Fewer than half of U.S. adults have the confidence, knowledge and skills to proactively manage their health care, according to a report from the Center for Studying Health System Change (HSC). This type of consumer engagement is critical to efforts to control the cost and quality of health care.

Data for the report came from the HSC 2007 Health Tracking Household Survey, which sampled more than 15,500 adults. Individuals contacted were asked 13 questions to determine their Patient Activation Measure (PAM), an assessment of an individual’s knowledge, skills and confidence in managing their health. Based on answers to these questions, the surveyed individuals were assigned to one of four levels of patient activation: 1–passive/not confident enough to play an active role in their own health; 2–lack basic knowledge and confidence in the ability to manage their own health; 3–taking some action to manage their health, but still lack some confidence/skills; and 4–have many of the behaviors necessary to manage their health, but may not be able to maintain these behaviors in times of stress.

Only 41% of the surveyed adults were at the highest level of patient activation, according to the report. At this level, “people still struggle to maintain healthy behaviors but tend to have the skills and confidence to manage their health in a more proactive way.”

Individuals who were younger, more educated and at higher income levels tended to have higher levels of patient activation, as did those with private health insurance. Individuals with chronic health conditions also had higher patient activation levels. However, the report notes that much demographic variation was found within each of the four patient activation levels, meaning that characteristics like less education should not be seen as a barrier to an individual being able to attain the knowledge, skills and confidence of a higher activation level.

What’s the benefit in trying to move individuals to attain higher levels of patient activation? According to the report, research shows that higher levels of patient activation are associated with healthy behaviors, preventive care and increased self-management of health conditions, and with seeking and using relevant health information. For example, 94% of individuals rated at the highest level of patient activation read about possible side effects when getting a new prescription, compared to 74% of individuals rated at the lowest level of patient activation.

The bottom line is this: Having involved and engaged consumers is key to controlling health care utilization, costs and outcomes. As the report states: “Payment reform and structural changes to care delivery only address one side of the equation. The other side is consumers and patients becoming more informed decision-makers and managers of their health.”