A challenge to all. A primer on inter-country differences of high-need, high-cost patients
Open accessAbstract
BACKGROUND: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. METHODS: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. FINDINGS: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. INTERPRETATION: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Differences in the way that health systems are structured likely explains some of this variation, which suggests the potential of cross-system learning opportunities. Our findings highlight the need for further studies including comparable performance metrics and institutional analysis.
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Children with special health and care needs (CSHCN) have a broad scope and variety of complex needs.
“Children with special health and care needs (CSHCN) have a broad scope and variety of complex needs”
From Integrated care for children and young people with special health and care needs: a systematic review (2024) · cites this paper as [1]
The Discussion and implications section describes high-need, high-cost patients as a heterogeneous group with multiple comorbidities, supporting the general point that their needs vary and can be complex. The study includes all age groups but does not specifically describe children with special health and care needs (CSHCN), so it does not establish the claim for that population. (LLM, conf=0.82)
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- Authors
- Tanke, M. A. C., Feyman, Y., Bernal-Delgado, E., Deeny, S. R., Imanaka, Y., Jeurissen, P., Lange, L., Pimperl, A., Sasaki, N., Schull, M., Wammes, J. J. G., Wodchis, W. P., & Meyer, G. S.
- Affiliations
- Harvard University (US)
- Boston University (US)
- Health Foundation (GB)
- Kyoto University (JP)
- Radboud University Medical Center (NL)
- Sunnybrook Hospital (CA)
- University of Toronto (CA)
- Corresponding author
- Tanke, Marit A. C.
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2019-06-19
- Volume
- 14
- Issue
- 6
- Pages
- e0217353
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6583982
- OpenAlex
- W2951320620
- Cited by
- 38
- References
- 1
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 7 · 2023: 1 · 2022: 4 · 2021: 7 · 2020: 2
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Kyoto University Research Information Repository (Kyoto University) (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- Zaguan (University of Zaragoza Repository) (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Funders
- Commonwealth Fund (Harkness Fellowship (personal grant))
- Institute for Clinical Evaluative Sciences
- Instituto de Salud Carlos III (RD16/0001/0007)
- Ministry of Science (ES) (ECO2017-83771-C3-2-R)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
- Keywords
- high-cost patients, high-need high-cost patients, health care spending, cross-national comparison, OECD countries, multimorbidity, socioeconomic status, inpatient utilization, healthcare quality and safety, health system structure
- MeSH terms
- Aged, Costs and Cost Analysis, Cross-Sectional Studies, Delivery of Health Care, Female, Humans, Japan, Male, Middle Aged, Quality of Health Care, Retrospective Studies, Spain
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