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Year 2016, Volume: 33 Issue: 1, 8 - 17, 01.01.2016

Abstract

References

  • 1. Waters HR, Hobart J, Forrest CB, Siemens KK, Pittman PM, Murthy A, et al. Health insurance coverage in central and Eastern Europe: trends and challenges. Health Affair (Millwood) 2008;27:478-86. [CrossRef]
  • 2. Rechel B, McKee M. Health reform in central and eastern Europe and the former Soviet Union. Lancet 2009;374:1186-95. [CrossRef]
  • 3. Bredenkamp C, Mendola M, Gragnolati M. Catastrophic and impoverishing effects of health expenditure: new evidence from the Western Balkans. Health Policy Plann 2011;26:349-56. [CrossRef]
  • 4. Jakovljevic M, Jovanovic M, Lazic Z, Jakovljević V, Đukić A, Velicković R, et al. Current efforts and proposals to reduce healthcare costs in Serbia. SJECR 2011;12:161-3. [CrossRef]
  • 5. Novakovic T, Tesic D, Stefanovic D, Medic G, Sovtic DD. Guidelines for pharmacoeconomic evaluation for Serbia. Value Health 2011;14:A358.
  • 6. Nagurney JT, Braham RL, Reader GG. Physician awareness of economic factors in clinical decision-making. Med Care 1979;17:727-36. [CrossRef

Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans

Year 2016, Volume: 33 Issue: 1, 8 - 17, 01.01.2016

Abstract

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: 20 (Updated on Sep. 2018- WoS)

References

  • 1. Waters HR, Hobart J, Forrest CB, Siemens KK, Pittman PM, Murthy A, et al. Health insurance coverage in central and Eastern Europe: trends and challenges. Health Affair (Millwood) 2008;27:478-86. [CrossRef]
  • 2. Rechel B, McKee M. Health reform in central and eastern Europe and the former Soviet Union. Lancet 2009;374:1186-95. [CrossRef]
  • 3. Bredenkamp C, Mendola M, Gragnolati M. Catastrophic and impoverishing effects of health expenditure: new evidence from the Western Balkans. Health Policy Plann 2011;26:349-56. [CrossRef]
  • 4. Jakovljevic M, Jovanovic M, Lazic Z, Jakovljević V, Đukić A, Velicković R, et al. Current efforts and proposals to reduce healthcare costs in Serbia. SJECR 2011;12:161-3. [CrossRef]
  • 5. Novakovic T, Tesic D, Stefanovic D, Medic G, Sovtic DD. Guidelines for pharmacoeconomic evaluation for Serbia. Value Health 2011;14:A358.
  • 6. Nagurney JT, Braham RL, Reader GG. Physician awareness of economic factors in clinical decision-making. Med Care 1979;17:727-36. [CrossRef
There are 6 citations in total.

Details

Other ID JA75JV39CF
Journal Section Research Article
Authors

Mihajlo Jakovljevic This is me

Mira Vukovic This is me

Chia Ching Chen This is me

Mirjana Antunovic This is me

Viktorija Dragojevic Simic This is me

Radmila Velickovic Radovanovic This is me

Mladenovic Siladji Djendji This is me

Nikola Jankovic This is me

Ana Rankovic This is me

Aleksandra Kovacevic This is me

Marko Antunovic This is me

Olivera Milovanovic0 This is me

Veroljub Markovic0 This is me

Babu N.s. Dasari This is me

Tetsuji Yamada This is me

Publication Date January 1, 2016
Published in Issue Year 2016 Volume: 33 Issue: 1

Cite

APA Jakovljevic, M., Vukovic, M., Chen, C. C., Antunovic, M., et al. (2016). Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans. Balkan Medical Journal, 33(1), 8-17.
AMA Jakovljevic M, Vukovic M, Chen CC, Antunovic M, Simic VD, Radovanovic RV, Djendji MS, Jankovic N, Rankovic A, Kovacevic A, Antunovic M, Milovanovic0 O, Markovic0 V, Dasari BN, Yamada T. Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans. Balkan Medical Journal. January 2016;33(1):8-17.
Chicago Jakovljevic, Mihajlo, Mira Vukovic, Chia Ching Chen, Mirjana Antunovic, Viktorija Dragojevic Simic, Radmila Velickovic Radovanovic, Mladenovic Siladji Djendji, Nikola Jankovic, Ana Rankovic, Aleksandra Kovacevic, Marko Antunovic, Olivera Milovanovic0, Veroljub Markovic0, Babu N.s. Dasari, and Tetsuji Yamada. “Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans”. Balkan Medical Journal 33, no. 1 (January 2016): 8-17.
EndNote Jakovljevic M, Vukovic M, Chen CC, Antunovic M, Simic VD, Radovanovic RV, Djendji MS, Jankovic N, Rankovic A, Kovacevic A, Antunovic M, Milovanovic0 O, Markovic0 V, Dasari BN, Yamada T (January 1, 2016) Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans. Balkan Medical Journal 33 1 8–17.
IEEE M. Jakovljevic, “Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans”, Balkan Medical Journal, vol. 33, no. 1, pp. 8–17, 2016.
ISNAD Jakovljevic, Mihajlo et al. “Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans”. Balkan Medical Journal 33/1 (January 2016), 8-17.
JAMA Jakovljevic M, Vukovic M, Chen CC, Antunovic M, Simic VD, Radovanovic RV, Djendji MS, Jankovic N, Rankovic A, Kovacevic A, Antunovic M, Milovanovic0 O, Markovic0 V, Dasari BN, Yamada T. Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans. Balkan Medical Journal. 2016;33:8–17.
MLA Jakovljevic, Mihajlo et al. “Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans”. Balkan Medical Journal, vol. 33, no. 1, 2016, pp. 8-17.
Vancouver Jakovljevic M, Vukovic M, Chen CC, Antunovic M, Simic VD, Radovanovic RV, Djendji MS, Jankovic N, Rankovic A, Kovacevic A, Antunovic M, Milovanovic0 O, Markovic0 V, Dasari BN, Yamada T. Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans. Balkan Medical Journal. 2016;33(1):8-17.