Introduction
The continuous rise in healthcare sectors expenditures have been at the
forefront of debates and controversies among health professionals,
legislators, economists, and many other stakeholders1. Although the most organizations are becoming more
oriented toward shrinking budgets, the matter is different in the
healthcare sectors which necessarily highlight the importance of
considering healthcare costs issues. This and even if the accessibility
and quality of care are supported, then the next paramount concern is
cost 2.
Recently and globally, many countries, including US, Australia, Europe,
and Middle East have showed a faster growth in health expenditures if
compared with the other Broad Economic Categories (BEC)3. Given the limited human and financial resources,
there is a persistent need of cost rationalization in healthcare systems4. Each cost-related decision must have a
methodological basis that grounds the monetary and clinical values. For
example, the fiscal feasibility and clinical benefits of new diagnostic
technology must be analyzed and determined in advance5,6.
Further, with respect of overall cost burden and out-of-pocket costs for
patients, clinical expenditures for healthcare are viewed by many as
unsustainable. Currently, healthcare expenditures are 8.1% of the
overall general budgeting in Jordan. In 2017, the total expenditures on
healthcare exceeded $3 billion, although difficult to estimate, the
cost of healthcare is projected to grow from approximately $3 billion
in 2017 to $6 billion in 2022 7. Further, the
inpatient costs, in Jordan, contributed to 50% of all costs while it
was 17% for outpatients. In general, the average cost per visit to
emergency was 19.7 US $, and for each admission the average cost was
674.2 US $, however, if surgery intervention is needed the average cost
per surgery was 454.2 US $ 8. Although the country
created many health reforms over the last two decades in order to
introduce a health equity funds on the national level. These reforms
have increased equitable access to health-care services. But, the
out-of-pocket payments are still high and public spending on health is
low 9,10.
Nursing impacts on patient clinical outcomes are known and well-studied;
however, the cost consumption of hospitalized patients care is driven by
nurses. Ostensibly, as the poor quality of nursing care such as
medication errors and falling down requiring additional resources to
compensate damages, the improving nursing care quality involve added
expenses as well 11,12. At the payment level, nursing
care for ill patients has been overlooked by health care system
administrates. A recent study concluded that nurses are aware about
their contributions in patients’ bills 13. However,
many hospitals are charging nursing care as a daily room service while
it is now more recommended than ever to list nursing care as an
independent reimbursement data. 14,15.
Recent publications, have promoted the health care providers to
communicate the cost issues with their patients. It is expected that the
financial communication could affect patient overall satisfaction with
the health care system 12,16. Although, some health
care providers feel uncomfortable to lead cost communication as it may
compromise the relationship with the patients. However, an evidence that
guide health care providers approach to such discussions is still
needed.
Due to the current expanded populations, different payment paradigms,
and costly therapeutic interventions, actual role of health care
providers in communicating and decreasing costs of patients cares are
debatable. Some believe that nurses and physicians held an ethical,
legal, and social obligation to provide the best of care for their
patients in a costly effective manner 17. Others
believe that utilizing the health care system scarce resources are
controlled by the organizations administrators, so it is not the
business of health care providers. However, some may support the last
opinion that health care providers have to be a mediator between
patients and organizations administrators, so clinical decisions can be
costly and clinically efficient 18. Therefore, we
sought in this study to describe nurses and physicians experiences
toward cost communication with their patients.