Do emergency physicians know the costs of medical care?

To estimate the level of knowledge that Canadian emergency physicians have of the costs of common diagnostic tests and interventions in the emergency department (ED).

In a cross-sectional survey, 75 emergency physicians from 7 community and academic EDs were asked to estimate the cost of 60 of the most commonly ordered imaging modalities, laboratory tests and pharmaceuticals. Their estimates were compared to actual costs obtained from hospital finance departments. For each test or pharmaceutical, physician error was calculated as a percentage of the actual value, using the formula [(actual - estimated) / actual] yen 100. For each item, the proportion of responses that were underestimates, the proportion that were overestimates and the proportion that were accurate within 25% were reported.

Mean error of the physicians' estimates was 40% (95% confidence interval [CI], 35%-45%) for imaging studies, 153% (95% CI, 128%-178%) for lab investigations, and 218% (95% CI, 179%-257%) for pharmaceutical costs. Rates of underestimation vs. overestimation were 68% vs. 16% for imaging modalities, 23% vs. 56% for laboratory tests, and 21% vs. 64% for pharmaceuticals.

Emergency physicians have a limited knowledge of the costs of the tests and interventions they use on a daily basis. They tend to overestimate lab and pharmaceutical costs but underestimate imaging costs. Cost-awareness programs for emergency physicians are most likely to be beneficial if they focus on imaging modalities.