$1.4 Trillion Goes to 5% of Patients

According to the National Institute of Healthcare, 5% of the country’s population is responsible for $1.4 trillion in spending. This seems out of hand, but can be explained by the solutions, or lack thereof, for high-need patients.

The NIH noted that there were varying levels of success among groups with the same medical issues, and that the success of treatment was not necessarily correlated with cost. There were some groups with low costs that had higher success rates than other similarly afflicted groups with higher costs.

This finding is the purpose of the Peterson Group’s new research into insurance plan solutions. The fact that these high-cost patients are not having better results even with sky-high prices is a huge problem in US healthcare.

It means that there needs to be a significant overhaul in the distribution of insurance coverage, the cost of healthcare, and the plan choices made by everyone seeking insurance. “What we want to do is find those programs that do it better, both from an outcome and cost standing … and spread those features across the country,” said Jeffrey Selberg, executive director of the Peterson Center.

This starts at Harvard T.H. Chan School of Public Health, where experts will be assessing what each studied individual’s payments actually funded in terms of care, and how much waste was preventable in each case.

The Institute of Medicine will then study the models of providing care to high-need patients, and the barriers that can negatively impact treatment.

Finally, the Bipartisan Policy Center will compare the two and assess what policy barriers would prevent implementation of the most efficient plans on a wide scale.

In the past, efforts have been made to quell this gap in success that seems to have nothing to do with how much you spend and everything to do with consumer choices, but the efforts were linear and without the facets that the current model carries. This study explains healthcare costs for a wide array of people, rather than treating the high-cost population as one in the same.

Also according to Selberg, if the problem of high-need patients isn’t addressed with better treatment models being adopted, the effects will be felt by the entire nation. Healthcare prices will continue to rise until they are unmanageable for just about everyone.

Hopefully we’ll learn to make better choices in the future. If not, we’ll see the absurd prices continue.