Shared Decision-making Lowers Medical Expenditures and the Effect Is Amplified in Racially-Ethnically Concordant Relationships

Abstract

Background: Racial-ethnic disparities are pervasive in health care. One mechanism that may underlie disparities is variation in shared decision-making (SDM), which encompasses high-quality clinician-patient communication, including deliberative discussions about treatment options. Objectives: To determine whether SDM has causal effects on outcomes and whether these effects are stronger within racial-ethnic concordant clinician-patient relationships. Research Design: We use instrumental variables to estimate the causal effect of SDM on outcomes. Subjects: A total of 60,584 patients from the 2003–2017 Integrated Public Use Microdata Series Medical Expenditure Panel Survey. Years 2018 and 2019 were excluded due to changes in the Medical Expenditure Panel Survey that omitted essential parts of the SDM index. Measures: Our key variable of interest is the SDM index. Outcomes included total, outpatient, and drug expenditures; physical and mental health; and the utilization of inpatient and emergency services. Results: SDM lowers annual total health expenditures for all racial-ethnic groups, but this effect is only moderated among Black patients seen by Black clinicians, more than doubling in size relative to Whites. A similar SDM moderation effect also occurs for both Black patients seen by Black clinicians and Hispanic patients seen by Hispanic clinicians with regard to annual outpatient expenditures. There was no significant effect of SDM on self-reported physical or mental health. Conclusions: High-quality SDM can reduce health expenditures without negatively impacting overall physical or mental health, supporting a business case for health care organizations and systems to improve racial-ethnic clinician-patient concordance for Black and Hispanic patients.

Racial and Ethnic Concordance Between National Health Service Corps Clinicians and Underserved Populations

“…Changes in the racial and ethnic composition of the patient population present clinicians with unique challenges, such as cultural and language barriers, which can impact the delivery of effective and equal care. Studies have demonstrated that patient-clinician racial and ethnic concordance can improve patient care and health outcomes and reduce health expenditures . Several professional organizations have issued statements promoting clinician diversity and supporting concordant care .…”

“…Studies have demonstrated that patient-clinician racial and ethnic concordance can improve patient care and health outcomes and reduce health expenditures. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 Several professional organizations have issued statements promoting clinician diversity and supporting concordant care. 15 , 16 , 17 , 18 Providing racially and ethnically concordant care may be particularly challenging in areas with health workforce shortages, which make it more difficult for patients to find racially and ethnically concordant clinicians.…”