ISSN : 2146-3123
E-ISSN : 2146-3131

Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans
Mihajlo Jakovljevic1, Mira Vukovic2, Chia Ching Chen3, Mirjana Antunovic4, Viktorija Dragojevic Simic5, Radmila Velickovic Radovanovic6, Mladenovic Siladji Djendji Djendji7, Nikola Jankovic8, Ana Rankovic9, Aleksandra Kovacevic5, Marko Antunovic4, Olivera Milovanovic10, Veroljub Markovic10, Babu N.S. Dasari11, Tetsuji Yamada12
1Health Economics and Pharmacoeconomics, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
2Department of Quality Assurance, Health Centre, Valjevo, Serbia
3Department of Epidemiology & Community Health, New York Medical College, School of Health Sciences & Practice, New York, USA
4Institute of Pharmacy, Military Medical Academy, Belgrade, Serbia
5Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
6Department of Pharmacy, Nis University Faculty of Medicine, Nis, Serbia
7Psychiatric Clinic, University Clinical Center Vojvodina, Novi Sad, Serbia
8Department of Statistics, University of Kragujevac Faculty of Medical Sciences, Kragujevac, Serbia
9Diagnostic Radiology Service, University Clinical Center Kragujevac, Kragujevac, Serbia
10Department of Pharmacy, University of Kragujevac Faculty of Medical Sciences, Kragujevac, Serbia
11Department of Economics, Rutgers University, the State University of New Jersey, New Jersey, USA
12Department of Economics, Rutgers University, the State University of New Jersey, Center for Children and Childhood Studies, New Jersey, USA
DOI : 10.5152/balkanmedj.2015.15869
Pages : 8-17


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.

JEL code: I180 Health

Total Times Cited: 29 (Updated on May. 10 2020 - WoS)

Keywords : Awareness, cost control, economics, government, health care reform, hospital costs, medical, policy, practice patterns, physicians

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