Patients’ grasp of treatment choices and the confidence with which they manage their health and medical care may influence healthcare spending, a newly published study said.

Patients with the highest scores on a self-reported survey of “knowledge, skills and confidence” to make healthy choices and informed medical decisions were less costly than those with the lowest scores, based on projected spending for roughly 33,610 patients in 2010, researchers wrote in the latest issue of the Health Affairs.

The study used medical bills and answers from primary-care patients surveyed by Fairview Health Services in 2010, which began that year to survey patient attitudes on health and care management. Patients were asked if they understood their medications, treatment options and the “nature and causes” of their diagnosis. Other questions gauged patients’ confidence managing their health and medical care, such as “I am confident I can tell my healthcare provider concerns I have even when he or she does not ask.”

The researchers, Judith Hibbard, an emerita professor of public policy and management at the University of Oregon who helped develop measures of patient knowledge and confidence used in the research; Jessica Greene, George Washington University School of Nursing director of research; and Valerie Overton, Fairview’s vice president for quality and informatics, estimated costs for care not provided by Fairview.

Patients were scored on the survey and ranked into four groups, from least to most knowledgeable and confident.

Projected costs were 8% lower, on average, for those ranked in the top tier than the lowest ranked patients. The projected costs per person among the 46% of patients who ranked as most knowledgable and confident were $4,320, compared with $4,679 among the lowest ranked. Costs were also lower for patients with hyperlipidemia, hypertension and asthma—12%, 14% and 21%, respectively—who reported greater knowledge of their diseases and greater faith in their ability to manage their treatment and health.

However, the study found no cost difference among diabetes patients, regardless of their score.

Researchers adjusted for demographic characteristics and health risk.

“These empirical findings add to the growing body of literature suggesting that patients play an important role in determining their own health outcomes,” the study said.

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