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The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

Author(s)
Goetz, Celine; Rotman, Stephen R.; Bishop, Tara F.; Hartoularos, George C.
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Abstract
BACKGROUND: While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted. OBJECTIVE: We aimed to determine the type and quality of charge display studies that have been published; to synthesize this information in the form of a literature review. METHODS: English-language articles published between 1982 and 2013 were identified using MEDLINE, Web of Knowledge, ABI-Inform, and Academic Search Premier. Article titles, abstracts, and text were reviewed for relevancy by two authors. Data were then extracted and subsequently synthesized and analyzed. RESULTS: Seventeen articles were identified that fell into two topic categories: the effect of charge display on radiology and laboratory test ordering versus on medication choice. Seven articles were randomized controlled trials, eight were pre-intervention vs. post-intervention studies, and two interventions had a concurrent control and intervention groups, but were not randomized. Twelve studies were conducted in a clinical environment, whereas five were survey studies. Of the nine clinically based interventions that examined test ordering, seven had statistically significant reductions in cost and/or the number of tests ordered. Two of the three clinical studies looking at medication expenditures found significant reductions in cost. In the survey studies, physicians consistently chose fewer tests or lower cost options in the theoretical scenarios presented. CONCLUSIONS: In the majority of studies, charge information changed ordering and prescribing behavior.
Date issued
2015-02
URI
http://hdl.handle.net/1721.1/104651
Department
Massachusetts Institute of Technology. Department of Chemical Engineering
Journal
Journal of General Internal Medicine
Publisher
Springer US
Citation
Goetz, Celine, Stephen R. Rotman, George Hartoularos, and Tara F. Bishop. “The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review.” Journal of General Internal Medicine 30, no. 6 (February 18, 2015): 835–842.
Version: Author's final manuscript
ISSN
0884-8734
1525-1497

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