How High-Need Patients Experience the Health Care System in Nine Countries

A large portion of U.S. health care spending goes to the care of high-need patients. These individuals—people with clinically complex conditions, cognitive or physical limitations, or behavioral health problems—use a disproportionate amount of health care services and therefore represent an outsized percentage of costs. Five percent of the U.S. adult population accounts for 50 percent of the nation’s health care costs and 10 percent accounts for 65 percent of total costs.1 The top 10 percent of spenders age 18 and older accrue health care expenditures of at least $12,000 per person per year, compared with a nationwide median of $1,100.2 Focusing on these high-need patients can go a long way toward containing costs while helping people lead healthier lives.

This analysis builds on an earlier Commonwealth Fund survey that focused on adults age 55 and older and their health care experiences in 11 high-income countries.3 In this brief, we describe the subset of high-need adults ages 65 and older in nine of these countries (Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United States) and then compare their patterns of health care use, financial barriers to care, care coordination, and their doctor–patient relationships to those of other older adults. We highlight important aspects that may play a role in reducing costly utilization for this population, and which should factor into the development of any policy solutions. We also highlight policies in countries that have had success in providing care for this population, drawing insight for the U.S. and other countries.

– The Commonwealth Fund

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