Systematic Review of High-Cost Patients’ Characteristics and Healthcare Utilisation

Joost Johan Godert Wammes
Philip J. van der Wees
Marit A.C. Tanke
Gert P. Westert
Partick P.T. Jeurissen
Journal Article
July 2018

This resource assesses the characteristics and health care utilization of high-cost patients and compares high-cost patients across payers and countries, based on a systematic review of studies in PubMed and Embase databases. It adds further data for the importance of segmentation and relevant strata.

  • The studies pointed to a high prevalence of multiple (chronic) conditions to explain high-cost patients’ utilization.
  • There was a high prevalence of mental illness across all studies.
  • High costs were associated with higher incomes in the USA but with lower incomes elsewhere.
  • Preventable spending was estimated at maximally 10% of spending.
  • High-cost patients are diverse populations and vary across payer types and countries. Tailored interventions are needed to meet the needs of high-cost patients and to avoid wasting resources.
Posted to The Playbook on
Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What are the characteristics and utilization patterns of patients with high-costs?
  • How did these compare across different countries?