Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T05:46:45.836Z Has data issue: false hasContentIssue false
  • English
  • Français

Can Information on Cost Improve Clinicians' Behavior?: Lessons from Health Care Trials and Management

Published online by Cambridge University Press:  10 March 2009

Peter F. Lowet  and
John M. Eisenberg
Peter F. Lowet
Affiliation:
Georgetown University Medical Center
John M. Eisenberg
Affiliation:
Georgetown University Medical Center
Get access Rights & Permissions [Opens in a new window]

Abstract

Facing intense price competition and societal pressures, health care provider organizations have focused increasingly on the cost-effectiveness of medical services. In instances when there is insufficient evidence that a more expensive treatment course generates improved outcomes, the lower cost option is often encouraged. Yet, with resource utilization still determined principally by individual physicians, large practice variations often persist. This paper reviews the literature and explores the impact of sharing cost information on physicians' practice patterns utilizing management theory concepts. More research should be conducted to determine long-term benefits of educational interventions, physicians' fundamental views on the relationship between cost and quality and its effect on their responsiveness to cost information, and the role of leadership in changing clinical behavior.

Type
Special Section: The Use And Abuse Of Low-Cost Technologies
Information
International Journal of Technology Assessment in Health Care , Volume 13 , Issue 4 , Fall 1997 , pp. 553 - 561
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Avorn, J., & Soumerai, S. B.Improving drug-therapy decisions through educational outreach: A randomized controlled trial of academically based ‘detailing.’ New England Journal of Medicine 1983, 308, 1457–63.CrossRefGoogle ScholarPubMed
2.Balzer, W., Doherty, M., & O’Connor, R. Jr., The effects of cognitive feedback on performance. Psychological Bulletin, 1989, 106, 410–33.CrossRefGoogle Scholar
3.Barton, M. B., & Schoenbaum, S. C.Improving influenza vaccination performance in an HMO setting: The use of computer-generated reminders and peer comparison feedback. American Journal of Public Health, 1990, 80, 534–36.CrossRefGoogle Scholar
4.Bazerman, M. H., & Neale, M. Heuristics in negotiation: Limitations to effective dispute resolution. In Bazerman, M. & Lewicki, R. (eds.), Negotiation in organizations. Beverly Hills: Sage, 1983.Google Scholar
5.Billi, J. E., Duran-Arenas, L., Wise, C. G., et al. The effects of a low-cost intervention program on hospital costs. Journal of General Internal Medicine, 1992, 7, 411–17.CrossRefGoogle ScholarPubMed
6.Calkins, E., Katz, L. A., Karuza, J., & Wagner, A.The small group consensus process for changing physician practices: Influenza vaccination. HMO Practice, 1995, 9,107–110.Google ScholarPubMed
7.Campion, M. A., & Lord, R. G.A control systems conceptualization of the goal setting and changing process. Organizational Behavior and Human Performance, 1982, 30, 265–87.CrossRefGoogle Scholar
8.Cohen, D.I., Jones, P., Littenberg, B., & Neuhauser, D.Does cost information availability reduce physician test usage? A randomized clinical trial with unexpected findings. Medical Care, 1982, 20, 286–92.CrossRefGoogle ScholarPubMed
9.Cummings, K.M., Frisof, K.B., Long, M.J., & Krynkiewich, G.The effect of price information on physicians' test ordering behavior: Ordering diagnostic tests. Medical Care, 1982, 20, 293.CrossRefGoogle ScholarPubMed
10.Durand-Zaleski, I., Rymer, J.C., Roudot-Thoravai, F., et al. Reducing unnecessary laboratory use with new test request form: Example of tumour markers. Lancet, 1993, 342, 150–53.CrossRefGoogle ScholarPubMed
11.Einhorn, H., & Hogarth, R.Confidence in judgment: Persistence of the illusion of validity. Psychological Review, 1978, 85, 395–416.CrossRefGoogle Scholar
12.Eisenberg, J.M.Doctors' decisions and the cost of medical care: The reasons for doctors practice patterns and ways to change them. Ann Arbor, MI: Health Administration Press, 1986.Google Scholar
13.Eisenberg, J.M., & Williams, S.V.Cost containment and changing physicians' behavior: Can the fox learn to guard the chicken coop? Journalofthe American Medical Association, 1981, 246, 2195–201.CrossRefGoogle ScholarPubMed
14.Eliot, T.S. The Rock. In Collected Poems: 1909–1962. New York: Harcourt, Brace an World, 1963.Google Scholar
15.Evans, J. H, Hwang, Y., & Nagarajan, N.Physicians' response to length-of-stay profiling. Medical Care, 1995, 33, 1106–19.CrossRefGoogle ScholarPubMed
16.Frazier, L. M., Brown, J. T., Divine, G. W., et al. Can physician education lower the cost of prescription drugs? Annals of Internal Medicine, 1991, 115, 116–21.CrossRefGoogle ScholarPubMed
17.Greco, P. J., & Eisenberg, J. M.Changing physicians' practices. New England Journal of Medicine, 1993, 329, 1271–74.CrossRefGoogle ScholarPubMed
18.Gutierrez, G., Guiscafre, H., Bronfman, M., et al. Changing physician prescribing patterns: Evaluation of an educational strategy for acute diarrhea in Mexico City. Medical Care, 1994, 32, 436–46.CrossRefGoogle ScholarPubMed
19.Hammond, K. R., Stewart, T. R., Brehmer, B., & Steinmann, D. O. Social judgment theory. In Kaplan, M. and Schwartz, S. (eds.), Human judgment and decision processes. New York: Academic Press, 1975.Google Scholar
20.Hogarth, R.Beyond discrete biases: Functional and dysfunctional aspects of judgmental heuristics. Psychological Bulletin, 1981, 90, 197–217.CrossRefGoogle Scholar
21.Horrow, J. C., & Rosenberg, H.Price stickers do not alter drug usage. Canadian Journal of Anaesthesia, 1994, 41, 1047–52.CrossRefGoogle Scholar
22.Kanfer, F. H. The maintenance of behavior by self-generated stimuli and reinforcement. In Jacobs, A. & Sachs, L. B. (eds.), The psychology of private events. New York: Academic Press, 1971.Google Scholar
23.Kirschenbaum, D. S., Ordman, A. M., Tomarken, A. J., & Holtzbauer, R.Effects of differential self-monitoring and level of mastery on sports performance: Brain power bowling. Cognitive Therapy and Research, 1982, 6, 335–42.CrossRefGoogle Scholar
24.Kosecoff, J., Kanouse, D. E., Rogers, W. H., et al. Effects of the National Institutes of Health Consensus Development Program on physician practice. Journal of the American Medical Association, 1987, 258, 2708–13.CrossRefGoogle ScholarPubMed
25.Locke, E. A., & Latham, G. P.A theory of goal setting and task performance. Englewoo Cliffs, NJ: Prentice-Hall, 1990.Google Scholar
26.Lomas, J., Anderson, G. M., & Domnick-Pierre, K.Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. New England Journal of Medicine, 1989, 91, 502–13Google Scholar
27.Mandelblatt, J., & Kanetsky, P. A.Effectiveness of interventions to enhance physician screening for breast cancer. Journal of Family Practice, 1995, 40, 162–71.Google ScholarPubMed
28.Manheim, L. M., Feinglass, J., Hughes, R., et al. Training house officers to be cost conscious: Effects of an educational intervention on charges and length of stay. Medical Care, 1990, 28, 29–39.CrossRefGoogle ScholarPubMed
29.Mason, M. A., & Redmon, W. K.Effects of immediate versus delayed feedback on error detection accuracy in a quality control simulation. Journal of Organizational Behavio Management, 1992, 13, 49–83.CrossRefGoogle Scholar
30.McAfee, R. B., & Winn, A. R.The use of incentives/feedback to enhance work place safety: A critique of the literature. Journal of Safety Research, 1989, 20, 7–19.CrossRefGoogle Scholar
31.Pugh, J. A., Frazier, L. M., DeLong, E., et al. Effect of daily charge feedback on inpatient charges and physician knowledge and behavior. Archives of Internal Medicine, 1989, 149, 426.CrossRefGoogle ScholarPubMed
32.Rodgers, R., & Hunter, J. E.Impact of management by objectives on organizational productivity. Journal of Applied Psychology, 1991, 76, 322–36.CrossRefGoogle Scholar
33.Rodgers, R., Hunter, J. E., & Rogers, D. L.Influence of top management commitment on management program success. Journal of Applied Psychology, 1993, 78, 151–55.CrossRefGoogle Scholar
34.Schectman, J., Kanwal, N., Schroth, W., & Elinsky, E.The effect of an education and feedback intervention on group-model and network-model health maintenance organization physician prescribing behavior. Medical Care, 1995, 33, 134–44.CrossRefGoogle ScholarPubMed
35.Soumerai, S. B., Avorn, J., Taylor, W. C., et al. Improving choice of prescribed antibiotics through concurrent reminders in an educational order form. Medical Care, 1993, 31, 552–58.CrossRefGoogle Scholar
36.Soumerai, S. B., McLaughlin, T. J., & Avorn, J.Improving drug prescribing in primary care: A critical analysis of the experimental literature. Millbank Memorial Fund Quarterly, 1989, 67, 268–317.CrossRefGoogle ScholarPubMed
37.Studnicki, J., Stevens, C. E., & Knisely, L.Impact of a cybernetic system of feedback to physicians on inappropriate hospital use. Journal of Medical Education, 1985, 60, 454–60.Google ScholarPubMed
38.Thompson, L., & DeHarpport, T.Social judgment, feedback, and interpersonal learning in negotiation. Organizational Behavior and Human Decision Processes, 1994, 58, 327–45.CrossRefGoogle Scholar
39.Tierney, W. M., Miller, M. E., & McDonald, C. J.The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. New England Journal of Medicine, 1990, 322, 1499–504.CrossRefGoogle ScholarPubMed
40.Tierney, W. M., Miller, M. E., Overhage, J. M., & McDonald, C. J.Physician inpatient order writing on microcomputer workstations: Effects on resource utilization. Journal of the American Medical Association, 1993, 269, 379–83.CrossRefGoogle ScholarPubMed
41.Waldersee, R., & Luthans, F.The impact of positive and corrective feedback on customer service performance. Journal of Organizational Behavior, 1994, 15, 83–95.CrossRefGoogle Scholar