Patients who participate in shared decision making while in the hospital stay a little longer and increase healthcare costs by about $865 (Tak, Ruhnke & Meltzer, 2013). The researchers looked at "the relationship between patient preferences for participation in medical decision making and health care utilization among hospitalized patients", and found that while over 96% of patients surveyed wanted information about their illnesses and the treatment options available to them, 71% wanted to leave the medical decisionmaking to their doctors.
But why the increased stay and costs? LeWine (2013) points out that patients participating in shared decision making are typically:
- Privately insured
- Better educated, and
- Financially more secure.
In other words, these patients were better empowered to participate in their own healthcare. And in the type of for-profit healthcare system we currently have, empowered patients are a threat to the corporations' bottom line.
Healthcare spending in the U.S. is about 18% of GDP, about twice as much as other developed countries (Rosenthal, 2013). And even after Congress passed the Affordable Care Act (ACA), which was supposed to reform healthcare, insurer profits are up. And these same profitable companies are threatening to raise premiums as much as 116%, including charging older customers higher rates at the same time they are seeking to add favorable changes to the ACA (Volsky, 2013). Any changes to this lucrative income stream have been, and will continue to be met with stiff opposition.
Health literacy advocacy (HLA) that leads to better-educated patients will initially benefit both providers and consumers of healthcare. When patients can understand instructions from physicans and on their presription bottles, fewer trips to the emergency room will be one of the benefits among many. But if we empower consumers to ask critical questions about their healthcare, some will inevitably question this lopsided system, and calls for reform will be renewed. Insurers will support HLA only as long as it improves or does not threaten their bottom line. Should it progress to the kinds of change and reform that are truly needed -- affordable healthcare for all akin to the rest of the developed world -- HLA programs will see their funding cut or eliminated. Health literacy education will be forced to move into the schools if it is to survive.
How do we prepare for the inevitable corporate backlash against HLA? What proactive efforts are being made to integrate health literacy into public education? Tell us at the fireside!
Reference
Eichler, A. (2013). Insurer Profits Are Up In The Wake Of Health Care Law They Opposed, The Huffington Post, January 6, 2012.
Tak, H., Ruhnke, G. W., & Meltzer, D. O. (2013). Association of patient preferences for participation in decision making with length of stay and costs among hospitalized patients. JAMA Internal Medicine, 1-8. doi: 10.1001/jamainternmed.2013.6048 (online early edition).
LeWine, H., MD. (2013). Base shared decision making on good information, personal preferences, Harvard Health Blog, June 5, 2013.
Rosenthal, E. (2013). Health care costs more in U.S. than anywhere else in world, Denver Post, June 2, 2013.
Volsky, I. (2013). Health Insurers Threaten To Increase Premiums, Even As Profits Soar. Think Progress, March 22, 2013.