Table 2

Predisposing, enabling and need factors for high-cost patients

VariablesNumber of studies
Predisposing factors
Age3217 20–22 24–31 34–36 57 59–62 65 67–72 76 77 79 81 82
 Gender=male917 18 20 22 26 27 36 78 83
 Gender=female1617 19 20 24 25 29–31 59–61 65 67 72 75 81
 Ethnicity=black/African–American426–28 82
 Ethnicity=white521 24 61 67 83
 Ethnicity=less likely black or Hispanic331 67 83
 Ethnicity=less likely immigrant121
 Ethnicity=less likely whites2 75 76
 Region426 67 72 74
 Urban residence619 26 28 34 36 75
 Rural residence2 22 72
 Living institutionalised320 27 66
 Employment status: early retiree172
 Job satisfaction160
 Marital status: divorced/widow/separated/living alone2 34 65
 Dependents less likely to incur high costs170
 Receive care in many census divisions127
 Harmful habits324 60 79
 Union membership172
 Education: less than a high-school degree (neighbourhod level)176
Enabling factors
 Health insurance
  Medicare: more likely dual eligible626–28 39 75 82
  Medicaid: specific eligibility status436 61 67 83
  Commercial: increased insurance2 59 72
  Total population: insurance status had no effect131
  Type of insurance170
 Income
  Positive relation with high costs331 65 72
  Negative relation518 21 22 71 81
  No relation324 27 34
 Organisational enabling factors
 Primary care physician supply126
 Specialist physician supply126
 Hospital bed supply126
 Medical specialist as usual source of care127
 Proportion of physicians who are medical specialists2 28 27
 Inadequate time during office visits127
 Proportion of providers operating for profit2 28 27
 Teaching hospitals128
 Low nurse-to-staffing ratios128
 Low supply of long-term care beds128
 Regular medical doctor or hospital179
 Regular medical doctor (negative relation)124
Need factors
 A00–B99 Certain infectious and parasitic diseases915 17 20 21 25 62 65 72 83
 C00–D48 Neoplasms2115 17 21 22 25 26 28 29 34 35 37 38 72 73 75–78 81 82 85
 D50–D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism416 20 35 81
 E00–E90 Endocrine, nutritional and metabolic diseases3216 17 20–22 25 26 28–30 32–34 36 37 58–60 62 66–68 70 73 75 77–79 81 82 84 85
 F00–F99 Mental and behavioural disorders349 15–18 20–22 24 26 28 29 33 36 38 39 60–63 66 67 70–73 75 77–79 81–83 85
 G00–G99 Diseases of the nervous system1017 20 25 32 37 38 62 75 81 83
 H00–H59 Diseases of the eye and adnexa517 21 36 38 81
 I00–I99 Diseases of the circulatory system369 15–18 20–22 26 28 29 32–35 37–39 58–60 62 66 68 70 72 73 75–79 81 82 84 85
 J00–J99 Diseases of the respiratory system309 15–17 20–22 26 28–30 32 34 36–38 58 59 62 65 67 70 73 75 77–79 81 82 84
 K00–K93 Diseases of the digestive system917 18 20 21 38 72 73 81 83
 L00–L99 Diseases of the skin and subcutaneous tissue517 20 21 36 81
 M00–M99 Diseases of the musculoskeletal system and connective tissue159 17 20 21 28 35 60 62 72 73 75 77 78 81 85
 N00–N99 Diseases of the genitourinary system229 16 17 20–22 26 28–30 32 34 35 37 38 70 72 73 75 78 81 82
 O00–O99 Pregnancy, childbirth and the puerperium515 36 39 63 81
 Q00–Q99 Congenital malformations, deformations and chromosomal abnormalities132
 R00–R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified617 21 36 60 78 81
 S00–T98 Injury, poisoning and certain other consequences of external causes915 17 21 36 38 72 75 76 78
 Z00–Z99 Factors influencing health status and contact with health services317 21 38
 Chronic illness2215 17 20 24 28–30 32–34 36 39 57 59 69 70 73 75 77 81 82 85
 Multimorbidity/burden of comorbid illness319 17 19 20 24–27 29 35 36 39 57 58 60 63 64 68–70 72–75 77 81–85
 Decedents/survival1415–17 19 20 27 31–33 36 57 75 81 82
 Activities daily living731 34 59 65 66 69 74
 Health status924 31 33 34 37 59 65 69 74