Investigation of the awareness of specialist physicians in Iran hospitals regarding treatment costs in 2022

doi:10.21203/rs.3.rs-3404133/v1

Introduction

In the current economic situation, where financing in healthcare services has become a major problem, awareness of costs and cost-effective decision-making has become more important than ever. Many factors are involved in healthcare spending, but physicians play the most important role. This study aimed to determine the level of awareness of specialist physicians working in Iran hospitals regarding treatment costs.

Method

This cross-sectional and analytical study was conducted in all public-educational hospitals in Mashhad. The data collection tool in this study was a researcher-made checklist, through which participants were asked to estimate the cost of 25 items of services and expenses. The questionnaire is a checklist of the most expensive items and services extracted by specialty. Data were analyzed using STATA version 14 software after collection.

Results

The awareness level of all groups of specialist participants in this study was evaluated as weak regarding treatment costs. In this study, the most accurate estimate of treatment costs was related to emergency medicine specialists (21.5%) and the weakest estimate was related to internal medicine and obstetrics and gynecology specialists (12.4%). All participating specialists in this study tended to estimate treatment costs higher than the actual cost. This study shows that the participating specialists had the highest accuracy in estimating the costs of imaging (22.9%) and the lowest accuracy in estimating the costs of consumables (11.6%). Also, more than 93% of respondents in this study stated that they have not passed any relevant courses on healthcare economics.

Conclusion

The low accuracy of physicians' estimates as the most important factor in managing healthcare costs is the main challenge identified in this section. Displaying item costs and monthly expenses in appropriate places, providing physicians with cost information, developing computer programs capable of displaying costs when physicians write orders, and including retraining programs on healthcare economics can improve physicians' awareness of treatment costs.

Awareness

Accuracy of estimation

Treatment costs

Specialist physicians

Hospital

Financial costs are one of the most well-known reasons for inadequate and unfair access to healthcare. High treatment costs have various negative consequences, including the impact on the patient's treatment outcome and decision-making in selecting the timing or method of treatment. Additionally, impoverishment of households or imposing financial burdens on the patient and their family are other effects of high treatment costs(1).

Most physicians are unfamiliar with the principles of healthcare economics. Despite this fundamental limitation, they are the main reference for allocating resources to their patients. Therefore, awareness of costs among physicians plays a crucial role in controlling treatment costs(2). Awareness of costs is a crucial step towards controlling healthcare costs. Recent studies in several surgical fields have revealed that physicians have a weak understanding of cost components. Changing physicians' attitudes towards cost control requires their initial knowledge of the costs of prescription(3) And multiple studies show that when physicians have access to cost information, they can control costs(1).

Previous studies have shown that physicians often have a poor understanding of the costs of tests and medications they prescribe, and providing cost information can affect their awareness of service costs. In a study conducted by Alizadeh, surgeons' awareness of the costs of various treatment methods was reported to be insufficient. This lack of awareness was not related to their age, gender, education, or position.(4)

In the study of Nethathe et al., it was found that doctors often have a limited understanding of the real cost of the items used, and in practice, they consistently tend to underestimate the price of expensive items and overestimate the price of cheaper items. This study shows us that doctors did not have enough training regarding cost awareness. In this study, participants stated that they would like cost information to be easily available to them. The accuracy of cost estimates is reported to be poor in almost all studies examining cost evaluation(1).

In another study conducted by Kim Bad et al., no significant difference was observed in the correct estimation of treatment costs between doctors working in the private sector and doctors working in public centers. In addition, they did not find a relationship between the level of experience, nationality and medical expertise. The results of this study show that the awareness of costs among surgical team members is very poor(5).

Schmidt and colleagues state that cost awareness is an important step toward cost containment and emphasize that physicians at all levels of training have poor knowledge of medical costs. In this study, there was no correlation between work experience, expertise, organizational role, academic rank and awareness of treatment costs(3).

In the health map of the Islamic Republic of Iran, in the form of the fifth development plan, the issue of reducing health costs has been addressed by setting two goals: reducing the share of direct payments from people's pockets and reducing the population in the face of catastrophic health costs(6). Also, this issue has been emphasized in the 6th Development Plan and it has been taken into consideration by focusing on eliminating gray payments, creating transparency in health service tariffs and managing actions defined by the Ministry of Health(7).

Deep changes in the socio-economic situation in the world have greatly transformed public health systems. Physicians are now not only involved in patient care, but also involved in cost control and budget implementation. The cost of health care has become a serious national issue, especially in the current economic climate(8).

To control costs, doctors are required to provide services at minimum cost without sacrificing quality. It is obvious that the goal of cost management and control is to optimize the resources allocated to health and not to reduce the quality level of treatment(9).Since cost awareness among doctors is an important part of cost containment in health services and that cost awareness is an important step towards cost containment, this study aims to investigate the awareness of medical specialists in Iran hospitals about treatment costs in the year 2022 was done.

This cross-sectional and analytical study was carried out in 13 general-teaching hospitals of Mashhad. First, using hospital HIS data in 2021, the specialists who provided the most services to the patients of public hospitals affiliated to Mashhad University of Medical Sciences were identified. The data collection tool in this research was a checklist made by researchers and based on the results of previous studies in other countries of the world(1, 4, 8, 9). It was designed and published anonymously among resident students and specialist doctors working in the mentioned hospitals. In fact, this questionnaire is a checklist of the most expensive items and services that were extracted in 2021 in the three hospitals of Imam Reza (AS), Hazrat Qaim (AS), and Shahid Hashminejad in Mashhad, separated by specialty, and includes 25 items of expensive items. It is possible that the questioner is asked to declare its price in the form of an open question. The list of items in this part of the questionnaire has been prepared separately for each specialty. (It is mentioned in the attachments) In this part of the questionnaire, the cost items are categorized into five groups. 1- Medical and therapeutic services 2- Tests 3- Graphs 4- Medicines 5- Consumables.

Sampling has also been done using the full count method. As a result, all specialists and residents of gynecology, internal medicine, emergency medicine, internal neurology, cardiology, general surgery, kidney and urinary tract, orthopedics, otolaryngology, heart surgeon and neurosurgeon of the target hospitals could participate in this study. Finally, out of a total of 984 people, 257 people responded to the sent questionnaire. The response rate is 26.1 percent. After receiving the code of ethics and obtaining the necessary permits based on the category of doctors, the contact numbers of all doctors working in Mashhad University of Medical Sciences were received and the designed questionnaire was sent to all doctors through social networks. In the first stage, all the doctors did not answer the questionnaire, so the link of the questionnaire was sent again to those doctors who did not answer. With the aim of reducing the non-response rate in the third stage, the questionnaire was given to the remaining doctors in person by the student to answer. Their non-response after visiting in person was considered as their non-participation in the study.

After collection, data analysis was done using STATA version 14 software and appropriate statistical tests. For analysis due to the non-normality of the data, appropriate non-parametric statistical tests at a significance level of 0.05 were used to compare the results.

The answers are divided into three categories. 1- Lower estimate 2- Correct estimate 3- More estimate. If the price estimate is within ± 25% of the actual price, it is considered as a correct estimate. If the answer was less than 25% of the actual price, it was considered as an underestimate and if the answer was more than 25% of the actual price, it was considered as an overestimate. In order to differentiate between cheap and expensive costs, the average price of the items included in the questionnaire was calculated and then the average of each category of questions (services-tests-graphics-medicines and consumables) was compared with the total average. If the result was less than the total average, those items were classified as cheap items, and if it was more than the total average, those items were classified as expensive items.

All participants provided a written informed consent form for various aspects of data collection. The Medical Ethics Committee of Mashhad University of Medical Sciences has approved this research (IR.MUMS.REC. 1399.552).

In this research, a total of 257 people answered the questionnaire, of which 54.5% were men and 45.5% were women. Also, the highest frequency is related to the age group of 30–40 years. (42.8 percent) and the lowest frequency is related to the age group of less than 30 years. (14.7%), in terms of work experience, the highest frequency is related to work experience of less than 10 years (62.6%), and the lowest frequency is people with more than 30 years of experience (2.3%), the place of service is more than 45.1 The percentage of respondents in Imam Reza (AS) hospital is stated. After that, Hazrat Qaim (AS) Hospital with 24.5% and Shahid Hashminejad Hospital with 7% respectively are the most frequent places of service of the respondents. (Table 1)

Table 1: Demographic characteristics of the research community

Percentage	Number		Variable name
54.5	140	Man	sex
45.5	117	Female
100	257	Total
14.7	38	Less than 30 years	Age
42.9	110	30 to 40 years
24.9	64	40 to 50 years
17.5	45	Above 50 years
100	257	Total
62.6	161	Less than 10 years	Work Experience
24.9	64	10 to 20 years
10.2	26	20 to 30 years
2.3	6	More than 30 years
100	257	Total
45.1	116	Imam Reza	Hospital of service
24.5	63	Qaim
7	18	Hasheminejad
3.5	9	Shariati
5.8	15	Umm al-Binin
6.6	17	Kamyab
1.5	4	Omid
1.2	3	Montserya
1.6	4	Akbar
0.8	2	Dr. Sheikh
0.8	2	Taleghani
0.8	2	Alevi
0.8	2	Ibn Sina
100	257	Total
24.5	63	employment	Type of cooperation
11.6	30	Contractual
7.4	19	sherkati
51	131	Student
5.5	14	other
100	257	Total
63	162	Yes	Full time cooperation
37	95	No
100	257	Total

Among the respondents, the highest frequency is related to internists with more than 17%, followed by cardiologists with more than 12%. The lowest frequency is related to cardiac surgeons and neurosurgeons with 0.7% and 1.5%, respectively. (Table 2)

Table 2

The frequency of the number of respondents by specialty
	Total	Brain Surgery	heart surgery	General surgery	Internal brain and nerves	Ear nose and throat	Emergency Medicine	Kidney and urinary tract	orthopedics	Obstetrics and Gynecology	Internal	internal heart
Number	257	4	2	31	21	19	33	19	20	30	46	32
Percentage	100	1.6	0.8	12	8.1	7.5	12.8	7.5	7.7	11.7	9.17	12.4

About 94% of the respondents (equivalent to 241 people) have not received any training on health economics during their service period, and on the other hand, about 6% of the respondents (equivalent to 16 people) have said that they have completed a training course related to health economics. (Table 3).

Table 3

The participation rate of the research community in courses related to health economics
	Total	no	yes
Number	257	241	16
Percentage	100	93.8	6.2

In response to the question "Does your organization/hospital encourage you to provide cost-effective services?", only 16% of the respondents chose the option often and always.

In response to the question "Does your organization/hospital monitor the cost effectiveness of the services you provide?" Only 10.1 percent of the respondents chose the option often and always.

In response to the question "Are you interested in providing a low-cost service for your patient?" 78 percent of the respondents chose the option often and always (Table 4).

Table 4

Frequency of responses to questions related to the cost effectiveness of services
		Always	mostly	sometimes	rarely	Never	Total
Does your organization/hospital encourage you to provide cost effective services?	Number	10	31	79	69	68	257
	Percentage	3.9	12.1	30.7	26.8	26.5	100
Does your organization/hospital monitor the cost effectiveness of the services you provide?	Number	4	22	86	75	70	257
	Percentage	1.5	8.6	33.5	29.2	27.2	100
Are you interested in providing a low-cost service for your patient?	Number	86	117	42	7	5	257
	Percentage	4.33	45.6	16.4	7.2	9.1	100

The accuracy of the estimates of different specialties of the overall treatment costs is shown in Table 5. In total, none of the groups of experts participating in this research could correctly estimate at least 75% of the cost of the items. As a result, the accuracy of the estimation of all participating expert groups of the treatment costs in this study has been evaluated as low. The most accurate estimate of treatment costs is related to emergency medicine specialists (21.5%) and the weakest estimate is related to internal medicine and obstetrics specialists (12.4%). Also, this study shows that the internal experts participating in this research tended to estimate the cost of items more than the actual price (68.4%).

Based on the results of this study, all groups of experts participating in this study often tended to estimate treatment costs more than the actual cost.

Table 5

Comparative table of estimates of different groups of experts on the total cost of treatment
Name of specialization	More estimate (percentage)	correct estimate (percentage)	lower estimate (percentage)
Heart	54.6	17.1	28.3
Internal	68.4	12.4	19.2
Obstetrics and Gynecology	32.5	12.4	25.1
orthopedist	64.8	12.6	22.6
Kidney and urinary tract	50.7	20.0	29.3
Emergency Medicine	59.0	21.5	19.5
Ear nose and throat	56.4	16.0	27.6
Neurology	55.0	16.0	29.0
General surgery	58.3	18.1	23.6
Total	59.8	16.1	24.1

In the group of questions related to the estimation of service costs, none of the groups of experts participating in this research could correctly estimate at least 75% of the cost of items. The most accurate estimate of service costs is related to internal specialists (25.2%) and the weakest estimate is related to neurologists (14.3%).

Based on the results of this study, cardiologists, orthopedists, emergency medicine and general surgeons have estimated the costs of services more than the actual cost. in return ; Specialists in obstetrics and gynecology, kidneys and urinary tracts, ear, nose and throat and neurology have estimated this group of costs lower than the actual cost. (Table 6)

Table 6

Comparative table of estimates of different groups of experts on the costs related to services
Name of specialization	More estimate (percentage)	correct estimate (percentage)	lower estimate (percentage)
Heart	51.8	14.4	33.8
Internal	37.4	25.2	37.4
Obstetrics and Gynecology	38.7	14.7	46.7
orthopedist	41.0	20.0	39.0
Kidney and urinary tract	32.6	22.1	45.3
Emergency Medicine	41.2	21.2	37.6
Ear nose and throat	23.2	22.1	54.7
Neurology	36.2	14.3	49.5
General surgery	42.6	22.6	34.8
Total	39.3	19.9	40.8

In the group of questions related to the cost estimate of diagnostic tests, the most accurate estimate of the cost of tests is related to emergency medicine specialists (25.5%) and the weakest estimate is related to orthopedic specialists (3%). However, none of the expert groups participating in this research could correctly estimate at least 75% of the cost of the items.

Based on the results of this study, all the groups of experts participating in this study have estimated the costs of tests more than the actual cost. (Table 7)

Table 7

Comparative table of the estimates of different groups of experts on the costs of tests
Name of specialization	More estimate (percentage)	correct estimate (percentage)	lower estimate (percentage)
Heart	65.6	14.4	20.0
Internal	71.7	8.7	19.6
Obstetrics and Gynecology	80.0	12.0	8.0
orthopedist	87.0	3.0	10.0
Kidney and urinary tract	53.7	15.8	30.5
Emergency Medicine	47.8	25.5	26.7
Ear nose and throat	63.2	12.6	24.2
Neurology	68.5	10.5	21.0
General surgery	56.7	16.8	26.5
Total	65.9	13.5	20.6

In the group of questions related to the estimation of the costs of graphics, none of the groups of experts participating in this research could correctly estimate at least 75% of the cost of the items. The most accurate estimate of test costs is related to kidney and urinary tract specialists (40%) and the weakest estimate is related to orthopedic specialists (8%).

Based on the results of this study, all groups of experts participating in this study have estimated the costs of graphics more than the actual cost. (Table 8)

Table 8

Comparative table of estimates of different groups of experts on the costs related to graphs
Name of specialization	More estimate (percentage)	correct estimate (percentage)	lower estimate (percentage)
Heart	68.7	21.9	9.4
Internal	77.8	12.6	9.6
Obstetrics and Gynecology	66.7	16.0	17.3
orthopedist	78.0	8.0	14.0
Kidney and urinary tract	42.1	40.0	17.9
Emergency Medicine	47.2	37.0	15.8
Ear nose and throat	70.5	24.2	5.3
Neurology	44.8	27.6	27.6
General surgery	49.0	26.5	24.5
Total	61.8	22.9	15.3

In the group of questions related to the estimation of drug costs, the most accurate estimation of drug costs is related to cardiologists (18.8%) and the weakest estimation is related to internal specialists (8.3%). However, none of the expert groups participating in this research could correctly estimate at least 75% of the cost of the items.

Based on the results of this study, all the groups of experts participating in this study have estimated the costs of medicine more than the actual cost. (Table 9)

Table 9

Comparative table of estimates of different groups of experts on costs related to drugs
Name of specialization	More estimate (percentage)	correct estimate (percentage)	lower estimate (percentage)
Heart	49.3	18.8	31.9
Internal	74.3	8.3	17.4
Obstetrics and Gynecology	63.4	13.3	23.3
orthopedist	56.0	10.0	34.0
Kidney and urinary tract	54.8	12.6	32.6
Emergency Medicine	84.3	10.9	4.8
Ear nose and throat	64.2	8.4	27.4
Neurology	44.8	16.2	39.0
General surgery	67.1	13.5	19.4
Total	64.1	12.4	23.5

In the group of questions related to estimating the costs of consumables, none of the groups of experts participating in this research could correctly estimate at least 75% of the cost of the items. The most accurate estimate of consumables costs is related to orthopedic specialists (22%) and the weakest estimate is related to obstetrics and gynecology specialists (6%).

Based on the results of this study, all groups of experts participating in this study have estimated the costs of consumables more than the actual cost. (Table 10)

Table 10

Comparative table of estimates of different groups of experts on the costs of consumables
Name of specialization	More estimate (percentage)	correct estimate (percentage)	lower estimate (percentage)
Heart	37.4	16.3	46.3
Internal	80.4	7.4	12.2
Obstetrics and Gynecology	64.0	6.0	30.0
orthopedist	62.0	22.0	16.0
Kidney and urinary tract	70.5	9.5	20.0
Emergency Medicine	74.6	12.7	12.7
Ear nose and throat	61.1	12.6	26.3
Neurology	81.0	11.4	7.6
General surgery	76.1	11.0	12.9
Total	68	11.6	20.4

The present study was conducted with the aim of determining the level of awareness of medical specialists in Iran hospitals about treatment costs.

The findings of this study showed that the knowledge of doctors specializing in different specialized groups about treatment costs is very poor. From the total of 9 specialized groups whose knowledge about treatment costs was evaluated in this study, no group could estimate 75% of the questions within the correct range (± 25% of the actual price). Inability to correctly estimate prices was evident in all five categories of questions (services-diagnostic tests-imaging-drugs and consumables). The remarkable point in the findings of this study was that, in general, all the specialized groups that participated in this study often had the tendency to raise the prices of the cost items. This study shows that the highest accuracy in cost estimation is related to imaging costs group (with 22.9 percent) and the lowest accuracy is related to consumables costs group (with 11.6 percent). Another important finding of this study is that more than 93% of the respondents stated that they have not taken courses related to health economics; At the same time, about 79 percent of the participants pay attention to the provision of a low-cost service. The current study considers the role of hospital management in the awareness of specialists about treatment costs very strong. According to the results of this study, hospitals neither monitor the cost effectiveness of services nor encourage doctors to provide cost effective services.

Each specialty is discussed separately:

Cardiologists

The present study shows that cardiologists' knowledge about all five groups of cost items is low. Also, most of the cardiologists participating in this research had a tendency to overestimate the cost of services, tests, graphs and drugs, while all the four mentioned cost groups are part of cheap services, it can be concluded that cardiologists tend to Hands up, they had cheap items. These results are consistent with the results of Nethathe and Allan's studies(1, 10).

Internal specialists

The obtained results show that the level of knowledge of internal specialists participating in this study is low about treatment costs. Also, most of the specialists of this group (68.4%) were inclined to overcharge the treatment costs. These results are consistent with the results of Nethathe's study(1). In the results of the entire questionnaire, internal specialists along with obstetricians and gynecologists had the least accuracy in estimating treatment costs (with 12.4%).

Gynecologists and obstetricians

Most of the obstetricians and gynecologists participating in this research had the tendency to overestimate the cost of tests, graphs, drugs and consumables, while all four mentioned cost groups are cheap items. On the other hand, most of this group of experts have estimated the costs of medical services lower than the real price. While the cost items of medical services of the group of obstetrics and gynecology specialists are among the expensive cost items. According to the mentioned results, it can be concluded that the obstetricians and gynecologists participating in this study had a tendency to buy cheap items and buy expensive items. These results are consistent with the results of Ryan, Schmidt, Sorber and Nethathe studies(1–3, 11).

Orthopedic specialists

Most of the orthopedic specialists participating in this research had the tendency to overestimate the cost of tests, graphs and drugs, while all three mentioned cost groups are cheap items. It can be concluded that the orthopedic specialists participating in this study in the mentioned cost groups have a tendency to overcharge the cheap costs. This result is consistent with the results of the studies of Rohman, Sorber and Al Zamil(4, 11, 12). Also, this study shows that orthopedic specialists often tended to estimate the cost of consumables more than the actual cost. Considering that the cost items related to consumables are part of the expensive costs, it is consistent with Tiong's study in which the underestimation of expensive items by experts has not been proven.(8)

Kidney and urinary tract specialists

The urologists participating in this study were able to keep 22.1% of the costs of medical services, 15.8% of the costs of laboratory tests, 40% of the costs of graphs, 12.6% of the costs of drugs, and 9.5% of the costs of consumables within the correct range. to estimate According to the mentioned results, it can be concluded that the kidney and urinary tract specialists participating in this study had a tendency to take cheap items with their hands up and expensive items with their hands down. These results are consistent with the results of Phan, Sorber and Allan studies(10, 11, 13) .

Emergency medicine specialists

It can be concluded that the emergency medicine specialists participating in this study had a tendency to overestimate cheap items and underestimate expensive items in the cost groups of medical services, tests, drugs and consumables. These results are consistent with the results of Schilling's studies(14). This group of experts often tended to estimate the questions related to the cost of graphs higher than the actual price. This is despite the fact that this group of expenses is one of the expensive items. In this sense, it is consistent with Tiong's study, in which the underestimation of expensive items by experts was not proven(8). Also, among the 9 groups participating in this study, emergency medicine specialists were the most accurate in estimating costs related to laboratory tests (with 25.5%).

Ear, nose and throat specialists

The otolaryngologists who participated in this study were able to save 22.1% of the costs of medical services, 12.6% of the costs of laboratory tests, 24.2% of the costs of graphs, 8.4% of the costs of drugs, and 12.6% of the costs of consumables. estimate within ± 25 percent of the actual price.

According to the mentioned results, it can be concluded that the otolaryngologists participating in this study had a tendency to pick up cheap items and downplay expensive items. These results are consistent with the results of studies by Ryan, Schmidt, Jackson and Allan (2, 3, 10, 15).

Neurologists

The neurologists participating in this study were able to save 14.3% of the costs of medical services, 10.5% of the costs of laboratory tests, 27.6% of the costs of graphs, 16.2% of the costs of drugs, and 11.4% of the costs of consumables. Estimate the correct range. According to the mentioned results, it can be concluded that the neurologists participating in this study in the cost groups of medical services, tests, drugs and consumables tend to pick up cheap items and pick up expensive items. had the These results are consistent with the results of Nethathe and Allan's studies(1, 10).

General surgery specialists

The general surgeons who participated in this study were able to save 22.6% of the costs of medical services, 16.8% of the costs of laboratory tests, 26.5% of the costs related to graphs, 13.5% of the costs related to drugs and 11% of the costs of consumables in the range estimate ± 25 percent of the actual price. The general surgeons participating in this study had a tendency to pick up cheap items and downplay expensive items. This result is consistent with the results of studies by Ryan, Schmidt, Jackson, Elzmail, Bade and Sorber (2–5, 11, 15). Also, most of the specialists of this group (59%) had a tendency to increase the treatment costs.

Also, this study shows that most of the general surgeons participating in this research tended to estimate the costs of services, diagnostic tests, graphs, drugs and consumables more than their actual costs.

Of the total participants in this study, only 19.9% of them were able to correctly estimate the cost of the service. The present study shows that experts' knowledge about service costs is poor, which is consistent with all the studies reviewed in this research, especially with Al Zamil's study.(4) In this study, the tendency to overestimate the costs of services was not evident, and for this reason, it is contrary to the studies of Ryan, Schmidt, Hernu, Jackson, Phan, and Allan, which states that most of the participants tend to estimate the items as more expensive than the actual price(2, 3, 13, 15–17) .

It should be noted that the current research has limitations, which include: the low willingness of experts to participate in the research and answer the questionnaire, the non-inclusion of other professionals who play a role in health costs, such as nurses.

Specialists' lack of cost awareness, coupled with their tendency to underestimate the prices of expensive drugs and overestimate the prices of cheaper products, indicates a lack of understanding of the significant cost differences between low-cost and high-cost items. This difference can, in turn, have profound consequences for overall treatment costs. Possible reasons for poor cost estimation accuracy among physicians likely include a lack of emphasis on healthcare economics during their years of training, poor collaboration between physicians and hospital managers, conflicts between quality care and treatment costs, and a lack of updates on healthcare economics knowledge after graduation. There are various ways to improve cost awareness among physicians, including displaying item costs and monthly expenses in strategic locations, providing physicians with cost information access, developing a computer program capable of displaying costs when physicians prescribe, and incorporating retraining programs on healthcare economics.

Ethics approval and consent to participate

This research has been approved by the Medical Ethics Committee of Mashhad University of Medical Sciences (No.IR.MUMS.REC. 1399.552). All participants provided a written informed consent form for various aspects of data collection. It was also implemented in compliance with the principles and regulations of secrecy and privacy. All research methods were carried out in accordance with the relevant guidelines and regulations.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This research did not receive any specific funding.

Authors' contributions

H.E. and M.U. designed the study and wrote the manuscript. S.M. and M.Kh. contributed to data collection. M.V. performed the statistical analysis and interpretation of the results. All authors read and approved the final manuscript and all authors individually in the author contribution statement.

Acknowledgements

This study is a part of the master's thesis on health services management, which was registered by the Faculty of Health at Mashhad University of Medical Sciences and approved by the University's Research Vice-Chancellor. The authors would like to thank all the people who helped in this study.

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No competing interests reported.

Investigation of the awareness of specialist physicians in Iran hospitals regarding treatment costs in 2022

Status:

Version 1

Abstract

Introduction

materials and methods

Results

Discussion