Khoo Joanna, Hasan Helen, Eagar Kathy
Australian Health Services Research Institute, Building 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. Email:.
Aust Health Rev. 2018 Sep;42(5):600-606. doi: 10.1071/AH17046.
Objective To develop and examine a profile of the demographic, hospital admission and clinical characteristics of high users of hospital resources within a cohort of privately insured Australians. Methods Hospital admissions claims data from a group of private health insurance funds were analysed. The top 1% of hospital users were selected based on three measures of resource utilisation: number of admissions, total bed days and total insurance benefits paid. The demographic, hospital admission and clinical characteristics data were compared for these three measures of resource utilisation. Results Compared with the general insured population, the three high-use cohorts are older, have more public hospital admissions and have more same-day admissions. The three high-use cohorts have the same top five principal diagnosis categories. These five categories account for more than two-thirds of admissions. The top 1% of users is responsible for a large proportion of total resource utilisation, accounting for 13% of total costs and 21% of total bed days. Conclusions The highest users of hospital resources have a distinct profile, accounting for a large proportion of total resource utilisation for a narrow range of health conditions. The age and hospital admission profile of this group suggest both policy and service considerations for the targeting of interventions to support this high-needs group. What is known about this topic? Statistics are regularly published on the uptake and use of private health insurance in Australia but there is little detailed information on resource utilisation in specific subgroups, particularly those with the highest levels of hospitalisation. What does this paper add? This paper provides a profile of high resource utilisation among a privately insured cohort, describing demographic, hospital admission and clinical characteristics across three measures of resource utilisation. Patterns of use are detailed in this profile, for example the top 1% of users have a higher proportion of public hospital admissions as a private patient. The clinical profile of admissions was similar for the three measures of resource utilisation and there was considerable overlap in the individuals categorised in each high-use group. What are the implications for practitioners? The narrow demographic and clinical profile of the high resource utilisation groups shows a chronic disease burden that is different to the focus of current chronic disease policy measures. The high-use conditions identified in this study are less amenable to preventive measures and new strategies may be required to target this high-needs group.
在一群澳大利亚私人保险人群中，制定并研究医院资源高使用者的人口统计学、住院情况及临床特征。方法：分析一组私人健康保险基金的住院理赔数据。根据资源利用的三项指标（住院次数、总住院天数和支付的保险福利总额）选出医院资源使用量排名前1%的人群。对这三项资源利用指标的人口统计学、住院情况及临床特征数据进行比较。结果：与一般参保人群相比，这三个高使用量人群年龄更大，公立医院住院次数更多，当日住院次数也更多。这三个高使用量人群的前五大主要诊断类别相同。这五个类别占住院次数的三分之二以上。资源使用量排名前1%的人群占总资源利用的很大比例，占总成本的13%和总住院天数的21%。结论：医院资源的最高使用者具有独特特征，在有限的健康状况范围内占总资源利用的很大比例。该群体的年龄和住院情况表明，在制定针对这一高需求群体的干预措施时，需要同时考虑政策和服务因素。关于该主题已知哪些信息？澳大利亚定期公布私人健康保险的参保和使用统计数据，但关于特定亚组，特别是住院率最高的亚组的资源利用情况，详细信息很少。本文补充了哪些内容？本文提供了私人保险人群中高资源利用情况的概况，描述了三项资源利用指标下的人口统计学、住院情况及临床特征。该概况详细说明了使用模式，例如资源使用量排名前1%的人群作为私人患者在公立医院的住院比例更高。三项资源利用指标下的住院临床特征相似，每个高使用量组中的个体有相当大的重叠。对从业者有何启示？高资源利用群体狭窄的人口统计学和临床特征表明，其慢性病负担与当前慢性病政策措施的重点不同。本研究中确定的高使用情况较难采取预防措施，可能需要新的策略来针对这一高需求群体。
