. 2018 Dec;109(5-6):810-820.

doi: 10.17269/s41997-018-0101-2. Epub 2018 Jun 28.

The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan

Maureen Anderson^{1

2}, Crawford W Revie³, Jacqueline M Quail^{4

5}, Walter Wodchis^{6

7}, Claire de Oliveira^{6

7

8}, Meriç Osman⁴, Marilyn Baetz^{5

9}, J McClure³, Henrik Stryhn³, David Buckeridge¹⁰, Cordell Neudorf^{5

9}

Affiliations

¹ Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada. manderson@hqc.sk.ca.
² Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada. manderson@hqc.sk.ca.
³ Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada.
⁴ Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
⁵ College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
⁷ Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
⁸ Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada.
⁹ Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada.
¹⁰ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.

PMID: 29981109
PMCID: PMC6267642
DOI: 10.17269/s41997-018-0101-2

The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan

Maureen Anderson et al. Can J Public Health. 2018 Dec.

. 2018 Dec;109(5-6):810-820.

doi: 10.17269/s41997-018-0101-2. Epub 2018 Jun 28.

Authors

Affiliations

¹ Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada. manderson@hqc.sk.ca.
² Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada. manderson@hqc.sk.ca.
³ Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada.
⁴ Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
⁵ College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
⁷ Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
⁸ Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada.
⁹ Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada.
¹⁰ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.

PMID: 29981109
PMCID: PMC6267642
DOI: 10.17269/s41997-018-0101-2

Abstract
in English, French

Objective: A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan.

Methods: We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009-2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study ('persistent high-cost use'). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents.

Results: The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased.

Conclusion: Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.

Objectif: Une faible proportion de la population compte pour la majorité des coûts des soins de santé. Les patients en santé mentale et en toxicomanie (SMT) engendrent systématiquement des coûts élevés. Nous avons cherché à délimiter les facteurs qui se prêteraient à des mesures de santé publique susceptibles de réduire l’utilisation à coût élevé dans une cohorte d’usagers en SMT de Saskatoon (Saskatchewan).

Méthode: Nous avons mené une étude de cohorte populationnelle rétrospective. Les données administratives sur la santé des exercices 2009 à 2015, jumelées au niveau individuel, ont été analysées (n = 129 932). Le résultat qui nous intéressait était ≥ au 90^e centile des coûts pour chaque exercice à l’étude (« utilisation à coût élevé persistante »). Des analyses descriptives ont été suivies par des modèles de régression logistique; ces derniers ont exclu les résidents en soins de longue durée.

Résultats: Le coût moyen des soins de santé chez les membres de la cohorte étudiée était d’environ 2300 $ durant l’exercice 2009; pour les utilisateurs à coût élevé, il était d’environ 19 000 $. Les personnes vivant dans des conditions de logement précaires et ayant été hospitalisées une ou plusieurs fois présentaient un risque accru d’utilisation à coût élevé persistante; les deux effets s’accentuaient avec la présence de comorbidités. Les patients schizophrènes, surtout ceux de moins de 50 ans, présentaient une probabilité accrue d’utilisation à coût élevé persistante. La probabilité d’utilisation à coût élevé persistante diminuait avec la qualité du lien vers un dispensateur de soins primaires; cet effet s’accentuait avec l’augmentation du nombre de troubles de santé mentale.

Conclusion: Bien qu’ils n’aient constitué que 5 % de la cohorte à l’étude, les usagers en SMT faisant une utilisation à coût élevé persistante des soins de santé (n = 6455) comptaient pour ~ 35 % des coûts totaux. Les efforts pour réduire l’utilisation à coût élevé devraient se concentrer sur la réduction des comorbidités, sur le lien vers un dispensateur de soins primaires (surtout pour les patients présentant plus d’un problème de SMT) et sur les jeunes patients schizophrènes, et ils devraient suffisamment tenir compte de la précarité du logement.

Keywords: High-cost users; Mental health and addictions; Social determinants of health.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest. This study is based in part on de-identified data provided by the Saskatchewan Ministry of Health and eHealth Saskatchewan. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan, the Saskatchewan Ministry of Health, or eHealth Saskatchewan. Data used in this report were also made available by the Saskatoon Regional Health Authority. Any opinions expressed by the authors do not necessarily reflect the opinion of the Saskatoon Regional Health Authority.

Figures

**Fig. 1**
Study cohort inclusion/exclusion criteria

**Fig. 2**
Mental health and addiction study cohort by total yearly cost, Saskatoon Health Region, Saskatchewan, FY 2009–2015 (n = 129,932)

See this image and copyright information in PMC

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The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan

Affiliations

The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Abstract in English, French

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Abstract
in English, French