International comparison of health spending and utilization among people with complex multimorbidity

Abstract

Objective: The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes.

Differences in health outcomes for high‐needhigh‐costpatients across high‐incomecountries

“…Unlike England, the United States has slightly lower average 30‐day mortality for both personas. While related analyses have shown that the United States is spending more both because of a comparatively higher unit cost and more utilization of postacute care, 16,17 these results suggest that this increased resource use may not be translating into improved long‐term outcomes. Prior work has similarly found that the United States performs above average when it comes to measuring performance related to the period immediately following a hospitalization but then lags behind other countries when assessing longer, population‐level health outcomes 18 .…”

International comparison of patient care trajectories: Insights from the ICCONIC project

“…One of the key results that emerged from the ICCONIC project was that there is considerable variability across health systems with regards to the relative share of care that occurs in hospitals relative to other care settings. 11 , 12 For example, our findings showed that for both personas, relative hospital utilization in the United States as compared to other countries was low; however, the United States had some of the highest utilization of rehab care days spent outside the hospital in short term rehab and skilled‐nursing facilities. When comparing total utilization, across both care settings, the United States went from being the lowest utilizer to among the highest.…”

“… 17 For the older adult with multimorbidity, we examined spending of different cohorts of patients to include subsets with limited comorbidity (CHF only) and greater comorbidity (CHF with diagnoses of diabetes and COPD). 12 …”

“…Overall, these differences accounted for greater spending per patient in the United States relative to other countries. 12 , 17 …”

A methodology for identifying high‐need, high‐cost patient personas for international comparisons

“…Finally, we demonstrate the comparability of these two specific personas—(1) an older adult with frailty who sustains a hip fracture and subsequent hip replacement or osteosynthesis, and (2) an older person with complex multimorbidity, specifically a person hospitalized with heart failure and a comorbidity of diabetes—across the 11 countries in the ICCONIC collaborative. Importantly, this work provides the methodological framework used in an accompanying six original research manuscripts copublished in the Health Services Research “Special Issue on International Comparisons of High Need, High‐Cost Patients.” 9 , 10 , 11 , 12 , 13 , 14 These six original research articles examine detailed variation in spending, utilization, and patient outcomes of the two specific high‐need patient cohorts across different care settings.…”