Experiences of High-Need Patients in 9 High-Income Countries

High-need patients, who have multiple chronic conditions or functional limitations to everyday living activities, use a greater amount of healthcare services, experience more coordination problems with their healthcare, and encounter more financial barriers to obtaining healthcare. In addition, they tend to have lower incomes.

The Commonwealth Fund looked at high-need patients who were 65 years of age or older and had either a minimum of 3 chronic conditions or a functional limitation. The study examined patterns of healthcare use, financial barriers, care coordination, and doctor-patient relationships in 9 countries: Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United States.

In the US alone, 5% of the adult population accounts for 50% of healthcare costs. High-need patients were more likely to have seen 4 or more doctors in the past year, to have taken 4 or more prescription drugs, to have been hospitalized overnight, and to have visited the emergency department (ED) on several occasions in the past 2 years. The US, Canada, France, Sweden, and Switzerland had greater numbers of high-need adults using the ED for a condition that could have been treated by a primary care physician.

Financial barriers to healthcare included not visiting the doctor for a condition, skipping recommended treatments and tests due to expenses, or not taking prescriptions due to expenses. More than 22% of US adults reported these issues, the most of any country examined.

At least 1 in 4 adults from all countries reported an issue with healthcare coordination. Germany, Norway, and the US had the highest numbers, with nearly half of their populations reporting a problem with healthcare coordination. The US had higher rates of patients who had issues with appointments for tests and orders for tests, who received conflicting information from different doctors, and who had trouble coordinating their regular doctors with their specialists.

High-need patients were also more likely to receive contact from their doctors in between visits. The US had the highest statistic of doctors contacting high-need patients in between visits and, in spite of financial barriers to high-quality care, 87% of US high-need patients have some form of daily treatment plan.

Of the 9 countries examined, the US had the highest number of patients with 3 or more conditions. The US ranked poorly in terms of patients who had avoidable ED usage and patients with cost-related access problems. The US ranked mid-range for issues with care coordination and patient-perceived medical mistakes. The US ranked the highest for contacting patients and providing treatment plans.

Healthcare systems abroad may outperform those of the US due to certain policies directed towards high-need patients. Physicians in many of these countries offer: after-hours arrangements, house calls, or nurse care managers for those with chronic conditions. Policies that, for example, eliminate copayments for qualifying patients or create disease management programs could be adapted within the US in order to provide better care to their high-need patients and reduce health care costs, the authors wrote.