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Letters to the Editor

Healthcare systems throughout the world have been undergoing dynamic changes because of social and financial pressures. Unprecedented efforts have been made to reform healthcare systems, improve their efficiency, and adopt costsaving measures. The new changes create problems and are a source of stress for physicians, due to management demands for accountability or to cut expenses, as well as patients demanding the best available treatments. Healthcare systems are increasingly needing doctors to cut costs and recognise financial issues. Physicians often oppose intervention by administrators, because they sense such intervention as a challenge to their clinical autonomy. Physicians regard limiting laboratory testing, procedures, and treatments to be inappropriate, and perceive this as a challenge to their authority and status. Many patients feel the physician is the right decision maker in the conflict between costs and treatment. Other studies have also suggested little awareness of treatment costs by physicians. Their awareness of treatment costs would have an impact on treatment decisions. However, it is neither clear if this knowledge will develop into attitudes, nor whether these attitudes will in turn be reflected in practice behaviour. Furthermore, implementation of cost-effectiveness in clinical practice may be problematic. Physicians recognise the ethical difficulty of applying cost-effectiveness arguments to individual patients, and they may consider that only primary care physicians and their patients should decide which treatment is cost-worthy, ignoring the healthcare system policy. Similar to the results of earlier surveys, we found evidence of willingness among some physicians to include cost considerations in their medical plans. This change, however, requires dialogue about the responsibility of physicians. Most of the physicians we interviewed felt there should be a balance between financial and medical considerations. However, they did not feel it was their responsibility to set limits, but rather the duty of medical administrators and decision makers. Continuing education by the health organisation would keep practitioners updated on medical advances and familiarise them with unique contracts and costs. This will enable them to feel more involved, and to understand the necessary economic considerations involved in the treatment. Dr Racheli Magnezi Department of Health System Management, School of Health Sciences, Ariel University Center, Israel