SynthesisBMC health services research2023
Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence.
Synthesis in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
5 citing papers in PubMed.
- Association Between Copayments and Attendance in Cardiac Rehabilitation: A Nationwide Analysis From the AACVPR Registry.Journal of the American Heart Association · 2026Article
- Healthcare quality in rural Armenia: Focus group perceptions : Healthcare quality in rural Armenia.BMC health services research · 2025Article
- Modeling determinants of accessibility for healthcare services in rural and urban areas of Dodoma, Tanzania.BMC public health · 2025Article
- Association between out-of-pocket expenditure and health-related quality of life among patients receiving cancer treatment: a cross-sectional study from Nepal.Health and quality of life outcomes · 2025Article
- Out-of-pocket Costs and Total Payments for Common Congenital Hand Difference Procedures.Plastic and reconstructive surgery. Global open · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOut 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.
methodsThe 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).
findingsA 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.
interpretationThe 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.
fundingThis study was funded by Medibank Better Health Foundation.
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Registered trials
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