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Shared Decision-making Lowers Medical Expenditures and the Effect Is Amplified in Racially-Ethnically Concordant
Timothy T Brown1, Vanessa B Hurley2, Hector P Rodriguez1,3
1University of California, Berkeley, Berkeley, CA.
Medical Care
|June 12, 2023
Summary
Shared decision-making (SDM) reduces healthcare costs for all racial groups. This cost-saving effect is significantly amplified for Black patients with Black clinicians, highlighting the importance of racial concordance in healthcare.
Area of Science:
- Health Services Research
- Health Disparities
- Health Economics
Background:
- Racial-ethnic disparities are prevalent in healthcare delivery.
- Shared decision-making (SDM), involving effective clinician-patient communication, may influence these disparities.
- Variations in SDM quality can impact patient outcomes and healthcare utilization.
Purpose of the Study:
- To investigate the causal impact of SDM on healthcare outcomes.
- To examine if SDM's effects are more pronounced in racially/ethnically concordant clinician-patient relationships.
- To identify potential mechanisms underlying racial-ethnic disparities in healthcare.
Main Methods:
- Utilized instrumental variables to estimate the causal effect of SDM.
- Analyzed data from 60,584 patients using the Medical Expenditure Panel Survey (2003-2017).
- Excluded 2018-2019 data due to survey modifications affecting the SDM index.
Main Results:
- SDM reduced total annual health expenditures across all racial-ethnic groups.
- The cost-reduction effect of SDM was substantially larger for Black patients treated by Black clinicians compared to White patients.
- Similar amplified effects of SDM on outpatient expenditures were observed for Black patients with Black clinicians and Hispanic patients with Hispanic clinicians.
- No significant impact of SDM on self-reported physical or mental health was found.
Conclusions:
- High-quality SDM can decrease healthcare expenditures without adverse health effects.
- There is a business case for healthcare systems to enhance racial-ethnic clinician-patient concordance.
- Improving concordance, particularly for Black and Hispanic patients, may mitigate healthcare cost disparities.
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