When it comes to health care, patients with the motivation, knowledge, skills and confidence to manage their own health have better health outcomes and incur fewer health care costs. Those are the findings of a study led by Judith Hibbard, a professor emerita in the Department of Planning, Public Policy and Management at the University of Oregon. Hibbard and co-authors found that patients with the lowest level of « activation »— that is, those most lacking in the skills and confidence to be actively engaged in their health care—had average costs that were from 8 percent to 21 percent higher compared to patients with the highest level of activation. The study was the basis for two papers appearing in the February issue of Health Affairs.

« The study highlights the important role that patients play in determining outcomes, » said Hibbard, who recently appeared as a featured expert on health care reform at a White House health care summit at Stanford University. « We found that patients who were more knowledgeable, skilled and confident about managing their day-to-day health and health care—also called patient activation—had health care costs that were substantially lower than patients who lacked this type of confidence and skill. » Hibbard and her team adjusted for patient differences, such as demographic factors and severity of illnesses. Even among patients with the same chronic illness, they found those who were more « activated » had lower overall health care costs than patients who were less so. An earlier study by the same authors had already established that more activated patients also had better health outcomes.

Using a Patient Activation Measure that assesses beliefs, knowledge and confidence in managing health-related tasks, the researchers found that patient scores on a questionnaire that ranks patient activation showed that patients’ responses in effect predicted their overall care costs—even when adjusted by the severity of patients’ health conditions, age, sex and income. The researchers recommend that health delivery systems consider assessing these patient activation scores and supporting patients to become more engaged in their health and health care, as a way to both improve patient outcomes and lower costs.

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