International Comparisons of High-Need, High-Cost Patients: New Directions in Research and Policy

Oct. 15th, 2021 — In partnership with ICCONIC, Health Services Research (HSR) is publishing an upcoming special issue, “International Comparisons of High-Need, High-Cost Patients: New Directions in Research and Policy.” The issue, to be released online November 4th, 2021 and in print November 12th, 2021, features six original research articles examining variation in healthcare utilization, spending, and outcomes among high-need, high-cost (HNHC) patients across eleven countries—Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.

Key Findings:
  1. Use of patient vignettes helps overcome some issues of data comparability across countries.
  2. Comparisons of care trajectories reveal important insights, including potential substitution effects across different care settings.
  3. There are relatively similar patterns of spending and utilization by age and sex across countries.
  4. HNHC patients incur more resource use than their healthier counterparts, but where this resource use occurs differs by health system.
  5. Drivers of high spending differ across countries, with the US having high prices per unit.
  6. These is substantial variation in health outcomes across countries, which does not appear to be correlated with health spending.
  7. Improvements in data access and data comparability are needed to carry out more robust health system comparisons in the future.
List of Papers:
  1. A methodology for identifying high-need, high-cost patient personas for international comparisons: The International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) Project.
  2. Differences in Health Care Spending and Utilization Among Older Frail Adults in High-Income Countries: ICCONIC Hip Fracture Persona. Papanicolas I, Figueroa JF, Schoenfeld AJ, et al. [Available here]
  3. International Comparison of Health Care Spending and Utilization Among People with Complex Multimorbidity. Figueroa JF, Papanicolas I, Riley K, et al. [Available here]
  4. Differences in Health Outcomes for High-Need High-Cost Patients Across High-Income Countries. Papanicolas I, Riley K, Abiona O, et al. [Available here]
  5. International Comparison of Spending and Utilization at the End of Life for Hip Fracture Patients. Blankart CR, Van Gool K, Papanicolas I, et al. [Available here]
  6. An International Comparison of Long-Term Care Trajectories and Spending Following Hip Fracture. Wodchis WP, Or Z, Blankart CR, et al. [Available here].
  7. Within and Across Country Variation in Treatment of Patients with Heart Failure and Diabetes. Or Z, Shatrov K, Penneau A, et al. [Available here]
  8. International Comparison of Patient Care Trajectories: Insights from the ICCONIC Project.
  9. Perspective – Insights from the Advisory Board.