Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
BMC Public Health. 2024 Oct 22;24(1):2917. doi: 10.1186/s12889-024-20325-y.
The phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system.
This study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU.
The secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU.
The characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB).
The HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics.
在医疗保健中，高成本使用者（HCU）现象是指一小部分患者占医疗保健支出的很大比例。通过在 COVID-19 大流行期间了解这一现象，可以提供针对性的干预措施，确保患者得到所需的护理，并减轻医疗系统的负担。
本研究旨在通过探索 2016 年至 2021 年期间住院医疗支出的变化模式，确定（1）在泰国，大流行期间是否存在 HCU 现象；（2）HCU 的患者特征；（3）HCU 的前 5 种主要诊断；以及（4）与成为 HCU 相关的潜在预测因素。
通过国家健康保障办公室全民医保计划的住院电子理赔数据进行二次数据分析，该计划为约 80%的泰国人口提供医疗保健。计算了随时间变化的医疗支出，并通过描述性分析检查了人口特征。应用多项逻辑回归探索与成为 HCU 相关的潜在预测因素。
2016 年至 2021 年，HCU 的特征基本保持不变。在男（55%）女（45%）患者比例、年龄范围为 55 至 57 岁、估计住院 8 天、每年 7 次住院和每位患者平均医疗费用≥2860 美元（100000 泰铢）方面。低成本使用者（LCU）组（人口的前 50%）中，女性患者更多（55%），年龄从 27 岁至 33 岁，住院 3 天，每年 1 至 2 次住院，每位患者的平均医疗费用较低，不到 315 美元（≤11000 泰铢）。
即使在 COVID-19 大流行期间实施了有限的医疗保健可及性或封锁措施，HCU 现象仍然存在。这一发现可能表明 HCU 对医疗服务的需求具有独特性，与其他人群群体的需求不同。通过了解医疗保健利用和支出的趋势，以及与成为 HCU 相关的潜在预测因素，可以制定政策，确保在未来的大流行期间，将适当的卫生资源分配给需要适当护理的合适人群。
