Knowledge and Awareness of Emergency Medicine Residents Regarding the Costs of Common Diagnostic Tests

Year 2026, Volume: 15 Issue: 1 , 86 - 94 , 30.04.2026

İbrahim Sarbay , Buğra İlhan , Mustafa Çalık , Turgut Deniz

https://doi.org/10.47493/abantmedj.1835722

https://izlik.org/JA65JU95LB

Abstract

Objective: Emergency departments are resource-intensive environments in which diagnostic testing accounts for a significant share of overall healthcare spending. Inadequate physician awareness of the costs associated with these tests has been associated with unnecessary utilization and increased strain on healthcare systems. This study assessed Emergency Medicine (EM) residents in Türkiye regarding their knowledge and awareness of costs for commonly ordered laboratory and imaging tests.
Materials and Methods: This prospective cross-sectional survey was conducted among EM residents across Türkiye. A 35-item questionnaire evaluated demographics, cost awareness, and estimation accuracy for 14 diagnostic tests. Estimates within ±25% of actual costs per the national Public Health Service Pricing Schedule were considered accurate, in accordance with thresholds used in prior studies assessing physicians’ awareness of medical costs
Results: A total of 270 residents participated (mean age 29.6 ± 3.4 years; 65.2% male). Only 12.6% believed they had sufficient knowledge, and 2.6% had prior cost-related training. The mean accuracy across participants was 17.7% (95% CI: 16.6%-18.9%), with no test accurately estimated by more than one-third of participants. The highest accuracies were observed for serum β-hCG (30.7%), abdominal ultrasound (26.3%), and blood gas analysis (23.3%). Laboratory tests like troponin (50.0%) and blood gas (47.0%) were mostly underestimated, whereas β-hCG (40.0%) and diffusion MRI (34.4%) were overestimated. Over half (56%) reported ordering unnecessary tests. Subgroup analyses showed no significant differences in accuracy by gender, hospital type, or experience.
Conclusion: EM residents in Türkiye show limited knowledge and low accuracy in estimating diagnostic test costs. The very low rate of prior education and high demand for training indicate a critical gap in medical curricula that should be addressed to reduce unnecessary testing and healthcare costs.

Keywords

Awareness , Health Care Costs , Diagnostic Tests , Emergency Medicine , Internship and Residency

Ethical Statement

This study was approved by the clinical research ethics committee of Kırıkkale University. Date: 26/03/2025, Number: 2025.03.33.

Supporting Institution

None

References

• National Center for Health Statistics. Emergency Department Visits [Internet]. 2025 [cited 2025 Aug 11]. Available from: https://www.cdc.gov/nchs/fastats/emergency-department.htm
• NHS England. A&E Attendances and Emergency Admissions [Internet]. [cited 2025 Aug 11]. Available from: https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/
• Beştemir A, Aydın H. 300 million Patient Examinations per year; Evaluation of Emergency and Polyclinic Services of 2nd and 3rd Stage Public Health Facilities in Turkey. Sak Med J. 2022 Aug 11 [cited 2025 Aug 11]. Available from: https://dergipark.org.tr/tr/doi/10.31832/smj.1128439
• Greenwood-Ericksen MB, Kocher K. Trends in emergency department use by rural and urban populations in the United States. JAMA Netw Open. 2019 Apr 12;2(4):e191919.
• Sarbay İ, Mercan Baspinar M, Erman E, Cavdar B, Tamer I, Adiyaman A, et al. Does patient satisfaction with primary and emergency care influence non-urgent emergency department utilization? A path analysis. J Multidiscip Healthc. 2025 Aug;18:4703–15.
• Innes G, Grafstein E, McGrogan J. Do emergency physicians know the costs of medical care? CJEM. 2000 Apr;2(02):95–102.
• Gervais N, Véronique G, Jacques J, Dominique V. How aware are Belgian permanent and resident emergency physicians of common medical costs and radiation doses? Eur J Emerg Med. 2011 Dec;18(6):344–50.
• Atun R. Transforming Turkey’s health system — lessons for universal coverage. N Engl J Med. 2015 Oct;373(14):1285–9.
• Türkiye İstatistik Kurumu. Sağlık Harcamaları İstatistikleri 2023 [Internet]. 2023 [cited 2025 Aug 11]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Saglik-Harcamalari-Istatistikleri-2023-53561
• General Directorate Of Health Information Systems. Health Statistics Yearbook 2021 [Internet]. The Ministry of Health of Türkiye; 2023 [cited 2025 Aug 11]. Available from: https://dosyasb.saglik.gov.tr/Eklenti/45317,siy2021-ingilizcepdf.pdf?0
• Rodriguez Santana I, Mason A, Gutacker N, Kasteridis P, Santos R, Rice N. Need, demand, supply in health care: working definitions, and their implications for defining access. Health Econ Policy Law. 2023 Jan;18(1):1–13.
• Kamu Hastaneleri Genel Müdürlüğü. Fiyat Tarifeleri [Internet]. [cited 2025 Aug 11]. Available from: https://khgmfinansalanalizdb.saglik.gov.tr/TR-40231/fiyat-tarifeleri.html
• Lee JA, Chernick L, Sawaya R, Roskind CG, Pusic M. Evaluating cost awareness education in US pediatric emergency medicine fellowships. Pediatr Emerg Care. 2012 July;28(7):655–75.
• Gandhi R, Stiell I, Forster A, Worthington J, Ziss M, Kitts JB, et al. Evaluating physician awareness of common health care costs in the emergency department. CJEM. 2018 July;20(4):539–49.
• Velleman T, Dierckx RAJO, Ongena YP, Koopmans KP, Noordzij W, Kwee TC. Financial illiteracy among internal medicine, surgery, and radiology residents regarding medical imaging costs in the Netherlands. Eur Radiol. 2025 Mar 20 [ahead of print]. doi: 10.1007/s00330-025-11510-7
• Vijayasarathi A, Duszak R, Gelbard RB, Mullins ME. Knowledge of the costs of diagnostic imaging: a survey of physician trainees at a large academic medical center. J Am Coll Radiol. 2016 Nov;13(11):1304–10.
• Mrwetyana KN, Janse Van Rensburg J, Joubert G. Cost awareness of radiological studies among doctors at Universitas Academic Hospital in Bloemfontein, South Africa. South Afr J Radiol. 2021 Sept 20;25(1).
• Maghbouli N, Akbari Sari A, Asghari F. Cost-consciousness among Iranian internal medicine residents. Med Teach. 2020 Apr 2;42(4):463–8.
• Long T, Bongiovanni T, Dashevsky M, Halim A, Ross JS, Fogerty RL, et al. Impact of laboratory cost display on resident attitudes and knowledge about costs. Postgrad Med J. 2016 Oct 1;92(1092):592–6.
• Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293(21):2609-17.
• Sayyad MH, Levi N, Bruoha S, Segoli M, Orpaz N, Shiyovich A, et al. Defensive medicine in an emergency department: the overuse of high-sensitivity cardiac troponin I testing. Life (Basel). 2024 Nov 28;14(12):1563.