Document Type : Original Article


1 Health Economics Department, School of Health Management and Information Sciences, Iran University of Medical Sciences

2 Health Economics Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Health Management and Economics Research Center‚ Iran University of Medical Sciences‚ Tehran, Iran

3 Health Management Research Center‚ Baqiyatallah University of Medical Sciences

4 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences

5 Health Economics Department, National Institute of Health Research, Tehran University of Medical Sciences Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran


The practice style variation (PSV) incurs undesirable clinical and economic consequences for patients
and the healthcare system. This review aims to analyze the economic consequences of PSV in
medical interventions. A comprehensive electronic search was conducted through PubMed, Web of
Sciences, EBSCO, EMBASE, and Cochrane databases to retrieve studies on economic consequences
of PSV within 1975–2018. The studies were independently assessed by two reviewers. The quality
of studies was assessed by Strengthening the Reporting of Observational Studies in Epidemiology
checklist. No language restriction was applied. Only four studies met the eligibility criteria. These
studies have been conducted retrospectively in developed countries. Most of the included studies
used consumer demand theory to measure the economic consequences of PSV. Findings showed
12%–74% of all variations in healthcare services are related to PSV, thereby incurring up to 23 million
dollars for the healthcare system. The PSV is related to the total expenditure, price elasticity, and
coefficient of variation of healthcare services. PSV associated with huge inefficiency and inequity in
access to healthcare services. To mitigate the consequences of PSV, policymakers should consider
PSV in both developing the medical education plans as well as cost management. Using multilevel
analysis to investigate the determinants of PSV would be beneficial.


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