Patients who feel confident and engaged in decisions about their health and taking care of themselves incur lower healthcare costs as a result of their improved outcomes, suggests a study in Health Affairs.
The US authors report that patients with the lowest levels of such "patient activation" could cost up to around a fifth more in healthcare than those with the highest.
"The study highlights the important role that patients play in determining outcomes," said lead author Judith Hibbard (University of Oregon, Eugene) in a press statement. "We found that patients who were more knowledgeable, skilled, and confident about managing their day-to-day health and healthcare - also called patient activation - all had healthcare costs that were substantially lower than patients who lacked this confidence and skill."
In the study, Hibbard and team used a Patient Activation Measure to assess beliefs, knowledge and confidence in managing health-related tasks among 33,163 patients at a large healthcare delivery system in Minnesota.
The Patient Activation Measure is a questionnaire consisting of 13 statements about self-managing health, such as "I know how to prevent problems with my health" and "I am confident that I can tell a doctor my concerns, even when he or she does not ask." Patients were scored according to how much they agreed with each statement, with total scores ranging from 0-100, and then categorized into one of four levels of activation.
An earlier study by the same authors had found that more activated patients had better health outcomes. In line with this, the current study results showed that levels of patient activation were inversely associated with the cost of care. Overall, patients in the lowest category of activation had significant 8% higher predicted healthcare costs for 2010 (based on the delivery system's inpatient and outpatient as well as laboratory and pharmacy costs) than patients with the highest activation levels.
Nearly half (48%) of the patients had one or more of the chronic conditions asthma, hypertension, diabetes, heart failure, coronary heart disease, hyperlipidemia, and chronic obstructive pulmonary disease. The same pattern of higher predicted costs with lower activation was seen in each of these groups, with the most pronounced effect seen in patients with asthma. In this group, the least activated patients had 21% higher predicted costs than their most highly activated counterparts.
Hibbard and colleagues emphasize that these findings were seen when controlling for demographics and condition severity, or health risk score, showing that "even sicker patients can make a difference in their cost of care through their own actions and choices."
This "suggests that strategies designed to support greater patient activation have the potential to affect costs, regardless of whether patients' illness burden is high or not," write the authors.
"For example, patients who both have a heavy disease burden and lack the skills to manage their conditions may need more support and outreach than patients who have the same disease burden but also have greater self-management skills and confidence."
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