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. 2018 Sep 8;8(9):e023113.
doi: 10.1136/bmjopen-2018-023113.

Systematic review of high-cost patients' characteristics and healthcare utilisation

Joost Johan Godert Wammes  1 , Philip J van der Wees  1 , Marit A C Tanke  1 , Gert P Westert  2 , Patrick P T Jeurissen  1
Affiliations

Systematic review of high-cost patients' characteristics and healthcare utilisation

Joost Johan Godert Wammes et al. BMJ Open. .

Abstract

Objectives: To investigate the characteristics and healthcare utilisation of high-cost patients and to compare high-cost patients across payers and countries.

Design: Systematic review.

Data sources: PubMed and Embase databases were searched until 30 October 2017.

Eligibility criteria and outcomes: Our final search was built on three themes: 'high-cost', 'patients', and 'cost' and 'cost analysis'. We included articles that reported characteristics and utilisation of the top-X% (eg, top-5% and top-10%) patients of costs of a given population. Analyses were limited to studies that covered a broad range of services, across the continuum of care. Andersen's behavioural model was used to categorise characteristics and determinants into predisposing, enabling and need characteristics.

Results: The studies pointed to a high prevalence of multiple (chronic) conditions to explain high-cost patients' utilisation. Besides, we found a high prevalence of mental illness across all studies and a prevalence higher than 30% in US Medicaid and total population studies. Furthermore, we found that high costs were associated with increasing age but that still more than halve of high-cost patients were younger than 65 years. High costs were associated with higher incomes in the USA but with lower incomes elsewhere. Preventable spending was estimated at maximally 10% of spending. The top-10%, top-5% and top-1% high-cost patients accounted for respectively 68%, 55% and 24% of costs within a given year. Spending persistency varied between 24% and 48%. Finally, we found that no more than 30% of high-cost patients are in their last year of life.

Conclusions: High-cost patients make up the sickest and most complex populations, and their high utilisation is primarily explained by high levels of chronic and mental illness. High-cost patients are diverse populations and vary across payer types and countries. Tailored interventions are needed to meet the needs of high-cost patients and to avoid waste of scarce resources.

Keywords: health care costs; health care utilization; high-need high-cost; integrated delivery of health care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of article selection.
See this image and copyright information in PMC

References

    1. Zook CJ, Moore FD. High-cost users of medical care. N Engl J Med 1980;302:996–1002. 10.1056/NEJM198005013021804 - DOI - PubMed
    1. Blumenthal D, Chernof B, Fulmer T, et al. . Caring for High-Need, High-Cost Patients - An Urgent Priority. N Engl J Med 2016;375:909–11. 10.1056/NEJMp1608511 - DOI - PubMed
    1. Bodenheimer T, Fernandez A. High and rising health care costs. Part 4: can costs be controlled while preserving quality? Ann Intern Med 2005;143:26–31. 10.7326/0003-4819-143-1-200507050-00007 - DOI - PubMed
    1. Colla CH, Lewis VA, Kao LS, et al. . Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries. JAMA Intern Med 2016;176:1167–75. 10.1001/jamainternmed.2016.2827 - DOI - PMC - PubMed
    1. Wennberg JE, Bronner K, Skinner JS, et al. . Inpatient care intensity and patients' ratings of their hospital experiences. Health Aff 2009;28:103–12. 10.1377/hlthaff.28.1.103 - DOI - PMC - PubMed

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