Patient's Role in Healthcare Decision-Making May Not Be Cost Effective

As the future of healthcare reform is considered, many discussions seem to center around the concept of shared decision-making, specifically in regards to the patient’s role in managing their own healthcare choices. However, in light of new research, the notion of patient participation is being questioned.

According to a recent study at the University of Chicago Medicine, patients who share medical decisions with their doctors will not only spend more money on their medical care, but often spend more time in the hospital. Researchers at UC sought to examine whether or not it would be possible to control healthcare costs and improve healthcare outcomes through patients’ involvement with decision-making. The UC findings were astonishing:

“There are about 35 million hospitalizations each year in the United States. If 30% of those patients chose to share decision making rather than delegate that role to their doctors, it would mean $8.7 billion of additional costs per year.”

UC researchers say that while shared decision-making between physicians and patients could be a crucial factor in improving overall care, the study results seem to demonstrate that greater patient involvement will likely not lead to lower costs.

"The result that everyone would have liked, that patients who are more engaged in their care do better and cost less, is not what we found in this setting," said David Meltzer, MD, PhD, associate professor of medicine, economics and public policy at the University of Chicago in the UC statement. "Patients who want to be more involved do not have lower costs. Patients, as consumers, may value elements of care that the healthcare system might not."

As a patient becomes more involved, they may request extra testing or question their doctor’s decisions, subsequently driving higher costs. Doctors, who may be worried about potential lawsuits or anxious to appease a patient’s requests, will then order the extra lab work or treatments. These extra tests and treatments obviously result in longer hospital stays as patients receive additional care. Providers wouldn’t feel as pressured into such decisions, if the patient were relying solely on a medical team’s assessment.

Another reason for higher costs could result from the time it takes for a medical team to come a conclusion as a result of the back-and-forth discussions with patients. The additional length in an individual’s episode of care takes more of a provider’s resources.

Dr Meltzer said providers need to heavily consider sharing healthcare decisions with patients. “We need to think harder and learn more about what it means to empower patients in multiple health care settings and how incentives facing both patients and caregivers in those settings can influence decisions.”

Around the Web

When Doctors and Patients Share In Decisions, Hospital Costs Go Up [UC Hospitals]

Involved Patients Pay More, New Study [The Inquisitr]

Patients Who Are More Involved in Medical Decisions Pay More [Time Magazine]