Beaulieu Nancy D, Joynt Karen E, Wild Robert, Jha Ashish K
Harvard T.H. Chan School of Public Health, 42 Church St, Cambridge, MA 02138. E-mail:
Am J Manag Care. 2017 Apr;23(4):233-238.
Although we know that healthcare costs are concentrated among a small number of patients, we know much less about the concentration of these costs among providers or markets. This is important because it could help us to understand why some patients are higher-cost compared with others and enable us to develop interventions to reduce costs for these patients.
Observational study.
We used a 20% sample of Medicare fee-for-service claims data from 2011 and 2012, and defined high-cost patients as those in the top 10% of standardized costs. We then characterized high-concentration hospitals as those with the highest proportion of high-cost patient claims, and high-concentration markets as the Hospital Referral Regions (HRRs) with the highest proportion of high-cost patients. We compared the characteristics and outcomes of each.
High-concentration hospitals had 69% of their inpatient Medicare claims from high-cost Medicare beneficiaries compared with 51% for the remaining 90% of hospitals. These hospitals were more likely to be for-profit and major teaching hospitals, located in urban settings, and have higher readmission rates. High-concentration HRRs had 13% high-cost patients compared with 9.5% for the remaining 90% of HRRs. These HRRs had a smaller supply of total physicians, a greater supply of cardiologists, higher rates of emergency department visits, and significantly higher expenditures on care in the last 6 months of life.
High-cost beneficiaries are only modestly concentrated in specific hospitals and healthcare markets.
尽管我们知道医疗费用集中在少数患者身上，但对于这些费用在医疗服务提供者或市场中的集中情况了解得要少得多。这一点很重要，因为它有助于我们理解为什么有些患者的费用比其他患者高，并使我们能够制定干预措施来降低这些患者的费用。
观察性研究。
我们使用了2011年和2012年医疗保险按服务收费索赔数据的20%样本，并将高费用患者定义为标准化费用排名前10%的患者。然后，我们将高集中医院定义为高费用患者索赔比例最高的医院，将高集中市场定义为高费用患者比例最高的医院转诊区域（HRR）。我们比较了两者的特征和结果。
高集中医院69%的住院医疗保险索赔来自高费用医疗保险受益人，而其余90%的医院这一比例为51%。这些医院更有可能是营利性医院和大型教学医院，位于城市地区，再入院率较高。高集中HRR中有13%的高费用患者，而其余90%的HRR中这一比例为9.5%。这些HRR的全科医生供应较少，心脏病专家供应较多，急诊就诊率较高，在生命的最后6个月护理支出显著更高。
高费用受益人仅适度集中在特定医院和医疗市场。
