Systematic Review of High-Cost Patients’ Characteristics and Healthcare Utilisation

Joost Johan Godert Wammes
Philip J. van der Wees
Marit A.C. Tanke
Gert P. Westert
Partick P.T. Jeurissen
Peer-Reviewed Article
July 2018

This resource assesses the characteristics and health care utilization of high-cost patients and compares high-cost patients across payers and countries, based on a systematic review of studies in PubMed and Embase databases. It adds further data for the importance of segmentation and relevant strata.

  • The studies pointed to a high prevalence of multiple (chronic) conditions to explain high-cost patients’ utilization.
  • There was a high prevalence of mental illness across all studies.
  • High costs were associated with higher incomes in the USA but with lower incomes elsewhere.
  • Preventable spending was estimated at maximally 10% of spending.
  • 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 wasting resources.
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