More Involved Patients Have Higher Costs

Involving patients in decision making about their health care could actually increase costs, according to a new report.

Although patient participation in health care decisions is typically urged, a report in JAMA, by researchers at the University of Chicago Medical Center, revealed that this involvement may increase hospital use and, thus, the cost of their stays.

“Patient participation in medical decision making has been hypothesized to decrease excess utilization but might be expected to increase utilization when other decision makers have incentives to reduce utilization, as under prospective payment systems for hospital care,” the authors wrote.

Patients who reported a strong desire to delegate medical decisions to their physicians had a 6% shorter stay in the hospital, which results in a savings of $865 over patients who preferred to participate in decisions.

“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 statement. “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 mean length of stay for all patients in the survey was 5.34 days, which cost $14,576. Of the total respondents, 96.3% wanted to receive information about their illnesses and treatment options, but 71.1% preferred if their physicians made any medical decisions.

There were some predictors of care costs. For instance, patients were more likely to want to participate in decision making as their education level increased. Also, patients with public insurance that pays less than the cost of care had longer than average admissions.