Factors influencing cost awareness in hospitals: a scoping review

Financing healthcare services remains a significant challenge in developing countries, with a 30% increase in healthcare costs attributed to the overutilization of diagnostic tests and therapies. Low-cost awareness within the hospital setting may contribute to this situation. This scoping review aims to identify factors influencing cost awareness and explore strategies for enhancing cost awareness in hospitals.

The scoping review method followed the framework of Arksey and O'Malley. Eligibility criteria used the Population, Concept, and Context mnemonic. The population covers all hospital workers with the concept of factors influencing cost awareness and strategies to enhance. The context encompasses hospitals across all countries. Literature was searched in seven databases (EBSCO, Cochrane Library, ProQuest, ScienceDirect, Scopus, PubMed, Web of Science), and through hand searching and grey literature. Data were extracted from publications between January 1990 to March 2024, coded inductively, and categorized thematically.

From 984 identified records, 54 studies met the inclusion criteria. Most were conducted in the United States (53.7%) and Europe (25.9%), with limited representation Asia (12.9%) and Africa (5.6%). Quantitative cross-sectional design was the most common methodology (40 studies, 74.1%), followed by intervention studies (11 studies, 20.3%) and qualitative studies (3 studies, 5.6%). Intervention studies were predominantly implemented in the United States, with one conducted in Europe. Internal factors, particularly professional knowledge (51.8%) and experience (42.6%), were the most frequently cited determinants. Organizational factors such as access to price information and cost containment policies were also influential. External factors included patient expectations, healthcare financing policies, and academic curricula. Cost education and visual pricing systems emerged as the most frequently cited strategies to improve cost efficiency and healthcare outcomes. Interventions were predominantly implemented in teaching hospitals in high-income countries.

Cost awareness in hospitals is shaped by internal and external factors, with professional knowledge, experience, and access to price information emerging as common influences. Cost education and visual pricing systems were the most frequently reported with evidence mostly from the high-income settings. Future research, particularly in low- and middle-income countries, should focus on developing and testing context-specific, multisectoral strategies to strengthen cost awareness across diverse hospital settings.

This scoping review is registered with the Open Science Framework at https://osf.io/7h5et /(OSF | Factors influencing cost awareness in hospitals: a scoping review).