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A Look at People Who Have Persistently High Spending on Health Care

This analysis looks at the amounts and types of health spending for people with employer-based health insurance who have continuing high health care spending.

It finds that, among people with three consecutive years of coverage from a large employer, just 1.3 percent of enrollees accounted for almost 20 percent of overall spending in 2017. This group – people in the top five percent of spending in each of the three years from 2015 to 2017 – had average health spending of $87,870 in 2017. That compared to average per person spending of $5,870 among all large group enrollees during that period. Spending on retail prescription drugs accounted for almost 40 percent spending for those with persistently high spending in 2017, more than twice the percentage for enrollees overall.

The analysis also finds a close association between having persistently high spending and being diagnosed with certain chronic health conditions such as HIV, multiple sclerosis, cystic fibrosis, rheumatoid arthritis, diabetes with complications, and a number of cancers. While not everyone with these conditions has persistently high spending, there are large shares of people with persistently high spending who have these diseases.

Overall, health spending is highly concentrated: a small share of people account for most health care spending in any year. This group changes from year to year as some people experience serious illness and recover, but a portion of the group continues to have high spending for longer periods.  Their extensive health needs and predictably high spending make them an important focus for any efforts to lower costs and improve quality.

The analysis is part of the Peterson-Kaiser Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.