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Treating high-need patients in 9 countries

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The Brandenburg Gate, Berlin.

This Commonwealth Fund study looks at how high-need patients experience healthcare in nine countries.

The study concludes:

“Poor performance for high-need patients may contribute to high costs. By using {emergency-room} visits instead of primary care (when such care is inaccessible), these patients inadvertently increase healthcare spending and further fragment their own care. In addition, lack of care coordination may lead to overuse of care, particularly in lab tests and imaging. Research also has shown that less-engaged patients cost more than highly engaged patients. Encouraging physicians to get patients involved in their care may further help reduce cost growth.”

“Health systems that tend to perform well specifically with regard to high-need patients share common markers of high performance in other areas as well. Data … indicate that these countries tended to have a higher percentage of physician practices that have after-hours arrangements for patients (Germany, the Netherlands, Norway), frequently make home visits (the Netherlands, France, Germany), and use nurse case managers for people with serious chronic conditions (France, the Netherlands, Sweden).”

Success in other countries, particularly in reducing financial barriers to care, may be the result of policies that target high-need patients. France, for instance, has eliminated copayments for individuals with any of 32 chronic illnesses—essentially eliminating any cost-related barriers to care for this population. Germany’s disease management programs for chronically ill patients combine technology, quality assurance (e.g., reminders and benchmarking), and financial incentives for physicians, patients, and payers. Since the implementation of these programs, hospitalization rates, duration of hospital stay, mortality, and drug costs have decreased while quality of care and patient satisfaction have improved.”

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