The NHS in England will "struggle to cope" this winter unless more beds can be freed up in care homes and other community settings, the Nuffield Trust has warned.
According to the health research group, just 3.6 per cent of patients took up more than a third of hospital beds last winter.
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Targeted help for this small group of patients, such as finding them intermediate care beds in the community, could free up beds in hospitals and help NHS trusts to meet the four-hour A&E target, said the group.
Nuffield Trust said the research helps to explain why the health service still suffered a winter crisis last year, despite receiving record extra funding of almost £700m specifically to deal with the pressures caused by winter.
A string of trusts declared major incidents, or 'black alerts', whereby they had to refuse new admissions and the four-hour A&E standard was the worst in a decade.
With no extra funding allocated for winter this year, the NHS could suffer an even worse crisis in the coming months, said researchers.
An NHS England spokesman said: "It's important patients who are well enough to leave hospital can do so at the earliest opportunity and are treated with dignity and compassion."
Rob Webster, chief executive of the NHS Confederation, which represents hospitals, told the BBC: "Hospitals under pressure has become the status quo, and this winter is unlikely to be any different. The solution often clearly lies outside of the walls of our hospitals and into communities."