International Collaborative on Costs, Outcomes, and Needs in Care

Performing international comparisons of high-need, high-cost individuals across the trajectory of healthcare.

LSE Health Research Team: Irene Papanicolas, Alberto Marino
Start Date: The Collaborative was founded in 2018
Regions: North America, Europe, Pacific
Keywords: International comparisons, high need high cost patients, health care spending

ICCONIC is a collaboration of researchers from 12 countries performing a series of international comparisons of high-need, high-cost individuals across the trajectory of healthcare.

Although health systems around the world are diverse, they all have similar goals: maximizing quality of care for their populations, offering services that are responsive to patient needs, and providing value for money.

One key challenge facing many health systems is how to best design services to provide care to a small number of high-need, high-cost individuals. This is a clinically diverse group of patients ranging from individuals who live with extreme functional limitations, others with persistent behavioural health challenges, and still others with multiple, complex chronic illnesses. These individuals often use high levels of health care services, tend to experience worse patient outcomes, and are often quite expensive to care for.

For these reasons, high-need, high-cost populations are arguably the group that stands to benefit the most from a better understanding of the effectiveness of different delivery systems. Despite the enormous importance of this population, there is limited comparable data on how common these types of patients are across countries, and how patterns of utilization and cost differ across health systems. This lack of information limits the potential for mutual learning and potential policy transfer across countries.

 ICCONIC hopes to address this problem by developing a novel methodology for comparing cost, utilization, and outcomes of high-need, high-cost populations across different healthcare systems.

ICCONIC has received funding from the Commonwealth Fund and the Health Foundation.


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