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The risk of becoming a high-cost user of healthcare strongly linked to socio-economic status including income, education, homeownership and food security


Individual, household and neighbourhood socio-economic status impact future high-cost users of healthcare according to researchers at the Institute for Clinical Evaluative Sciences (ICES), the University of Toronto and Public Health Ontario (PHO).

High-cost users of healthcare generally refer to the top five per cent of healthcare users. They are a small portion of the population who consume a disproportionately high share of healthcare resources.

“We need to recognize high-cost users before their frequent and high-cost care trajectories begin. This study shows that another way to identify those at risk of becoming a high cost user is to use other information about the individual such as income, housing and food security,” said Laura Rosella, lead author, an adjunct scientist at ICES and assistant professor at the Dalla Lana School of Public Health, University of Toronto. “Ultimately, looking at the lifestyle and environmental factors that lead people to become high-cost users is crucial to improving population health, health system sustainability and quality of care in a fair and just manner.”

The researchers have shown that individual, household and neighbourhood socio-economic status impact future high-cost users of healthcare and that the ‘problem’ of high-cost users is rooted not only in chronic disease and suboptimal healthcare, but also in the growing inequities in Canadian society.

Despite high-cost users’ significant impact on the healthcare system, research on high-cost users has been limited in scope, focusing mostly on those characteristics that can be defined in administrative databases. Social or demographic characteristics of the individual have rarely been considered. However, this study examined a broadened list of characteristics that influence high-cost use.

The researchers found that future high-cost use of healthcare is strongly associated with multiple dimensions of socio-economic status including income, education, homeownership, food security and neighborhood marginalization. These findings suggest that addressing social determinants of health, such as food and housing security, may be important components of interventions aimed at improving health outcomes and subsequently reducing costs.

“In order to improve health outcomes and prevent future high-cost healthcare use, factors must be addressed from within and outside the healthcare system. Inequities in socio-economic status and health are at the core of public health; using collaborative, intersectoral approaches and policies will allow us to address high-cost users of healthcare by aligning public health and healthcare goals,” added Rosella, also a scientist at PHO.

“Looking beyond income and education: socioeconomic status gradients among future high-cost users of healthcare,” was published today in the American Journal of Preventive Medicine.

Author block: Fitzpatrick T, Rosella LC, Calzavara A, Petch J, Pinto AD, Manson H, Goel V, Wodchis WP.

ICES is an independent, non-profit organization 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.

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