José F. Figueroa is an instructor of medicine at Harvard Medical School and an associate physician in the Department of Medicine, Brigham and Women's Hospital, both in Boston, Massachusetts.
Xiner Zhou was an analyst at the Harvard T. H. Chan School of Public Health, in Boston, when this manuscript was submitted. She is now a PhD candidate in the Department of Statistics at the University of California Davis.
Health Aff (Millwood). 2019 Jan;38(1):107-114. doi: 10.1377/hlthaff.2018.05160.
One strategy for reducing health care spending is to target the Medicare beneficiaries who remain persistently high cost over time. Using a 20 percent sample of Medicare fee-for-service beneficiaries in the period 2012-14, we sought to identify the proportion of patients who remained persistently high cost (that is, in the top 10 percent of spending each year) and determine the characteristics and spending patterns that differentiated them from other patients. We found that 28.1 percent of patients who were high cost in 2012 remained persistently high cost over the subsequent two years. On average, persistently high-cost patients were younger, more likely to be members of racial/ethnic minority groups, eligible for Medicare based on having end-stage renal disease, and dually eligible for Medicaid, compared to transiently and never high-cost patients. Persistently high-cost patients had greater relative spending on outpatient care and medications, while very little of their spending was related to preventable hospitalizations. Health care systems and policy makers can use this information to better target spending reductions and care improvements over time.
降低医疗保健支出的一种策略是针对长期持续高成本的医疗保险受益人。我们使用了 2012-14 年期间 Medicare 按服务收费受益人的 20%的样本，试图确定持续高成本（即每年支出排名前 10%）的患者比例，并确定将他们与其他患者区分开来的特征和支出模式。我们发现，2012 年高成本的患者中有 28.1%在随后的两年中持续保持高成本。平均而言，与短暂高成本和从未高成本的患者相比，持续高成本患者更年轻，更有可能属于少数族裔群体，有资格基于终末期肾病获得医疗保险，并且有资格同时获得医疗补助。持续高成本患者的门诊护理和药物治疗的相对支出更大，而与可预防的住院治疗相关的支出则很少。医疗保健系统和政策制定者可以利用这些信息来更好地针对支出减少和护理改善进行定位。
