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Table 3 An overview of the MHAQ, viewing all items per subscale. (R) Reversed items.

From: A new instrument to measure high value, cost-conscious care attitudes among healthcare stakeholders: development of the MHAQ

Survey item

Cronbach’s alpha

Residents

Staff-physicians

Administrators

Patients

(1) High-value care

α = .65

α = .61

α = .77

α = .67

Physicians should take a more prominent role in limiting use of unnecessary tests.

The cost of a test or medication is only important if the patient has to pay for it out of pocket. (R)

Managing health care resources for all patients is compatible with physicians’ obligation to serve individual patients.

Eliminating unnecessary tests and procedures will improve patient safety.

Physicians should consider a patient’s doubts and values in their clinical decisions.a

Physicians should offer patients choices of care, taking advantages, disadvantages and costs into account.a

Physicians should limit waste of care in their own hospital/clinic.a

Physicians should have sufficient knowledge of the interplay between advantages/disadvantages and costs of common tests.a

(2) Cost incorporation

α = .71

α = .69

α = .74

α = .80

Physicians should try not to think about the cost to the health care system when making treatment decisions. (R)

Physicians should be aware of the costs of the tests or treatments they recommend.

Physicians should talk to patients about the costs of care when discussing treatment options.

Physicians should change their clinical practices (e.g., ordering, prescribing) if the costs of care they provide is higher than colleagues who care for similar patients.

Physician clinical practices (e.g., ordering, prescribing) are key drivers of high health care costs.

Costs to society should be important in physician decisions to use or not to use an intervention.

It is unfair to ask physicians to be cost-conscious and still keep the welfare of their patients foremost in their minds. (R)

Cost-effectiveness data should be used to determine what treatments are offered to patients.

Trying to contain costs is the responsibility of every physician.

Physicians should discuss cost efficiency of care with their patients.a

(3) Perceived drawbacks

α = .67

α = .70

α = .79

α = .82

Patients will be less satisfied with the care they receive from physicians who discuss costs when choosing tests and treatments.

Doctors are too busy to worry about the costs of tests and procedures.

Practicing cost-conscious care will undermine patients’ trust in physicians.

Ordering fewer tests and procedures will increase physicians’ risk of medical malpractice litigation.

Ordering more tests reduces a physicians’ diagnostic uncertainty.a

Ordering fewer tests and procedures will lead to more complications.a

Patients find it unpleasant to talk about costs of tests or treatments.a

  1. aNew items that were added in phase 2. The item “if a physicians’ medical practices have a direct influence on a physicians’ salary, it will obstruct a physicians’ cost-conscious care approach” did not cluster on any of the subscales