHC score (F=4.958; df=1; p=0.027). There was no substantial impact of policy interventions on professional behavior and judgment with regard to the CDMAI, CCP, and total EAHPQ-29 scores. CONCLUSION Although cost savings were forcibly imposed in practice, the effects on clinical decision-making were modest. Clinicians' perceptions of quality of medical care were explained in a less effective manner due to the severely constrained resources allocated to the providers. This pioneering effort in the Balkans exposes the inefficiency of current policies to expand clinicians' cost consciousness.
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Affiliation(s)
- Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Mira Vukovic
- Department of Quality Assurance, Health Centre, Valjevo, Serbia
| | - Chia-Ching Chen
- Department of Epidemiology & Community Health, New York Medical College, School of Health Sciences & Practice, New York, USA
| | | | | | | | | | - Nikola Jankovic
- Department of Statistics, University of Kragujevac Faculty of Medical Sciences, Kragujevac, Serbia
| | - Ana Rankovic
- Diagnostic Radiology Service, University Clinical Center Kragujevac, Kragujevac, Serbia
| | | | - Marko Antunovic
- Institute of Pharmacy, Military Medical Academy, Belgrade, Serbia
| | - Olivera Milovanovic
- Department of Pharmacy, University of Kragujevac Faculty of Medical Sciences, Kragujevac, Serbia
| | - Veroljub Markovic
- Department of Pharmacy, University of Kragujevac Faculty of Medical Sciences, Kragujevac, Serbia
| | - Babu N S Dasari
- Department of Economics, Rutgers University, the State University of New Jersey, New Jersey, USA
| | - Tetsuji Yamada
- Department of Economics, Rutgers University, the State University of New Jersey, Center for Children and Childhood Studies, New Jersey, USA
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Sommers BD, Desai N, Fiskio J, Licurse A, Thorndike M, Katz JT, Bates DW. An educational intervention to improve cost-effective care among medicine housestaff: a randomized controlled trial. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:719-728. [PMID: 22534589 DOI: 10.1097/acm.0b013e31825373b3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE High medical costs create significant burdens. Research indicates that doctors have little awareness of costs. This study tested whether a brief educational intervention could increase residents' awareness of cost-effectiveness and reduce costs without negatively affecting patient outcomes. METHOD The authors conducted a clustered randomized controlled trial of 33 teams (96 residents) at an internal medicine residency program (2009-2010). The intervention was a 45-minute teaching session; residents reviewed the hospital bill of a patient for whom they had cared and discussed reducing unnecessary costs. Primary outcomes were laboratory, pharmacy, radiology, and total hospital costs per admission. Secondary measures were length of stay (LOS), intensive care unit (ICU) admission, 30-day readmission, and 30-day mortality. Multivariate adjustment controlled for patient demographics and health. A follow-up survey assessed resident attitudes three months later. RESULTS Among 1,194 patients, there were no significant cost differences between intervention and control groups. In the intervention group, 30-day readmission was higher (adjusted odds ratio 1.51, P = .010). There was no effect on LOS or the composite outcome of readmission, mortality, and ICU transfer. In a subgroup analysis of 835 patients newly admitted during the study, the intervention group incurred $163 lower adjusted lab costs per admission (P = .046). The follow-up survey indicated persistent differences in residents' exposure to concepts of cost-effectiveness (P = .041). CONCLUSIONS A brief intervention featuring a discussion of hospital bills can fill a gap in resident education and reduce laboratory costs for a subset of patients, but may increase readmission risk.
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Affiliation(s)
- Benjamin D Sommers
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
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Bellian DP, King KA, Wahl J, Price JH. Psychiatrists' knowledge and attitudes about costs of commonly prescribed treatments in psychiatry. J Community Health 2001; 26:11-22. [PMID: 11297187 DOI: 10.1023/a:1026533013729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A survey was conducted to assess psychiatrists' knowledge and attitudes regarding the costs of various psychiatric treatments. Psychiatrists (n = 500) were randomly selected from the membership of the Ohio Psychiatric Association. The survey explored several aspects of psychiatrists' knowledge of costs, including estimated prices of 24 specific psychiatric treatments (frequently used psychotropic medications, laboratory tests, and inpatient and outpatient procedures) as well as their level of confidence in their estimates. The survey also asked a series of attitude/opinion questions and specific demographic data. The psychiatrists (n = 265, 59% response) perceived that knowing the costs of treatments was an important consideration when choosing a particular treatment. Psychiatrists' actual knowledge of the costs of treatment was inconsistent with their beliefs of the importance of knowing the costs as well as their reported confidence in their knowledge of costs. Information about the costs of psychiatric treatments is an important clinical consideration and a program to improve clinicians' knowledge of the costs of psychiatric treatment could occur during residency training.
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Affiliation(s)
- D P Bellian
- Department of Psychiatry, Medical College of Ohio, Toledo 43614, USA.
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Kuiken T, Prather H. A computer education program to improve physician awareness of rehabilitation hospital charges. Arch Phys Med Rehabil 1998; 79:910-4. [PMID: 9710161 DOI: 10.1016/s0003-9993(98)90086-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To quantify physician knowledge of hospital charges and determine if computer fiscal feedback would improve physician awareness of hospital charges. DESIGN Comparison of physicians' knowledge of hospital charges before and 6 months after the instigation of a computer feedback educational program. PARTICIPANTS AND SETTING All physicians (attendings, residents, and fellows) at a large academic rehabilitation hospital. INTERVENTION After surveying physicians' knowledge of hospital charges, the billing fees for some items were placed on the computer ordering menu so that these charges were viewed when orders were made by physicians. MAIN OUTCOME MEASURES Error in physician charge estimates before and after computer education program, and physician confidence in charge estimates. RESULTS The baseline survey found that physicians had poor awareness of hospital charges, regardless of ordering frequency, relative charge for the item, or physician experience. Physicians expressed little confidence in their knowledge of the charges and were twice as likely to underestimate than to overestimate charges. Six months after the implementation of a computer feedback educational program, improvement was seen in the awareness of hospital charges for all imaging studies and most laboratory tests. Fiscal awareness of items that had not been included in the computer feedback also showed some small improvement. Physicians' confidence in their knowledge of fees improved. Physicians indicated the program was beneficial and should be expanded to include fiscal information on more services. CONCLUSIONS Immediate computer feedback of hospital charges improves physicians' fiscal awareness and may lead to their practice of more cost-efficient medicine.
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Affiliation(s)
- T Kuiken
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, IL 60611, USA
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