JMIR Publications

ABSTRACT

Background:

High-cost (HC) patients, defined as the top 10% or 5% of patients with the highest healthcare costs, are responsible for over half of all healthcare-related spending. Multiple studies have reported that identifying HC beneficiaries could help clearly establish priority actions for policymakers in the context of allocation of scarce resources and provide effective solutions for addressing the aforementioned challenges. In the context of increasing rates of population mobility and migration, accepting medical treatment and obtaining reimbursements outside of the patient’s original location are inevitable.However, little is known about the characteristics of cross-provincial HC patients.

Objective:

This study analyzed the characteristics of high-cost patients among cross-provincial beneficiaries in rural China in order to facilitate the formulation of relevant policies.

Methods:

The study used data from the Cross-provincial Medical Immediate Settlement System collected between 2017 and 2019. A total of 2987 patients who utilised cross-province inpatient services were included. Based on the underlying motivations, patients who had relocated to another province for occupational or personal reasons and subsequently required medical attention were defined as Migration-driven Cross-province Patients (MCPs), whereas those who sought better medical care off-province were referred to as Disease-driven Cross-province Patients (DCPs). Patients whose annual total costs ranked among top 10% were defined as high-cost (HC) patients. Descriptive statistical and multivariate logistic regression model analyses were performed.

Results:

The study used data from the Cross-provincial Medical Immediate Settlement System collected between 2017 and 2019. A total of 2987 patients who utilised cross-province inpatient services were included. Among MCPs, the proportion of males with high costs was higher than that of non-HC patients. Compared with non-HC patients, HC patients were more inclined to go to tertiary medical institutions and enjoyed a higher reimbursement ratio. HC patients were more likely to suffer with neoplasms and circulatory diseases. The incidence of potentially preventable hospitalizations (PPHs) among HC patients was lower than that among non-HC patients. Among DCPs, HC patients were more likely to suffer from neoplasms. Additionally, the proportion of HC MCPs with two or more diseases was higher than that of non-HC patients.

Conclusions:

Targeted policies are needed to improve the management and service level of HC patients and ultimately reduce financial burdens and improve quality of care.