Does Physicians' Knowledge of Costing Related to Clinical Decision Making Change the Consumption of Resources despite Unchanged Medical Standards?

Abstract

The problem formulation of the present project was as expressed in the title, with a secondary approach that if a difference could be measured, its magnitude would have to be evaluated in relation to the total bed day price of the study period, amounting to DKR 3600. The investigation comprised a hidden and an open phase, each covering 2 months, April-May and September-October 1983. During the second phase all physicians of the department inserted prices in the case records for all clinical decisions, consumption of utensils, drugs, X-ray investigations, clinical-chemical analyses, clinical-physiological analyses, ultrasonographies, endoscopies, and visits by specialist consultants. The price setting was done from a price catalogue made for the study, in accordance with either existing prices or prices calculated for the present purpose. During the first hidden phase it was possible to calculate the total price of all clinical interventions by secondarily applying prices as in phase 2. In this manner it was possible to create a starting level representing a period in which none of the participants had any idea of the later health economy study. In both phases 293 patients entered, with an identical distribution of age, sex, admittance periods, and so forth. The total sum of registered interventions for phase 1 was DKR 612,839 and for phase 2, DKR 532,515, giving a reduction of approximately 13%, corresponding to total expenses per day within the subgroups mentioned of DKR 199 in phase 1 and DKR 176 in phase 2. These sums must be judged in relation to the bed day price for the study phases. The expense variables used enter as a part of this total sum. A pre- and a post-test of the participating physicians showed that the level of information increased measurably during the study. As a whole, the participating physicians answered no to the question of whether they had changed ordering habits because of the study. Moreover, they explicitly emphasized that standards of clinical work had not changed, according to their opinion.

Key Words:

• Costing
• health economy
• decision making
• resource consumption