Active Management Can Drive Up Effectiveness, Drive Down Costs

Americans have grown used to active treatment of all diseases. Doctors identify a problem and patients want aggressive and immediate treatment. The underlying impatience has grown so bad that many people insist on an antibiotic prescription even for virus infections that will be unaffected by the drugs, according to the Centers for Disease Control.


Health care providers, and their managers, must break out of an assumption that everything has an immediate treatment and cure. Instead, MBAs in health administration should learn to think differently and consider longer term approaches that can improve outcomes while reducing unnecessary costs. One example of using patience with patients is a Canadian study that compared active surveillance with immediate treatment for low-risk prostate cancers, according to researcher Alice Dragomir.

The patients receiving active surveillance were assumed to receive delayed treatment at a rate of 8.35%, 4.17% and 2.1% per year for the first 2 years, years 3 to 5, and years 6 to 10 of follow-up, respectively. All costs were assigned in Canadian dollars and reflect Quebec’s health system.

The average cost of immediate treatment was $13,735 in Canadian dollars, while using management over the first year and then five years of follow-up was $6200. The reason such a difference in treatment options is possible is because prostate cancer is often very slow to grow. As the Mayo Clinic puts it, an older man, or a younger one with a condition that limits life expectancy, might not need rapid treatment if the cancer is not likely to become a major problem until a patient has already died from some other cause. And yet, according to Dragomir, 70 percent to 90 percent of patients in the U.S. and Canada receive immediate treatment, even though half may not need it.

Developing a watchful patience is useful in many other ways. Rather than seeing people cycle through expensive hospital treatments, some organizations actively try to provide timely care and monitoring, rather than seeing patients unnecessarily show up in the emergency room. There are also many chronic conditions, like heart problems or diabetes, that are frequently best treated by monitoring that can predict or pinpoint when to take appropriate action.

Moving from an accustomed aggressive response to a more watchful approach to care requires a significant change on the part of organizations and of patients. Shifting health care culture and teaching patients the benefit of new ways will be difficult. Getting people to behave differently always is. But the potential to cut costs and improve health with less aggravation and discomfort for patients is too good a possibility to ignore with the thought, “We’ve always treated patients this old way.”