AUTHOR=Wang Chenzhou , Lu Shan , Zhang Yan 

TITLE=Drivers of high-cost persistence in rural China: A population-based retrospective study

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.988664

DOI=10.3389/fpubh.2022.988664

ISSN=2296-2565

ABSTRACT=Purpose: High-cost patients account for over 70% of total health expenditures in rural China. This population has become a key focus of health insurers, and persistently high-cost patients constitute a substantial proportion of medical resources. Hence, exploring high-cost persistence (HCP) and what drives it is considered meaningful and necessary.
Patients and methods: A population-based retrospective study was carried out. Annual healthcare utilization data of Dangyang New Rural Cooperative Medical Scheme from 2012 to 2017 was analyzed. Patients with spending in the top 10% in a given year were considered high-cost patients. The persistence level was estimated through Markov matrices between years. A total of 19,405 patients categorized as high-cost patients in 2016 were divided into two groups according to whether they kept high-cost status in 2017. A multilevel logistic regression model was used in examining the determinants of HCP.
Results: On average, about 31.48% of high-cost patients each year still maintained high-cost status in the subsequent year from 2012 to 2017. Elderly (OR = 2.150), families with more non-labor members (OR = 2.307), applying for subsistence allowances (OR = 1.245), patients with blood and immune diseases (OR = 2.614) or tumors (OR = 2.077) were more likely to maintain high-cost status. While hospitalization frequency was tested to be a mediator.
Conclusion: About one-third of high-cost patients in a given year had persistently high costs in the subsequent year. Health status and family support were considered the main drivers of HCP. High inpatient service utilization as a mediator was a prominent manifestation of persistently high-cost patients. More accurate identification of persistently high-cost patients is the basis for our management.