Nearly one-tenth of provincial healthcare budget spent on senior high-cost users

29/10/2019

In Ontario, nearly 10 per cent of the provincial healthcare budget is spent on senior high-cost users, according to a new study conducted at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. The researchers found that 40 per cent of those costs came from hospital admissions.

The researchers looked at new, senior high-cost users who were defined as individuals aged 66 years or older with annual total healthcare spending in the top 5 per cent of all Ontarians in 2013, and who were not in the top 5 per cent of healthcare spending in 2012.

The study, published today in BMJ Open, found costs attributable to new, senior high-cost users accounted for almost one-tenth of the provincial healthcare budget. Prolonged hospitalizations made a major contribution to the total incremental costs.

“In order to be defined as a high-cost user, the annual threshold in this study was $10,192. In approximately 40 per cent of high-cost users, the threshold was exceeded due to expenditures in a single health service category, usually hospital stays,” says Michael Paterson, an author of the study and core scientist at ICES.

The researchers found that senior, high-cost users incurred $25,527 per patient in total healthcare costs more than non-high-cost users, which collectively cost $4.5 billion or 9 per cent of the 2013 Ontario healthcare budget.

“Our study shows that senior high-cost users were already on an upward trajectory during the year before becoming high-cost users, showing higher healthcare utilization and costs. However, a spike in healthcare expenditures put them in the top five per cent of healthcare spending,” says lead author Sergei Muratov, who completed the study as part of his doctoral thesis at McMaster University, Hamilton.

In Canada, where public health and healthcare are under provincial jurisdiction, on average, health spending accounts for 37 per cent of the total provincial program spending.

The researchers add that approximately 12 per cent of senior high-cost users in this study had no hospitalization in the year that they became a high-cost user. Instead, they achieved high-cost user status by incurring costs largely on physician services and prescription medications.

The study “Incremental healthcare utilisation and costs among new senior high-cost users in Ontario, Canada: a retrospective matched cohort study,” was published in BMJ Open. doi: 10.1136/bmjopen-2018-028637

Author block: Sergei Muratov, Justin Lee, Anne Holbrook, Jason R Guertin, Lawrence Mbuagbaw, J Michael Paterson, Tara Gomes, Priscila Pequeno and Jean-Eric Tarride.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario