Shared decision-making bumps up hospital costs

For years the healthcare industry has promoted the benefits of doctors and patients sharing decision-making regarding their treatments. The more engaged the patients, proponents said, the better the communication, patient satisfaction, improved health outcomes and lower costs.

But a new study, published in JAMA Internal Medicine, finds patients who are involved in their medical decisions spend more time in the hospital, increasing costs of the hospital stay by an average of $865.

Researchers at the University of Chicago approached all patients admitted to the University of Chicago Medical Center's general internal medicine service between July 2003 and August 2011. Approximately 22,000 patients or 70 percent of those asked, agreed to answer a wide-ranging, 44-question survey to examine how patients' desire to participate in medical decisions affects their use of healthcare resources.

The main multiple-choice question asked was, "I prefer to leave decisions about my medical care up to my doctor." More than one-third of patients (37.6 percent) definitely agreed, one-third (33.5 percent) somewhat agreed, and a little less than one-third (28.9 percent) somewhat or definitely disagreed.  

Patients who preferred not to delegate decisions to their doctors--those who wanted to work with their caregivers to reach decisions--spent about 5 percent more time in the hospital and incurred about 6 percent higher costs. Since there are about 35 million hospitalizations each year in the United States, the researchers noted that if 30 percent 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.

"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 study author David Meltzer, M.D., Ph.D., associate professor of medicine, economics and public policy at the University of Chicago, 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 healthcare system might not."

Melzer said he wasn't surprised by 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." In fact, the authors note, "Policies that increase patient engagement may increase length of stay and costs."

To learn more:
- here is the study abstract
- check out the  video of Meltzer talking about the study
- read the statement