Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

TitleHealth System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences
Publication TypeJournal Article
Year of Publication2016
AuthorsSalzberg, CA, Hayes, SL, McCarthy, D, Radley, DC, Abrams, MK, Shah, T, Anderson, GF
JournalIssue brief (Commonwealth Fund)
Type of ArticleArticle
ISBN Number15586847 (ISSN)
KeywordsAdult, chronic disease, Communication, Comorbidity, disabled person, Disabled Persons, doctor patient relation, economics, health care cost, health care delivery, Health Expenditures, health insurance, health service, Health Services Accessibility, Health Services Needs and Demand, human, Humans, Insurance, Health, interpersonal communication, organization and management, patient care, Patient-Centered Care, Physician-Patient Relations, Private Sector, statistics and numerical data, United States

Issue: Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients--those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs--those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks--to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009--2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient-provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured high-need adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their needs.