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.