000086392 001__ 86392
000086392 005__ 20200716101602.0
000086392 0247_ $$2doi$$a10.1371/journal.pone.0217353
000086392 0248_ $$2sideral$$a115088
000086392 037__ $$aART-2019-115088
000086392 041__ $$aeng
000086392 100__ $$aTanke, Marit A.C.
000086392 245__ $$aA challenge to all. A primer on inter-country differences of high-need, high-cost patients
000086392 260__ $$c2019
000086392 5060_ $$aAccess copy available to the general public$$fUnrestricted
000086392 5203_ $$aBackground 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.
000086392 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII-REDISSEC/RD16-0001-0007
000086392 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000086392 590__ $$a2.74$$b2019
000086392 591__ $$aMULTIDISCIPLINARY SCIENCES$$b27 / 71 = 0.38$$c2019$$dQ2$$eT2
000086392 592__ $$a1.023$$b2019
000086392 593__ $$aMultidisciplinary$$c2019$$dQ1
000086392 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000086392 700__ $$aFeyman, Y.
000086392 700__ $$0(orcid)0000-0002-0961-3298$$aBernal-Delgado, Enrique
000086392 700__ $$aDeeny, S.R.
000086392 700__ $$aImanaka, Y.
000086392 700__ $$aJeurissen, P.
000086392 700__ $$aLange, L.
000086392 700__ $$aPimper, l A.
000086392 700__ $$aSasaki, N.
000086392 700__ $$aSchull, M.
000086392 700__ $$aWammes, J.J.G.
000086392 700__ $$aWodchis, W.P.
000086392 700__ $$aMeyer, G.S.
000086392 773__ $$g14, 6 (2019), e0217353 [11 pp.]$$pPLoS One$$tPLoS ONE$$x1932-6203
000086392 8564_ $$s717488$$uhttps://zaguan.unizar.es/record/86392/files/texto_completo.pdf$$yVersión publicada
000086392 8564_ $$s473231$$uhttps://zaguan.unizar.es/record/86392/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000086392 909CO $$ooai:zaguan.unizar.es:86392$$particulos$$pdriver
000086392 951__ $$a2020-07-16-09:53:09
000086392 980__ $$aARTICLE