Across health systems internationally, five percent of patients are estimated to make up approximately 50 percent of all healthcare costs. A combination of multiple physical, behavioural and social problems often mean that these patients' care needs aren't effectively addressed by the traditional organization of healthcare systems and care delivery. Further, both patients and healthcare staff report the care process of complex patients is chaotic and wasteful, reducing quality and raising costs. Therefore, strategies to redesign care to better meet these patients' needs, and increase the value of the care that is delivered, offer an opportunity to reduce cost. However, there remains a lack of clarity about what care is modifiable, and which patients to target. We will quantify utilisation of primary care (contacts with nurses or general practitioners in general practice, diagnostic tests, immunisations and prescriptions) and secondary care (attendances at emergency departments, inpatient admissions and procedures, and appointments and procedures in an outpatient setting) and attach estimated costs to each individual instance of utilisation. Data will not include utilisation and costs associated with palliative care, prescriptions dispensed in secondary care, and those arising from social care. We will then answer questions including; what are the demographic and clinical characteristics of top 5% and top 1% high cost patients in England, what types of healthcare use make up these costs, and how does this vary across different groups?
At the patient level, for patients of all ages, we will calculate health care utilisation across primary and secondary care for a two year period from March 2014 to March 2016, and cost each part of care delivered using available data on direct costs to the NHS. In primary care, we will quantify and attach costs to contacts with clinical staff (GPs and nurses), diagnostic tests, immunisations and prescriptions for medicines and devices. In secondary care, we will quantify utilisation in accident and emergency departments, spells of admitted patient care, and attendance at outpatient clinics. We will then use the national tariff payment system to calculate healthcare resource groups (HRGs) for each occurrence of care. We will then analyse the cost make-up of the top 1% and top 5% for our two year period, and compare their demographic (age, sex, ethnicity, region, socio-economic deprivation) and clinical characteristics (long-term conditions as per primary care clinical coding) to the rest of the population. We will then investigate whether the utilisation cost make-up of the high-cost patients differs across certain subgroups; age bands, patients with a mental health condition, and patients living alone.
ypes of health care utilisation; Cost of health care utilisation.
Sarah Deeny - Chief Investigator - The Health Foundation
Adam Steventon - Collaborator - The Health Foundation
Anya Gopfert - Collaborator - The Health Foundation
Arne Wolters - Collaborator - The Health Foundation
Carlotta Greci - Collaborator - The Health Foundation
Fiona Grimm - Collaborator - The Health Foundation
Isaac Barker - Collaborator - The Health Foundation
Karen Hodgson - Collaborator - The Health Foundation
Kathryn Dreyer - Collaborator - The Health Foundation
Mai Stafford - Collaborator - The Health Foundation
Rocco Friebel - Collaborator - Imperial College London
Will Parry - Collaborator - The Health Foundation
2011 Rural-Urban Classification at LSOA level;HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation