Involving Patients in Decisions Raises Health Care Costs, Study Finds

Those who delegate medical decisions to their doctor have shorter hospital stays, researchers say

By Mary Elizabeth Dallas

Tuesday, May 28, 2013

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TUESDAY, May 28 (HealthDay News) -- Although doctors and patients have long been urged to share decision-making, new research finds that patients who are involved in their care spend more time in the hospital and increase the cost of their hospital stay.
Researchers at the University of Chicago Medical Center found that patients who share in decision-making raise the cost of their admission by an average of $865.
"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," the study's author, Dr. David Meltzer, associate professor of medicine, economics and public policy at the University of Chicago, said in a university news release. "Patients who want to be more involved do not have lower costs. Patients, as consumers, may value elements of care that the health care system might not."
The researchers said there are roughly 35 million hospitalizations each year in the United States. They calculated that if 30 percent of those patients shared in decision-making on their care instead of allowing their doctor to call the shots, it would result in $8.7 billion in additional costs every year.
Meltzer said he was not surprised by the findings. "I wasn't shocked. It could have gone either way. Our results suggest that encouraging patients to be more involved will not, alone, reduce costs," he said. "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."
For the study, which was published in the May 27 issue of the journal JAMA Internal Medicine, the researchers asked all patients admitted to the University of Chicago's general internal medicine service between July 2003 and August 2011 to complete an extensive survey. Nearly 22,000 people participated.
The surveys revealed that 37.6 percent of the patients felt strongly about wanting to leave the decision-making on their medical care to their doctor. Another 33.5 percent agreed somewhat and 28.9 percent disagreed with that approach.
The patients who preferred to work with their doctor rather than delegate decisions spent roughly 5 percent more time in the hospital and incurred about 6 percent higher costs, the study found.
The researchers also considered patients' insurance. They found that provider incentives to use fewer services were not the only predictors of care costs. Although uninsured patients had shorter stays and lower hospitalization costs, those with public insurance that pays less than the cost of care had longer than average admissions and higher costs.
The study's authors also said 75 percent of the patients involved in the study were black and more than half of the participants had a high school education or less. They said 80 percent were covered by Medicare or Medicaid or were uninsured.
"This isn't about demographics," Meltzer said. The study showed that patients with the most education had lower costs than those with the least education.
"We want patients to be more involved, to have the richest form of interaction," Meltzer said. "That can align preferences, prevent mistakes and avoid treatments patients don't want. But we need to find ways to create functional doctor-patient partnerships that lead to good health as well as sound decisions about resource utilization."
The researchers also said, however, that their findings may not apply in every hospital setting.

SOURCE: University of Chicago Medical Center, news release, May 27, 2013

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