Incentivizing Cost Containment in Healthcare

Last registered on May 09, 2024


Trial Information

General Information

Incentivizing Cost Containment in Healthcare
Initial registration date
April 27, 2024

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
May 09, 2024, 1:49 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.


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Primary Investigator

University of Chicago

Other Primary Investigator(s)

PI Affiliation
Duke University
PI Affiliation
University of California at San Diego

Additional Trial Information

In development
Start date
End date
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
In the context of the rising costs of healthcare, our study seeks to address a key component of input costs in hospital systems: the costs of supplies used in surgical procedures. Physicians are given substantial autonomy in the way they perform medical procedures including the choice of which supplies to use during treatment. This autonomy is an integral part of the organizational design of most hospitals, as it is thought that decentralization puts decision rights in the hands of the most informed agents. However, doctors are not typically incentivized to reduce costs and thus often select expensive supplies even when less expensive options exist. Our project uses several interventions to encourage doctors to select lower cost, but equal quality, supplies. Our interventions include (1) a message containing only information about lower cost alternatives (information-only), (2) information about lower cost alternatives with message indicating that cost savings will be shared with the patient (altruism), (3) information about lower cost alternatives combined with information about how the doctor ranks in terms of their supply costs (social comparison), and (4) information about lower cost alternatives with a message indicating that cost savings will be shared with the doctor and deposited in the departmental budget (financial incentives).

Our treatments are rolled out in a series of emails from each doctor's department head (e.g., surgery department chair or sub-group chair). Our outcomes will measure the doctor's responsiveness to the emails, and whether they click "accept" to the suggested changes. We will subsequently measure total cost supply cost savings realized by our treatments.
External Link(s)

Registration Citation

Costello, Anna, Henry Eyring and Eric Floyd. 2024. "Incentivizing Cost Containment in Healthcare." AEA RCT Registry. May 09.
Experimental Details


1) We have one information intervention (which will be the baseline control group), who will get an email message about suggested supply changes that will result in $X of savings.

2) We will have an altruism intervention, which gets information about supply swaps in addition to the following message: As a reminder, much of the cost incurred in the <procedure_name> procedure is charged to your patient. By agreeing to make the changes below, you would pass an estimated savings of $x on to your patients each year.

3) We will have a peer comparison intervention, which gets information about supply swaps in addition to the following message: We performed a cost analysis of all surgeons performing the <procedure_name> procedure, and found that your current DPC is more expensive than ___ (e.g, 9) out of ___ (e.g., 12) of your peers who do this procedure at UUHC. By agreeing to make the changes below, you would improve your cost ranking by X points (e.g., you would move to a rank of 3 out of 12 doctors performing this procedure).

4) We will have a financial incentives intervention, which gets information about supply swaps in addition to the following message: We recognize that your effort in cost reduction is beneficial to the hospital and would like to share that benefit with you. By agreeing to make the changes below, we will pay 30% of the first year’s savings that you generate into your division’s budget.

Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
Whether the doctor clicks "accept" to the suggested supply swaps.
Primary Outcomes (explanation)
As soon as a doctor clicks "accept," we will enter the new supplies into the doctor's "doctor preference card" which then changes which supplies will get stocked in each procedure. Thus, by clicking "accept" to our email, this should translate into real cost savings for the hospital (see secondary outcome).

Secondary Outcomes

Secondary Outcomes (end points)
Supply cost savings, measured several months after treatment.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Treatments will be randomized at the doctor level. Administrators in the given health care system (University of Utah Health Care, and University of Chicago Medicine) will send out the emails to doctors at the same system. The emails will describe the operating room stocking options. Doctors can choose to ignore the emails or to click a link to record whether they accept or decline the stocking option suggested in the email. If doctors do not wish to participate, they can decline to click on that link.
Experimental Design Details
Not available
Randomization Method
Randomization by computer.
Randomization Unit
Individual (doctor)
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
1 hospital system.
Sample size: planned number of observations
100 for first wave of treatment (more to follow)
Sample size (or number of clusters) by treatment arms
25 control, 25 for each of three treatments
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Institutional Review Boards (IRBs)

IRB Name
Duke University
IRB Approval Date
IRB Approval Number