Freelisting on Costs and Value in Health Care by Pediatric Attending Physicians

In preparation for the development of a curriculum on health care costs and value for pediatricians, the goal of this study was to assess pediatricians' baseline perceptions about the concepts of "cost" and "value" in health care, and topics that should be included in a curriculum that teaches about costs and value in pediatrics.

Physicians in the Department of Pediatrics at The Children's Hospital of Philadelphia received an online freelisting survey asking them to generate lists of words that come to mind when thinking about "costs" in health care, "value" in health care, and topics to include in a curriculum on costs and value in pediatrics. AnthroPac software generated salience scores, indicating the relative importance of each term.

A total of 207 surveys were completed for a 40% response rate. For the "cost" prompt, the most salient responses were "excessive," "waste," and "insurance." For the "value" prompt, the most salient responses were "outcomes" and "quality." For elements to include in a curriculum, the most salient responses were "insurance" and "costs." Analyzing responses based on years in practice, percentage clinical time, and division resulted in slightly different lists and salience scores.

In this freelisting exercise, there was general agreement that health care costs are "excessive," that "outcomes" and "quality" are integral to value, and that there is a need for education in these areas, especially around "insurance." Differences based on years in practice, percentage clinical time, or division can inform the development of targeted curricula that consider the needs, knowledge, and interests of these groups.