Capsule Commentary on Goetz et al., The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

Abstract

I n response to the rising cost of health care in the United States, third-party payers are shifting more of the cost burden to patients. Physicians are often confronted with clinical decisions that have important economic implications for patients and health care payers. Providing physicians with information about the cost of health care services and pharmaceuticals serves two main purposes: first, it enables physicians to make informed decisions on the cost and effectiveness of diagnostic and treatment alternatives; second, it increases transparency and awareness among the medical community regarding the affordability of such treatment options for patients.Health professionals rely on the biomedical literature as part of their clinical practice, often neglecting the economic literature that has extensively illustrated the theory of incentives and its effects on the health care provider's behavior. The significance of the study by Goetz et al. (2015) would have been further enhanced had the authors 1 included the economic literature on payment mechanisms and provider behaviors. [2][3][4][5] In addition, an assessment of the quality of studies included in the review would be helpful for explaining the implications of the different methodological designs used (Cross-sectional, Cohort, Case-control studies). The literature review could also discern the effect of including studies conducted in distinct health care systems (USA, South Africa, Sweden, France), assessing a variety of health care services (laboratory test, imaging and radiology, pharmaceuticals, emergency visits), provided in different health care settings (hospital, outpatient, emergency), to different patients (adult, pediatric). A more comprehensive and systematic literature review could disentangle these factors and result in more robust findings.Health care systems coverage, funding, and reimbursement mechanisms are significantly correlated with the provision of care. These are also key factors driving providers' decisionmaking processes, clinical practice, and prescribing behaviors. The effect of the display of cost information (or, alternatively, charges and fees to proxy cost) on physicians' behavior is a timely policy issue of high clinical and economic importance. Further research is needed to assess the effect of providing outcomes and cost information to health care providers on the efficient allocation of scarce health care resources. Conflict of interest:The author has no conflicts of interest related to this article. REFERENCES1. Goetz C, Rotman SR, Hartoularos G, Bishop TF. The effect of charge display on cost of care and physician practice behaviors: a systematic review.