05 Oct Ontarios’ High-Cost Users in Healthcare.
The Ontario government has identified that understanding and being able to identify who high-cost users (HCUs) are would help inform policy making and better management of healthcare resource utilization. A study by Rais et al. found that HCUs in Ontario (1.5% of the Ontario population), account for approximately 61% of healthcare expenditure. This is an extremely small population that is using the majority of Ontario’s healthcare resources (Rais et al., 2013).
The study found that 60% of the high-cost users stemmed from the 65+ age group accounting for 56% of costs. However, while older age groups tend to account for the majority of high-cost users, the study found that as age increased, healthcare costs associated with high-cost users decreased. They also found statistically significant evidence that showed that costs were slightly higher for male patients versus female patients, and males accounted for 65% of HCU costs (Rais et al., 2013). This study provided a few insights to high-cost users, but further research is needed to better understand HCUs.
This Ontario focused study confirms what previous studies have found – that a very small population of healthcare users consumes the majority of our healthcare resources and we need to better identify and manage these patients. The authors recommend that there should be more of a focus on the community-based delivery of care as opposed to having costly patient readmissions. They put an emphasis on coordinated care in the community within the Local Health Integration Networks (LHINs). Lastly, they recommend that interventions be put in place to help identify those patients who may become at-risk of becoming a HCU in order to improve patient outcomes and reduce the financial strain that is currently plaguing the Ontario healthcare system (Rais et al., 2013).
Similarly, a study conducted by the Hamilton Niagara Haldimand Brant (HNHB) LHIN found that 1% of the Ontario population (approximately 39,000 people) are costing our healthcare system $4.4 billion dollars a year (34% of overall costs). They identified that the HNHB LHIN had the second-most high-cost healthcare users overall (4,700 people), costing the LHIN a grand total of $523 million a year. The HNHB LHIN found that the top high-utilizing patients diagnosis’ included COPD, heart failure, diabetes, and mental health and addictions in acute care. For Emergency department visits, pain (addictions-related), mental health conditions and mental health and substance abuse were the top high-utilizing users. Similar to the study conducted by Rais et al., the study concluded that in order for our healthcare system to be sustainable, there needs to be a way to identify these patients to improve their quality of care and reduce costs through reducing readmission rates (Ontario Local Health Integration Network, 2012).
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Ontario Local Health Integration Network. (2012). ACTION: A Call To IntegratiOn Now Strategic Health System Plan 2012-2017. Retrieved from www.hnhblhin.on.ca/~/media/…/Planning…/Environmental%20Scan%20FINAL.pdf
Rais, S., Nazerian, A., Ardal, S., Chechulin, Y., Bains, N., & Malikov, K. (2013). High-Cost Users of Ontario’s Healthcare Services. Healthcare Policy, 9(1), 44–51. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999548/pdf/policy-09-044.pdf