Is there an association between out-of-pocket hospital costs, quality and care outcomes?: A systematic review of contemporary evidence

Ramya Walsan; Rebecca J. Mitchell; Jeffrey Braithwaite; Johanna Westbrook; Peter Hibbert; Virginia Mumford; Reema Harrison

doi:10.1186/s12913-023-09941-3

Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence

Ramya Walsan, Rebecca J. Mitchell, Jeffrey Braithwaite, Johanna Westbrook, Peter Hibbert, Virginia Mumford, Reema Harrison

Research output: Contribution to journal › Review article › peer-review

2 Citations (Scopus)

47 Downloads (Pure)

Abstract

Background: Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking.

Methods: The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763).

Findings: A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes.

Interpretation: The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs.

Funding: This study was funded by Medibank Better Health Foundation.

Original language	English
Article number	984
Pages (from-to)	1-13
Number of pages	13
Journal	BMC Health Services Research
Volume	23
Issue number	1
DOIs	https://doi.org/10.1186/s12913-023-09941-3
Publication status	Published - 13 Sept 2023

Bibliographical note

Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Humans
Health Expenditures
Hospital Costs
Inpatients
Electronics
Hospitals
Health outcomes
Out of pocket costs
Patient payment
Healthcare quality
Gap payment

Access to Document

10.1186/s12913-023-09941-3Licence: CC BY

Publisher version (open access)Final published version, 1.38 MBLicence: CC BY

Cite this

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title = "Is there an association between out-of-pocket hospital costs, quality and care outcomes?: A systematic review of contemporary evidence",

abstract = "Background: Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking.Methods: The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763).Findings: A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes.Interpretation: The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs.Funding: This study was funded by Medibank Better Health Foundation.",

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author = "Ramya Walsan and Mitchell, {Rebecca J.} and Jeffrey Braithwaite and Johanna Westbrook and Peter Hibbert and Virginia Mumford and Reema Harrison",

note = "Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

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AU - Westbrook, Johanna

AU - Hibbert, Peter

AU - Mumford, Virginia

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N2 - Background: Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking.Methods: The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763).Findings: A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes.Interpretation: The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs.Funding: This study was funded by Medibank Better Health Foundation.

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KW - Gap payment

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