Family practice residents' awareness of medical care costs in British Columbia

Abstract

Background and objectives: Health economics continues to be an important issue, and past studies in the United States and Europe have found that physicians and physicians in training have a limited understanding of medical care costs. No medical care cost-awareness studies have been done in Canada. In this study, the costs of 46 commonly used diagnostic tests and therapeutics were determined, and family practice residents' awareness of these costs was assessed.

Methods: Ninety-seven first- and second-year residents of the University of British Columbia Family Practice Program were surveyed using the modified Dillman Total Design Method. Resident cost estimations were considered correct if within 25% or 50% of actual costs, and awareness was correlated with training location, gender, residency year, and importance ratings for ordering behavior. Degree of error was assessed by calculating median percent errors and confidence intervals for each therapeutic and diagnostic test.

Results: Costs were determined from the British Columbia Medical Association Guide to Fees, British Columbia Centre for Disease Control, hospital finance departments, and pharmaceutical wholesalers. A total of 82 (85%) residents completed the survey, but 11 were only partially completed. Few residents could estimate the cost of diagnostic tests or therapeutics to within 25% of the true cost, and the estimations were highly variable. Residents underestimated the cost of expensive drugs and overestimated the cost of inexpensive drugs. There was no relationship between cost awareness and training location, gender, residency year, or residents rating cost as important in ordering behaviour.

Conclusion: Resident physicians in British Columbia, Canada have limited awareness of medical care costs.