The Hidden Costs of Short-Term Care

In the Netherlands, a type of post-acute care called short-term residential care (STRC) is designed to help older adults recover and return home. However, the reality is that less than half of patients who enter STRC are able to go back to living on their own.

The cost of this care varies greatly from one patient to another. Researchers looked at the medical bills of nearly 16,300 patients who were admitted to STRC between February and July 2022. They found that the average cost of care over six months was around €29,859. But when they dug deeper, they discovered that some patients were much more expensive to care for than others.

There were three main groups of patients. One group was receiving palliative care, which is focused on comfort rather than curing a condition. This group had 3,277 patients and cost around €23,200 on average. A second group of 9,796 patients had relatively low costs, averaging €22,723. But a third group of 3,205 patients had much higher costs, with an average bill of €58,478.

These high-cost patients accounted for 39% of the total costs. They were more likely to end up in the hospital again within two weeks of being discharged, and they were also more likely to be sent to a nursing home. Patients with dementia, or those who had had a stroke, cancer, or heart disease, were more likely to be in this high-cost group.

The study suggests that the way care is delivered, rather than the patients' conditions, is a big factor in the variation in costs. This has important implications for how to improve the system. For example, better support for patients to transition back to living at home could help reduce costs. The study also highlights the need to carefully consider whether STRC is the right choice for patients who may end up needing to move to a nursing home. And it suggests that hospitals and care providers should take a closer look at how they are using hospital resources during STRC episodes.

The researchers used a type of modeling to identify the different cost trajectories. They found that routinely available information about patients, such as their diagnosis and living situation, was not very good at predicting which patients would be high-cost. This suggests that other factors, such as the quality of care and the way services are coordinated, may play a bigger role in determining costs.

The study used national health claims data from Statistics Netherlands. The data included information on reimbursed costs across seven categories of care. The researchers measured costs from one month before admission to STRC, and then for five months after admission.

The findings of this study have important implications for policymakers and healthcare providers. They suggest that a more nuanced approach to understanding cost variation is needed, one that takes into account the complex interactions between patients, providers, and the healthcare system. By understanding these interactions, it may be possible to identify new ways to improve the efficiency and effectiveness of care.