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Patient Accountability: The Missing Link in Healthcare?

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Higher readmission rates, increased lengths of stay, higher costs of care, decreased patient satisfaction, bad healthcare outcomes …

In some respects, the American healthcare system is one of the best—structure, resources, accessibility, technology, research, physicians. But our healthcare outcomes do not reflect (and in fact, are worse given) the significant amount of healthcare spending relative to other developed nations.

The United States spent almost three times more on healthcare than the average of other countries with comparable incomes. And yet, U.S. healthcare outcomes are quite poor on measurements like life expectancy, rates of chronic disease, preventable disease admissions, etc.

Changes in health policies, budgeting, and payment systems are continual, but efforts have contained healthcare costs. Doctors and hospitals are paid based on quality measures like readmission rates, patient satisfaction, length of stay, etc. There is increased physician burnout and decreased retention rates. Healthcare law adds further to cost challenges by changing physician behavior—e.g., doctors are now practicing defensive medicine and ordering unnecessary tests.

One of the most important but neglected factors in our healthcare system is patient accountability and involvement. Shared accountability is the way to go for better patient-centered outcomes and will result in healthcare cost reduction. There are different arenas in healthcare delivery where patients can be involved in preventative and therapeutic goals of care.

According to the National Vital Statistics System (NVSS), heart disease, respiratory disease, stroke, diabetes, hypertension, and liver disease are among the 15 leading causes of death. (1) In most cases, these are preventable diseases. Patients can have tremendous influence on disease and treatment outcomes if they work in conjunction with the provider's plan of care. The behavioral changes needed in this regard can be in the form of lifestyle changes (diet, exercise, weight reduction, etc.), smoking cessation, regular follow-ups, medication compliance, etc. Similarly, deaths from drug overdose are on the rise. Per the provisional data from NVSS, drug overdose deaths accounted for 2.4 percent of deaths in the United States from July 2016 to June 2017. (2) The practice of "shopping" for doctors and hospitals among some patients, either to get narcotic prescriptions or for better/satisfactory care, may also result in added healthcare costs.

Of course, many patients do not have the healthcare resources they need because of unemployment, financial instability, or lack of social and family support. These patients may be tough to manage; the challenges they face often prevent them from achieving/maintaining their healthcare goals. But changing patients' behavior will benefit them by keeping them fit and healthy, decreasing their suffering and incidence of hospitalizations, bettering their quality of life, and increasing their longevity.

But many questions arise in this regard: how do we change patients' behavior to be more compliant and accountable? Can it be either? Is it fair to punish physicians/healthcare organizations for patients' wrongdoings/noncompliance—especially when they have limited control over patients' behavior?


  1. Xu JQ, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: Final data for 2016. National Vital Statistics Reports; vol 67 no 5. Hyattsville, MD: National Center for Health Statistics. 2018.
  2. Ahmad FB, Rossen LM, Spencer MR, Warner M, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2018.

Faheemuddin Ahmed, MD is triple board-certified physician in Internal Medicine, Geriatric Medicine, and Nephrology. His primary interests are hospitalist medicine, geriatric nephrology and palliative care.

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