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Life Health > Long-Term Care Planning

High-income, high-need people may use hospitals more

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High-income, “high-need” people who have trouble with the activities of daily living may be a little more likely to see the doctor than similar, lower-income people, and a lot more likely to go to the hospital.

They may also use considerably less home health care, according to data compiled by Susan Hayes, an analyst at the New York-based Commonwealth Fund, and several colleagues.

Hayes and her colleagues found, for example, that high-need people who had household income over 400 percent of the federal poverty level, and had problems with handling life activities, had an average of 10.7 medical office visits per year, compared with an average of 9.6 office visits per year for similar people at all income levels.

There were also differences in use of inpatient hospital care and average out-of-pocket health care spending.

The high-income, high-need people with functional limitations ended up as inpatients in the hospital about 595 times per year per 1,000 lives, and they spent an average of $2,255 per year out-of-pocket on care.

Other, comparable adults went to the hospital at a rate of 535 times per year per 1,000 lives, and they had an average of $1,669 in out-of-pocket spending.

But the high-income, high-need people with limitations used fewer paid home care days: just 22, compared with an average of 26.1 for similar people at all income levels.

Related: 3 peeks inside your health prospects’ brains

Hayes and her colleagues included data on the health spending of U.S. people with incomes of at least 400 percent of the federal poverty level in a report on the health care spending of high-need patients.

The analysts based the study on data collected through the Medical Expenditure Panel Survey team from 2009 through 2011. An arm of the U.S. Department of Health and Human Services manages the survey.

The analysts classified people as high-need if they told the MEPS team they had three or more chronic illnesses, such as diabetes. The analysts also broke out separate columns of data for high-need people who reported having trouble with the activities of daily living, such as going to the bathroom or eating, or with the instrumental activities of daily living, such as cooking and cleaning. 

Many issuers of private long-term care insurance classify people as needing long-term care services if they are unable to perform two or more activities of daily living.


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