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

Background: Serbia, as the largest market of the West-ern 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 ar-eas. 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 physi-cians. Therefore, a broad national survey was conducted at all levels of the healthcare system hierarchy to distin-guish 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 inter-ventions 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 con-ducted through a hierarchy of medical facilities across diverse geographical regions before and after policy ac-tion, from January 2010 to April 2013. In the middle of the observed period, the National Health Insurance Fund (RFZO) adopted severe cost-containment measures. Inde-pendently, pharmacoeconomic guidelines targeted at pre-scribers were disseminated. Administration in large hos-pitals 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 document-ed clinician's attitudes on: Clinical-Decision-Making-between-Alternative-Interventions(CDMAI),Quality-of-Health-Care(QHC),andCost-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 CD-MAI score compared to physicians (1.017±0.453). The urgical group compared to the internist group had a high-er total EAHPQ-29 score, CCP score and CDMAI score. Policy intervention had a statistically significant nega-tive 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 severe-ly constrained resources allocated to the providers. This pioneering effort in the Balkans exposes the inefficiency of current policies to expand clinicians' cost consciousness

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