Frequency and Clinical Description of High-Cost Patients in 17 Acute-Care Hospitals

To assess the potential impact of national "catastrophic" health insurance on the medical-care system, the frequency and clinical characteristics of high-cost patients were surveyed at 17 acute-care hospitals in the San Francisco Bay Area. The percentage of patients whose yearly hospital charges exceeded 4000 in 1976 ranged from 4 at a community hospital to 24 at a referral hospital. Hospital costs charged to these patients ranged from 20 to 68 per cent of total billings, with the highest percentages generally occurring at large referral hospitals. Forty-seven per cent of adult high-cost patients had chronic medical conditions, and only one in six suffered from an acute medical "catastrophe. " In addition, more than 13 per cent of high-cost patients died in the hospital. National catastrophic health insurance is likely to pay for much chronic illness and terminal care and divert resources toward acute-care hospitals.