Savvy Patients Could Drive Costs Up


The renewed hope that shared decision making might finally fulfill its promise and lower costs (see our April cover story http://tinyurl.com/Burns-shared) just hit some static. Patients who participate in their medical decisions spend more time in the hospital (0.26 of a day) and raise the cost of their stay by an average of $865, according to a study in JAMA Internal Medicine.

Researchers at the University of Chicago surveyed about 21,750 patients at the university’s medical center between July 1, 2003 and August 31, 2011. Ninety-six percent of the patients wanted more information about their treatment, while about 29 percent expressed a strong preference for shared decision making.

The authors say, “This contrasts with the expectation that patient participation in care decisions might decrease costs and suggests that it is important to evaluate efforts to increase patient engagement in decision making with respect to their effects on outcomes and costs.”

The study, “Association of Patient Preferences for Participation in Decision Making With Length of Stay and Costs Among Hospitalized Patients,” extrapolates the costs.

The authors say that “when multiplied by the approximately 35 million annual hospitalizations in the United States, the 28.9 percent of patients who somewhat or definitely disagreed with delegating decisions to their physician would represent about 10 million hospitalizations, for which an additional 0.26 day and $865 per hospitalization would total 2.6 million hospital days and about $8.7 billion in costs.”

Another red flag: The authors say that older patients, people with government sponsored insurance, and African Americans are less inclined to participate in care decisions.

“This could cause efforts to make physicians more responsive to medical decision preferences to increase health disparities by having little effect on utilization for these less empowered groups while increasing utilization among more empowered groups, who are already more likely to receive medical care.”

One of the study’s authors, David Meltzer, MD, says, “Patients who want to be more involved do not have lower costs. Patients, as consumers, may value elements of care that the heath care system might not.”

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