High Users of Hospital Care

BACKGROUNDEfforts to curb healthcare spending have included interventions that target frequently hospitalized individuals. It is unclear the extent to which the most frequently hospitalized individuals also represent the costliest individuals.OBJECTIVETo examine the relationship between 2 types of “high users” commonly targeted in cost‐containment interventions—those incurring the highest hospital costs (“high cost”) and those incurring the highest number of hospitalizations (“high admit”).DESIGN, SETTING, AND PATIENTSCross‐sectional study of 2566 individuals with a primary care physician and at least 1 hospitalization within an academic health system from 2010 to 2011.MEASUREMENTSOverlap between the population constituting the top decile of hospital costs and the population constituting the top decile of hospitalizations; characteristics of the 3 resulting high user subgroups.RESULTSOnly 48% of individuals who were high cost (>$65,000) were also high admit (≥3 hospitalizations). Compared to hospitalizations incurred by high cost–high admit individuals (n？=？605), hospitalizations incurred by high cost–low admit individuals (n？=？206) were more likely to be for surgical procedures (58 vs 22%, P