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

Abstract

ObjectivesTo investigate the characteristics and healthcare utilisation of high-cost patients and to compare high-cost patients across payers and countries.DesignSystematic review.Data sourcesPubMed and Embase databases were searched until 30 October 2017.Eligibility criteria and outcomesOur 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.ResultsThe 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.ConclusionsHigh-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.

Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan

“…In our study, it was found that gender, age, education, social welfare status, having a primary caregiver, BMI, dependency level, depression symptoms, IADL functions, mental status, service resources level, and proportion of CNAs significantly affected the HCBS utilization time period based on the regression analysis. These results were mostly consistent with the findings of previous studies [16,17,42,43].…”

Impact of socioeconomic status on end-of-life costs: a systematic review and meta-analysis

“…To the best of our knowledge, our systematic review and meta-analyses were the first to examine the effects of socioeconomic variation on EOL cost of care. While SES has been shown to be an important determinant of population health across the life continuum [43][44][45][46][47], its relationship with health-care expenditures was less consistent and more variable across jurisdictions [48]. The focus on EOL care has also been less studied than the relationships between SES and health-care during other periods of life.…”

Effectiveness of A 24-h Access Outpatient Clinic for Patients with Chronic Conditions in Hospital Outpatient Follow-Up: A Registry-Based Controlled Cohort Study of Healthcare Utilisation and Mortality

“…Such a change has been called for in the literature on ambulatory care sensitive conditions, proper ambulatory care being hypothesised to reduce unplanned acute care. [53] Unplanned acute admissions have been identi ed as a main driver of costs for patients with chronic conditions [54] and are considered a system failure in the delivery of chronic care.…”