title: The effect of charge display on cost of care and physician practice behaviors: a systematic review.
abstract: BACKGROUND
  While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted.
  
  
  OBJECTIVE
  We aimed to determine the type and quality of charge display studies that have been published; to synthesize this information in the form of a literature review.
  
  
  METHODS
  English-language articles published between 1982 and 2013 were identified using MEDLINE, Web of Knowledge, ABI-Inform, and Academic Search Premier. Article titles, abstracts, and text were reviewed for relevancy by two authors. Data were then extracted and subsequently synthesized and analyzed.
  
  
  RESULTS
  Seventeen articles were identified that fell into two topic categories: the effect of charge display on radiology and laboratory test ordering versus on medication choice. Seven articles were randomized controlled trials, eight were pre-intervention vs. post-intervention studies, and two interventions had a concurrent control and intervention groups, but were not randomized. Twelve studies were conducted in a clinical environment, whereas five were survey studies. Of the nine clinically based interventions that examined test ordering, seven had statistically significant reductions in cost and/or the number of tests ordered. Two of the three clinical studies looking at medication expenditures found significant reductions in cost. In the survey studies, physicians consistently chose fewer tests or lower cost options in the theoretical scenarios presented.
  
  
  CONCLUSIONS
  In the majority of studies, charge information changed ordering and prescribing behavior.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Mount Sinai Hospital, 1 Gustave Levy Place, Box 1087, New York, NY, 10029, USA, celine.goetz@mountsinai.org.
authors.forename: Celine
authors.initials: C
authors.lastname: Goetz
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Rotman
authors.forename: George
authors.initials: G
authors.lastname: Hartoularos
authors.forename: Tara F
authors.initials: TF
authors.lastname: Bishop
mesh_terms: D017046:Cost Savings / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005249:Fees and Charges; D017048:Health Care Costs; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D010818:Practice Patterns, Physicians'; D011306:Prescription Fees