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Persistence of High Health Care Costs among VA Patients.
- Source :
-
Health Services Research . Oct2018, Vol. 53 Issue 5, p3898-3916. 19p. 5 Charts, 2 Graphs. - Publication Year :
- 2018
-
Abstract
- <bold>Objectives: </bold>To examine high-cost patients in VA and factors associated with persistence in high costs over time.<bold>Data Sources: </bold>Secondary data for FY2008-2012.<bold>Data Extraction: </bold>We obtained VA and Medicare utilization and cost records for VA enrollees and drew a 20 percent random sample (N = 1,028,568).<bold>Study Design: </bold>We identified high-cost patients, defined as those in the top 10 percent of combined VA and Medicare costs, and determined the number of years they remained high cost over 4 years. We compared sociodemographics, clinical characteristics, and baseline utilization by number of high-cost years and conducted a discrete time survival analysis to predict high-cost persistence.<bold>Principal Findings: </bold>Among 105,703 patients with the highest 10 percent of costs at baseline, 68 percent did not remain high cost in subsequent years, 32 percent had high costs after 1 year, and 7 percent had high costs in all four follow-up years. Mortality, which was 47 percent by end of follow-up, largely explained low persistence. The largest percentage of patients who persisted as high cost until end of follow-up was for spinal cord injury (16 percent).<bold>Conclusion: </bold>Most high-cost patients did not remain high cost in subsequent years, which poses challenges to providers and payers to manage utilization of these patients. [ABSTRACT FROM AUTHOR]
- Subjects :
- *MEDICAL care costs
*MEDICAL care of veterans
*HEALTH insurance reimbursement
*MEDICAL care use
*UTILIZATION review (Medical care)
*MEDICARE
*ECONOMIC impact
*MEDICAL care cost statistics
*COMPARATIVE studies
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*RESEARCH funding
*EVALUATION research
Subjects
Details
- Language :
- English
- ISSN :
- 00179124
- Volume :
- 53
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Health Services Research
- Publication Type :
- Academic Journal
- Accession number :
- 131949481
- Full Text :
- https://doi.org/10.1111/1475-6773.12989