5% of US Population Accounts For 50% of Health Care Costs


H. Joanna Jiang, Ph.D. Agency for Healthcare Research and QualityMedicalResearch.com Interview with:
H. Joanna Jiang, Ph.D.
Agency for Healthcare Research and Quality

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Jiang: A large proportion of health care resources in the United States are consumed by a relatively small number of individuals, who have been dubbed super-utilizers. Approximately 25% of U.S. health care expenses are incurred by 1% of the U.S. population, and 50% of expenses are incurred by 5% of the population.

Our study found that across all types of payers of medical care (Medicare, Medicaid, and private insurance), super-utilizers on average had approximately 4 times as many hospital stays as other patients, and the 30-day hospital readmission rate for super-utilizers was 4 to 8 times higher than for other patients. Among Medicaid and privately insured patients, super-utilizers had longer hospital stays and higher average hospital costs than other patients.

We also found that patients with multiple chronic conditions, such as diabetes, hypertension, and congestive heart failure, accounted for a greater share of hospital stays among super-utilizers than among other hospitalized patients. Mental health and substance use disorders were among the top 10 principal diagnoses for super-utilizers aged 1 to 64 years regardless of payer.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Jiang: Clinicians should be aware of the types of patients who are likely to be super-utilizers. They can then work with these patients to develop treatment plans and interventions that may reduce the likelihood of frequent hospitalization and possibly shift care to less intensive outpatient settings.

Our findings further highlight the negative health impact of chronic conditions and reinforces the need for patients to work with physicians to manage and control their chronic diseases, before hospitalization becomes necessary.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Jiang: Our study was limited to the characteristics of hospital inpatient stays among super-utilizers. It would be helpful to have a more complete picture by looking at super-utilizers in the emergency department, ambulatory or outpatient surgery, and physician office settings. Further research also could focus on the types and severity of chronic conditions that are highly present among super-utilizers.


Jiang HJ (AHRQ), Weiss AJ (Truven Health Analytics), Barrett ML (M.L. Barrett, Inc.), Sheng M (Truven Health Analytics). Characteristics of Hospital Stays for Super-Utilizers by Payer, 2012. HCUP Statistical Brief #190. May 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb190-Hospital-Stays-Super-Utilizers-Payer-2012.pdf.

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H. Joanna Jiang, Ph.D. (2015). 5% of US Population Accounts For 50% of Health Care Costs

Last Updated on July 17, 2015 by Marie Benz MD FAAD