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The phenomenon that a small percentage of patients comprise the majority of health costs is not unique to the US, nor is it unique to this moment in time. There are many studies from other countries -- in Asia, Europe etc -- and even of the US decades ago -- that all highlight the same phenomenon

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It's Pareto's Principle that a small number of patients at any particular point are going to produce most of the costs.

But that doesn't mean that way Pareto's Principle manifests isn't going to be different in different circumstances.

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