A 3-year study of high-cost users of health care
Open Access
- 11 January 2016
- journal article
- Published by CMA Impact Inc. in CMAJ : Canadian Medical Association Journal
- Vol. 188 (3), 182-188
- https://doi.org/10.1503/cmaj.150064
Abstract
Background: Characterizing high-cost users of health care resources is essential for the development of appropriate interventions to improve the management of these patients. We sought to determine the concentration of health care spending, characterize demographic characteristics and clinical diagnoses of high-cost users and examine the consistency of their health care consumption over time. Methods: We conducted a retrospective analysis of all residents of Ontario, Canada, who were eligible for publicly funded health care between 2009 and 2011. We estimated the total attributable government health care spending for every individual in all health care sectors. Results: More than $30 billion in annual health expenditures, representing 75% of total government health care spending, was attributed to individual costs. One-third of high-cost users (individuals with the highest 5% of costs) in 2009 remained in this category in the subsequent 2 years. Most spending among high-cost users was for institutional care, in contrast to lower-cost users, among whom spending was predominantly for ambulatory care services. Costs were far more concentrated among children than among older adults. The most common reasons for hospital admissions among high-cost users were chronic diseases, infections, acute events and palliative care. Interpretation: Although high health care costs were concentrated in a small minority of the population, these related to a diverse set of patient health care needs and were incurred in a wide array of health care settings. Improving the sustainability of the health care system through better management of high-cost users will require different tactics for different high-cost populations.Keywords
This publication has 12 references indexed in Scilit:
- For Many Patients Who Use Large Amounts Of Health Care Services, The Need Is Intense Yet TemporaryHealth Affairs, 2015
- New evidence on the persistence of health spending.Medical Care Research and Review, 2015
- Where Are the Health Care Cost Savings?JAMA, 2012
- The Effect of Guided Care Teams on the Use of Health ServicesJAMA Internal Medicine, 2011
- Variations in Lifetime Healthcare Costs across a Population.2008
- Geriatric Care Management for Low-Income SeniorsJAMA, 2007
- Geriatric Resources for Assessment and Care of Elders (GRACE): A New Model of Primary Care for Low‐Income SeniorsJournal of the American Geriatrics Society, 2006
- Integrated Services for Frail Elders (SIPA): A Trial of a Model for CanadaCanadian Journal on Aging / La Revue canadienne du vieillissement, 2006
- Des services intégrés pour les personnes âgées fragiles (SIPA): expérimentation d'un modèle pour le CanadaCanadian Journal on Aging / La Revue canadienne du vieillissement, 2006
- Neuroleptic Drug Therapy in Older Adults Newly Admitted to Nursing Homes: Incidence, Dose, and Specialist ContactJournal of the American Geriatrics Society, 2004