A 3-year study of high-cost users of health care

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.

Figure 1:

Cost distribution across health care sectors in 2011/12, by deciles of cost. *Lowest decile with no spending omitted.

Figure 2:

Cost distribution across health care sectors in 2011/12 for the total study population, for people in the top 1% cost group and for those in the top 1% cost group who had no acute care costs.

Figure 3:

Distribution of total expenditures across cost percentiles (< 50th, 50th–89th, 90th–94th, 95th–98th, 99th), by age group. The bar on the far left represents the percentiles of the study population ranked from lowest to highest cost.