Cost-consciousness among Swiss doctors: a cross-sectional survey

Doctors (n = 1184) in Geneva, Switzerland, answered questions about their cost-consciousness, practice patterns (medical specialty, public.vs. private sector, number of patients per week, time spent with a new patient), work satisfaction, and stress from uncertainty. General linear models were used to identify independent risk factors of higher cost-consciousness.Most doctors agreed that trying to contain costs was their responsibility ("agree" or "totally agree": 90%) and that they should take a more prominent role in limiting the use of unnecessary tests (92%); most disagreed that doctors are too busy to worry about costs (69%) and that the cost of health care is only important if the patient has to pay for it out-of-pocket (88%). In multivariate analyses, cost-consciousness was higher among doctors in the public sector, those who saw fewer patients per week, who were most tolerant of uncertainty, and who were most satisfied with their work.Thus even in a setting with very high health care expenditures, doctors' stated cost-consciousness appeared to be generally high, even though it was not uniformly distributed among them.Because most health care expenditures are the results of doctors' decisions, whether doctors are cost-conscious is an important matter. Many decisions regarding medical tests and treatments are influenced by factors other than the expected benefit to the patient, including the doctor's demographic characteristics [1,2], training [3-6], work context [7,8], financial incentives [9,10] and information about costs [11-13]. Medical decisions are also influenced by subjective considerations, including risk aversion [14,15], tolerance for uncertainty [16], and concerns about cost and income [17].In this paper, we are interested in cost-consciousness, defined as a concern to contain costs of health care borne by society [18]. Cost-consciousness was the first factor identified from a series of different attitudes hypothesized to influence physicians' res