Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE (Open Access)

Examining the high users of hospital resources: implications of a profile developed from Australian health insurance claims data

Joanna Khoo A B C , Helen Hasan A and Kathy Eagar A
+ Author Affiliations
- Author Affiliations

A Australian Health Services Research Institute, Building 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. Email: hasan@uow.edu.au; keagar@uow.edu.au

B Capital Markets Cooperative Research Centre Health Market Quality Research Program, Capital Markets Cooperative Research Centre Ltd., Level 3, 55 Harrington Street, Sydney, NSW 2000, Australia.

C Corresponding author. Email: jkhoo@cmcrc.com

Australian Health Review - https://doi.org/10.1071/AH17046
Submitted: 24 February 2017  Accepted: 28 September 2017   Published online: 13 November 2017

Journal compilation © AHHA 2017 Open Access CC BY-NC-ND

Abstract

Objective To develop and examine a profile of the demographic, hospital admission and clinical characteristics of high users of hospital resources within a cohort of privately insured Australians.

Methods Hospital admissions claims data from a group of private health insurance funds were analysed. The top 1% of hospital users were selected based on three measures of resource utilisation: number of admissions, total bed days and total insurance benefits paid. The demographic, hospital admission and clinical characteristics data were compared for these three measures of resource utilisation.

Results Compared with the general insured population, the three high-use cohorts are older, have more public hospital admissions and have more same-day admissions. The three high-use cohorts have the same top five principal diagnosis categories. These five categories account for more than two-thirds of admissions. The top 1% of users is responsible for a large proportion of total resource utilisation, accounting for 13% of total costs and 21% of total bed days.

Conclusions The highest users of hospital resources have a distinct profile, accounting for a large proportion of total resource utilisation for a narrow range of health conditions. The age and hospital admission profile of this group suggest both policy and service considerations for the targeting of interventions to support this high-needs group.

What is known about this topic? Statistics are regularly published on the uptake and use of private health insurance in Australia but there is little detailed information on resource utilisation in specific subgroups, particularly those with the highest levels of hospitalisation.

What does this paper add? This paper provides a profile of high resource utilisation among a privately insured cohort, describing demographic, hospital admission and clinical characteristics across three measures of resource utilisation. Patterns of use are detailed in this profile, for example the top 1% of users have a higher proportion of public hospital admissions as a private patient. The clinical profile of admissions was similar for the three measures of resource utilisation and there was considerable overlap in the individuals categorised in each high-use group.

What are the implications for practitioners? The narrow demographic and clinical profile of the high resource utilisation groups shows a chronic disease burden that is different to the focus of current chronic disease policy measures. The high-use conditions identified in this study are less amenable to preventive measures and new strategies may be required to target this high-needs group.

Additional keywords: chronic disease, diagnosis, need, private.


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