Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Room T414, Toronto, ON, M5S 2S1, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Eur J Health Econ. 2019 Aug;20(6):869-878. doi: 10.1007/s10198-019-01051-4. Epub 2019 Apr 5.
Research has shown that a small proportion of patients account for the majority of health care spending. The objective of this analysis was to determine the amount and proportion of preventable acute care spending among high-cost patients.
We examined a population-based sample of all adult high-cost patients using linked administrative health care data housed at ICES in Toronto, Ontario. High-cost patients were defined as those in and above the 90th percentile of the cost distribution. Preventable acute care (emergency department visits and hospitalisations) was defined using validated algorithms. We estimated costs of preventable and non-preventable acute care for high- and non-high-cost patients by category of visit/condition. We replicated our analysis for persistent high-cost patients and high-cost patients under 65 years and those 65 years and older.
We found that 10% of all acute care spending among high-cost patients was considered preventable; this figure was higher for non-high-cost patients (25%). The proportion of preventable acute care spending was higher for persistent high-cost patients (14%) and those 65 years and older (12%). Among ED visits, the largest portion of preventable care spending was for primary care treatable conditions; for hospitalisations, the highest proportions of preventable care spending were for COPD, bacterial pneumonia and urinary tract infections.
Although high-cost patients account for a substantial proportion of health care costs, there seems to be limited scope to prevent acute care spending among this patient population. Nonetheless, care coordination and improved access to primary care, and disease prevention may prevent some acute care.
研究表明，少数患者的医疗支出占了大部分。本分析旨在确定高成本患者中可预防的急性医疗支出的数量和比例。
我们使用安大略省多伦多市 ICES 机构中存储的链接行政医疗保健数据，对所有成年高成本患者进行了基于人群的抽样。高成本患者被定义为成本分布中处于或高于第 90 个百分位的患者。使用经过验证的算法定义可预防的急性医疗保健（急诊就诊和住院）。我们按就诊/疾病类别估算了高成本和非高成本患者的可预防和不可预防的急性医疗保健费用。我们对持续性高成本患者、65 岁以下高成本患者和 65 岁以上高成本患者重复了我们的分析。
我们发现，10%的高成本患者的急性医疗支出被认为是可预防的；而非高成本患者的这一比例更高（25%）。持续性高成本患者（14%）和 65 岁及以上患者（12%）的可预防急性医疗保健支出比例更高。在急诊就诊中，可预防护理支出的最大部分是可由初级保健治疗的疾病；在住院治疗中，可预防护理支出的最高比例是 COPD、细菌性肺炎和尿路感染。
尽管高成本患者占医疗保健费用的很大一部分，但似乎在这个患者群体中预防急性医疗支出的范围有限。尽管如此，协调护理和改善初级保健的获得以及疾病预防可能会预防一些急性护理。
