Kenmerken en zorggebruik van patiënten met de hoogste zorgkosten

OBJECTIVE: To determine characteristics and healthcare utilization of high-cost patients in the Netherlands.

DESIGN: Cross-sectional study, using claim data for 2013 from one Dutch health insurer. Analyses were limited to the curative health system (care that falls under the Health Insurance Act), including voluntary supplementary insurance.

METHOD: We established total healthcare costs per beneficiary by summing all claims with a starting date in 2013. We categorized hospital-related diagnosis related groups (DRGs) and mental health care DRGs according to the ICD-10 International Classification of Diseases main chapters and sub-chapters. Per patient we determined which ICD-10-(sub-)chapter carried the highest costs. In addition, we developed several indicators for healthcare utilization and analysed healthcare utilization using descriptive statistics. Finally, we broke down high-cost patients by age group and compared characteristics and health care utilization between age groups.

RESULTS: High-cost patients, those in the top 1% in 2013, incurred an average total cost of over € 56,000 per patient. They were treated by multiple providers for numerous health problems. Approximately one third of high-cost patients had one or more expensive treatments, including transplant surgery, dialysis, expensive drugs, intensive care unit use, or DRGs exceeding € 30,000. The majority of high-cost patients were treated for cardiovascular disorders, neoplasms or mental and behavioural disorders. Though the high-cost patients were relatively old, more than half were younger than 65 years and average costs per patient decreased sharply with age.

CONCLUSIONS: There is a need for an integral approach in the treatment of high-cost patients. Tailored policy and interventions are needed to improve care quality and to avoid unnecessarily high costs of care.