Shared Decision-Making and Racial or Ethnic Concordance Reduces Health Expenditures

Synopsis

Researchers found that a 3% increase in high-quality, shared decision-making (SDM) is associated with a 10% reduction in health care expenditures. Racially and ethnically concordant patient-clinician relationships increase the reduction, especially among Black patients seen by Black clinicians. The findings may inform policies intended to address disparities in health care and reduce the risk of health care overutilization, without compromising quality of care.

Shared Decision-Making Reduces Expenditures

Shared decision-making, or high-quality clinician-patient communication, plays an imperative role in reducing health expenditures by more closely aligning treatment decisions with patient preferences and values. It may also lead to improved clinician engagement, the initiation of superior treatment, and better health outcomes. Yet, only 45% of patients report experiencing SDM at its highest level. These clinician-patient relationships are further benefited when racially or ethnically concordant, when there is a shared racial or ethnic identity between a clinician and patient.

This study may be beneficial to policymakers and health care organizations seeking to reduce expenditures without negatively impacting patient health outcomes. The value of SDM highlights the need for improved evidence-based standards and incentives for health care organizations to adopt this mechanism of addressing racial or ethnic disparities in care. To maximize the value of SDM, efforts should be strengthened to increase the racial and ethnic diversity of the health care workforce to be representative of the populations they serve and to expand opportunities for racially and ethnically concordant clinician-patient relationships.

Key Findings

This study used data from 60,584 patients over 15 years, looking at Black patients and clinicians, White patients and clinicians, Hispanic patients and clinicians, and Asian and Pacific Islander patients and clinicians.

Annual General Health Expenditures:

• Higher levels of SDM reduced overall health expenditures. This study found that a 3% increase in high-quality SDM could cause a 10% reduction in annual health expenditures.

• Very large reductions were observed among Black patients seen by Black clinicians.

Annual Outpatient Expenditures:

• Racial concordance was found to reduce annual outpatient expenditures for both Black patients seen by Black clinicians and Hispanic patients seen by Hispanic clinicians.

• No significant effects were reported for Asian and Pacific Islander patients and clinicians.

Other Outcomes:

• SDM was not found to impact drug expenditures, inpatient care utilization, or patient physical or mental health.

• There was a small overall effect reported on emergency department (ED) use, specifically among Asian and Pacific Islanders, who when seen by Asian and Pacific Islander clinicians, were more likely to visit the ED.

• Over the study period, levels of racial and ethnic clinician-patient concordance across all groups did not improve.

For more information about this study, contact Timothy T. Brown at timothy.brown@berkeley.edu. For more information about the NIHCM Foundation Investigator-Initiated Research Grant Program, contact Cait Ellis at cellis@nihcm.org.