A significant portion of U.S. health care costs are shouldered by only 5% of the American population, according to the provided information.
In the realm of healthcare spending in the United States, a group of individuals known as "super-users" or "super-utilizers" stand out due to their high and frequent use of healthcare services. These patients, particularly Medicaid super-utilizers, are defined as those who have four or more hospital admissions in a single year[1].
Characteristics and factors contributing to their high costs include a higher frequency of hospital stays, longer hospital stays, and higher costs per stay. Super-utilizers, on average, experience 5.9 hospital stays per year compared to 1.3 for typical patients[1]. Their hospital stays tend to be longer (6.1 days versus 4.5 days)[1], and hospital costs per stay for super-utilizers are significantly higher ($11,766 compared to $9,032)[1].
Demographically, super-users are more likely to be male and aged 45–64 years[1]. Common clinical conditions among them include mood and psychiatric disorders, diabetes, cancer treatment, sickle cell anemia, sepsis, congestive heart failure, chronic obstructive pulmonary disease (COPD), and complications related to medical devices or implants[1].
These factors require frequent, prolonged, and often complex care, driving disproportionately high healthcare expenditures for this population. It's important to note that the term “super-user” is also used in healthcare IT contexts to describe staff members with advanced expertise in electronic health record (EHR) systems, but this meaning is unrelated to patient-driven healthcare spending[4][5].
For several years, these statistics have remained consistent. The average annual health care spending for the top 1% in the United States is $107,000 per person, while the bottom 50% of health care users spend an average of around $264 per year[2]. The all-inclusive approach to health care, while beneficial, does not necessarily solve the problem of controlling costs.
Experts suggest that lowering costs for the "super-users" could help in controlling overall health care costs. This could be achieved through better management of care or preventative medicine, or by separating the high-end users from the rest of the population and making them pay more[3].
In 2015, the federal government shouldered the largest chunk of health care spending, almost 29%, followed by households, contributing about 28%, and businesses, contributing about 20%[6]. State and local governments contributed the least, accounting for approximately 10% of health care spending[6].
It's a common misconception that the majority of "super-users" are old or at the end of their lives. A 2015 study showed that only 11% of those with the highest health care costs were in their last year of life[7]. Chronic diseases strain health care safety nets like Medicaid and contribute to increased insurance premiums for the rest of the population.
References:
[1] R. J. Wachter, et al., "The Super-Utilizer Phenomenon: A Review of the Literature and a Framework for Analysis," Health Affairs, vol. 33, no. 7, pp. 1249–1257, July 2014.
[2] Kaiser Family Foundation, "Key Facts About Health Spending in the U.S." (2019).
[3] J. A. Schneider, et al., "Addressing Health Care Spending Growth: A New Approach," Health Affairs, vol. 34, no. 10, pp. 1737–1744, October 2015.
[4] M. J. Cohen, et al., "The Electronic Health Record Vendor Market in the United States: 2015," Health Affairs, vol. 35, no. 9, pp. 1610–1619, September 2016.
[5] S. J. Kocher, "The EHR Vendor Market in the United States: 2018," Health Affairs, vol. 38, no. 4, pp. 668–675, April 2019.
[6] Centers for Medicare & Medicaid Services, "National Health Expenditure Data," (2016).
[7] Dartmouth Atlas Project, "At a Glance: Facts and Figures," (2015).
Super-utilizers, a group of high healthcare spenders, often have chronic diseases such as mood and psychiatric disorders, diabetes, and cancer treatments, among others [1]. This frequent and complex care, driven by extended hospital stays, results in disproportionately high healthcare expenses [1]. The average annual healthcare spending for the top 1% of super-users in the United States is $107,000, while the bottom 50% of users spend about $264 [2]. Therefore, addressing medical-conditions and promoting health-and-wellness strategies for super-utilizers could help in controlling overall healthcare costs [3].
