High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics

BMC Health Services Research

Vivek Goel¹  Heather Manson⁴  Andrew Calzavara²  Walter P Wodchis³  Tiffany Fitzpatrick⁴  Laura C Rosella⁴ 

[1] Institute of Health Management Policy and Evaluation, University of Toronto, Suite 425, 155 College Street, Toronto M5T 3M7, ON, Canada;Institute for Clinical Evaluative Sciences, Room 424, 155 College Street, Toronto, ON, Canada;Toronto Rehabilitation Institute, 550 University Avenue, Toronto M5G 2A2, ON, Canada;Public Health Ontario, 480 University Avenue, Suite 300, Toronto M5G 1V2, ON, Canada

关键词: Canadian Community Health Survey;    Population perspective;    Upstream determinants;    High-cost users;    Health care utilization;   

Others  :  1092497
DOI  :  10.1186/s12913-014-0532-2

 received in 2014-03-25, accepted in 2014-10-17,  发布年份 2014

【 摘 要 】

Background

Health care spending is overwhelmingly concentrated within a very small proportion of the population, referred to as the high-cost users (HCU). To date, research on HCU has been limited in scope, focusing mostly on those characteristics available through administrative databases, which have been largely clinical in nature, or have relied on ecological measures of socio-demographics. This study links population health surveys to administrative data, allowing for the investigation of a broad range of individual-level characteristics and provides a more thorough characterization of community-dwelling HCU across demographic, social, behavioral and clinical characteristics.

Methods

We linked three cycles of the Canadian Community Health Survey (CCHS) to medical claim data for the years 2003–2008 for Ontario, Canada. Participants were ranked according to gradients of cost (Top 1%, Top 2-5%, Top 6-50% and Bottom 50%) and multinomial logistic regression was used to investigate a wide range of factors, including health behaviors and socio-demographics, likely associated with HCU status.

Results

Using a total sample of 91,223 adults (18 and older), we found that HCU status was strongly associated with being older, having multiple chronic conditions, and reporting poorer self-perceived health. Specifically, in the fully-adjusted model, poor self-rated health (vs. good) was associated with a 26-fold increase in odds of becoming a Top 1% HCU (vs. Bottom 50% user) [95% CI: (18.9, 36.9)]. Further, HCU tended to be of lower socio-economic status, former daily smokers, physically inactive, current non-drinkers, and obese.

Conclusions

The results of this study have provided valuable insights into the broader characteristics of community-dwelling HCU, including unique demographic and behavioral characteristics. Additionally, strong associations with self-reported clinical variables, such as self-rated general and mental health, highlight the importance of the patient perspective for HCU. These findings have the potential to inform policies for health care and public health, particularly in light of increasing decision-maker attention in the sustainability of the health care system, improving patient outcomes and, more generally, in order to achieve the common goal of improving population health outcomes.

【 授权许可】

   
2014 Rosella et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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