Patient Engagement
Talk
People Want Health Outcomes, Not Health Care (10:16)

When it comes to improving health care spending and efficiency, or to improving patients’ health and well-being, what does health insurance actually do? This question is harder to answer than you might think, says Katherine Baicker, Chair of the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.

If you want to know how effective Medicaid is, for example, simply comparing mortality rates for those on Medicaid versus those who are uninsured won’t provide enough evidence. Randomized controlled trials are better for answering public policy questions like this one, as demonstrated by the rare opportunity Oregon had to conduct one. In this trial, patients on a waiting list for public health insurance received Medicaid via lottery. The results: those who received Medicaid used more health care — a cost, from an economist standpoint — but they benefited from the financial protection and security that insurance is meant to bring.

What happens to people’s health when you expand health insurance? In the Oregon trial, self-reported health improved substantially, and depression was reduced by 30%. But clinical measures were much more nuanced: there were no detectable improvements in blood pressure or cholesterol, for example. This kind of evidence leaves policymakers with a much more difficult decision. Medicaid has enormous benefits to the people enrolled, but it’s an expensive program.

“I don’t think anybody wants health care,” says Baicker. “People want health outcomes. They want to have better health, and health care’s the resource you use to get that better health. If we could deliver the same health outcomes or better health outcomes using fewer health care resources, that would be a great thing.”

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.

More From Patient Engagement
Rabson01_pullquote barriers to patient engagement in primary care practices

What Does It Take to Increase Patient Engagement in Primary Care Settings?

Massachusetts primary care practices are beginning to invest in programs to increase patient engagement, but these strategies can be challenging to implement and remain underutilized and undervalued.

Many Barriers to Engaging Patients in Treatment for Obesity

Survey Snapshot: Approaches to Address Clinician and Societal Roles in Obesity

The obesity problem is getting larger and larger. Some solutions lie beyond the traditional medical setting.

Esch01_pullquote patient activation

OpenNotes, Patient Narratives, and Their Transformative Effects on Patient-Centered Care

The development of standardized tools and techniques are enhancing the ability of providers to interact with patients, but true patient engagement requires a common understanding of its theoretical foundation and an open mind for including patients’ needs and beliefs — in their language — as part of each encounter.

Patients and PCPs Hold Primary Responsibility for Addressing Obesity

Patient Engagement Survey: The Failure of Obesity Efforts and the Collective Nature of Solutions

Patients hold responsibility for their actions, but providers’ approaches to address obesity often fall short as well.

Items from the Shared Decision-Making Process Survey for Elective Surgical Procedures - patient decision aids - decision quality - informed consent

Shared Decision-Making: Staying Focused on the Ultimate Goal

Despite growing acceptance and enthusiasm for patient involvement in their health care decisions, clinicians, at times, lose focus on the ultimate goal of shared decision-making: better health decisions from the informed patient’s perspective.

Kangovi01_pullquote community health workers boom

The Community Health Worker Boom

Practical insights that can help organizations optimize their investments in community health workers.

MD Anderson Cancer Center PAAC Health Information Data Before and After Implementation of New EHR System

Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost

The University of Texas MD Anderson Cancer Center saw active participation from patients by encouraging them to document their own health information into a new EHR.

Phrases That Enhance Physician-Patient Communication for Scripps Health Hospitalist Groups

Improving Hospitalist Patient Experience Scores: The Importance of Physician-to-Physician Coaching and Medical Director Engagement

With the Centers for Medicare and Medicaid Services incorporating patient experience into Value-Based Purchasing metrics, hospital leaders must focus on improving this important aspect of patient care.

DLewis01_pullquote Opening Up to Patient Innovations Like Automated Insulin Delivery

Opening Up to Patient Innovation

Next-gen innovations — by new stakeholders — will need a next-gen regulatory system, and clinicians willing to adapt.

Karen DeSalvo - public health population health social determinants of health expert social services infrastructure

Moving from a Sickness Model of Health Care to One of Well-Being — Part 2

A public health expert discusses the scientific, technological, and financial foundations needed to modernize the social services infrastructure and address social determinants of health.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

OpenNotes, Patient Narratives, and Their Transformative…

The development of standardized tools and techniques are enhancing the ability of providers to interact…

What Does It Take to Increase…

Massachusetts primary care practices are beginning to invest in programs to increase patient engagement, but…

Care Redesign Survey: Lessons Learned from…

Although care delivery models in rural and urban/suburban areas are distinct, by virtue of geographic…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now