Because of their number of illnesses and physical limitations, the 12 million sickest people have much higher health expenses than other kinds of sick adults, as well as the overall population.
The average annual health spending per person for the sickest adults is $21,021. That's almost three times the $7,526 per capita annual spending of adults with at least three chronic illnesses but no functional limitations, one of the reports noted. And it's more than four times what is spent on average for adults, $4,845.
The amount of annual out-of-pocket expenses for medical services — the share not covered by insurance and personally owed by a patient — was an average $1,669 for the sickest adults, according to the Commonwealth Fund. That's more than twice the average annual out-of-pocket expenses for all adults, who spend $702.
Yet the median household income of the sickest adults is less than half that of the overall population.
"We are asking the sickest people to pay the most, when they have the lowest incomes," said Gerard Anderson, a co-author of the studies and a professor at Johns Hopkins Bloomberg School of Public Health.
At the same time, "this much higher level of spending care does not appear to buy consistently better access and care experiences," one of the studies noted.
A total of 20 percent of the sickest patients reported having an unmet medical need, defined as either not getting or delaying necessary medical care or medications. That compares with just 12 percent of adults who have at least three chronic illnesses but no functional limitation, and 8 percent of the total adult population.
Unmet medical need was highest among the sickest Americans with private health insurance, according to one of the studies.