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High-cost patients often have terminal illnesses, accounting for significant hospital charges and complications. Physician-clinicians have limited control over these substantial medical costs.
Area of Science:
- Medical Economics
- Healthcare Costs
- Clinical Medicine
Background:
- Physicians are often blamed for rising medical costs, but societal and political factors are significant contributors.
- Clinicians recognize the high costs of serious illnesses, with recent literature addressing this issue in relation to medical care.
- The limitations of medicine itself play a role in escalating healthcare expenses.
Purpose of the Study:
- To analyze the relationship between high-cost patients, terminal illness, and resource utilization.
- To investigate the incidence of complications and associated costs in high-cost patient populations.
- To re-evaluate the extent of physician-clinician control over total medical costs.
Main Methods:
- Analysis of a random sample of 776 adult high-cost patients.
- Review of studies published in JAMA and The New England Journal of Medicine.
- Examination of patient outcomes, including mortality and complication rates, two years post-discharge.
Main Results:
- High-cost illness is strongly associated with terminal illness; 34% of high-cost patients died within two years.
- These high-cost patients accounted for 39% of total hospital charges in the studied group.
- The same patient group exhibited the highest incidence of surgical complications, incurring substantial costs.
Conclusions:
- The majority of high-cost patients suffer from terminal conditions, representing a significant financial burden on the healthcare system.
- While some complications may be avoidable, a high complication rate is likely inevitable in this patient group.
- Physician-clinicians exert control over only a small fraction of the total costs associated with serious illnesses.
Abstract:
While doctors get the blame for increasing medical costs, studies how that societal, political factors, and medicine's limitations are the culprit. Clinicians (I use the term to distinguish between those M.D.s who work at the bedside and others who are in nonpatient direct care) are well aware of the hugh costs associated with serious illness, but it is only recently that many papers are appearing in the medical literature discussing this problem in relation to medical care. In a study published in JAMA (April 10, 1981), Steven A. Schroeder, et al., found that high cost illness is really terminal illness in a random sample of 776 adult high-cost patients. Two years after discharge at least 34% of high cost patients had died and these patients accounted for 39% of the hospital charges incurred by the total group studied. Francis Moore and colleagues pointed out in the New England Journal of Medicine (March 12, 1981) that this very group of patients also had the highest incidence of complications in the surgical field. In one year they identified 36 such cases at the Peter Bent Brigham Hospital in Boston; the total cost of their care was nearly $2,000,000. While there were unnecessary complications, in this group of patients it is very likely inevitable that the complication rate will be high. Since many authors seem to imply that it is the clinicians who are at fault to a large extent in generating these costs, I would like to point out that the physician-clinician actually has control over a relatively small percent of the total cost.