Frequency and Clinical Description of High-Cost Patients in 17 Acute-Care Hospitals

TLDR

National catastrophic health insurance is likely to pay for much chronic illness and terminal care and divert resources toward acute‑care hospitals. The study assessed the potential impact of national catastrophic health insurance on the medical‑care system. It surveyed the frequency and clinical characteristics of high‑cost patients at 17 acute‑care hospitals in the San Francisco Bay Area. High‑cost patients represented 4–24 % of patients at the hospitals, accounted for 20–68 % of total billings (especially at large referral hospitals), 47 % had chronic conditions, only about 17 % experienced an acute medical catastrophe, and more than 13 % died in hospital. Published in N Engl J Med 300:1306–1309 (1979).

Abstract

Abstract To assess the potential impact of national "catastrophic" health insurance on the medical-care system, the frequency and clinical characteristics of high-cost patients were surveyed at 17 acute-care hospitals in the San Francisco Bay Area. The percentage of patients whose yearly hospital charges exceeded $4000 in 1976 ranged from 4 at a community hospital to 24 at a referral hospital. Hospital costs charged to these patients ranged from 20 to 68 per cent of total billings, with the highest percentages generally occurring at large referral hospitals. Forty-seven per cent of adult high-cost patients had chronic medical conditions, and only one in six suffered from an acute medical "catastrophe." In addition, more than 13 per cent of high-cost patients died in the hospital. National catastrophic health insurance is likely to pay for much chronic illness and terminal care and divert resources toward acute-care hospitals. (N Engl J Med 300:1306–1309, 1979)