A new set of papers takes an in-depth look at healthcare spending, use of hospitals and rehabs, and health outcomes across 11 countries for high-need, high-cost (HNHC) patients—those who are frail and have multiple chronic conditions.
The research, published in a special issue of Health Services Research (December 2021), was led by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC), founded in 2018 by Jose Figueroa, assistant professor of health policy and management at Harvard T.H. Chan School of Public Health, and Irene Papanicolas of the London School of Economics. The two researchers began the ICCONIC project because, previously, little was known about differences in spending and utilization of care for HNHC patients across health systems. Even though these patients constitute a relatively small segment of the population, they account for a disproportionately large share of healthcare expenditures—and their numbers are expected to grow over time as populations age.
The researchers looked at the care trajectories of HNHC patients in 11 countries, including the U.S., Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, and Switzerland. They modeled the experiences of two types of patient “personas”: a frail older adult recovering from a hip fracture, and an older person with complex multimorbidity who is hospitalized with heart failure and also has diabetes.
The research showed that average use of health care services and spending vary substantially across countries for both an older person with complex multimorbidity and a frail older person who sustains a hip fracture, with the U.S. spending far more than comparison countries for both personas. Higher costs in the U.S. were driven by higher prices for health care across most settings and above-average use of both rehab and outpatient specialty care.
The research also revealed substantial variation in mortality rates for both personas across countries. A November 10, 2021 article in The Guardian highlighted one of the ICCONIC project’s findings—that England had the highest death rates of frail and older hospitalized patients among all the countries in the study.
In the U.S., higher spending did not necessarily lead to better long-term outcomes for HNHC patients, the research found.
Understanding what drives the differences in cost and quality of care across countries is an important step toward improving high-need patients’ lives and optimizing health system performance, according to Figueroa.
Read the studies: Special Issue: International Comparisons of High-Need, High-Cost Patients: New Directions in Research and Policy
Read the Guardian article: England has highest death rates of older patients in western world, study finds