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A 3-year study of high-cost users of healthcare


Background — Characterizing high-cost users of healthcare resources is essential for the development of appropriate interventions to improve the management of these patients. We sought to determine the concentration of healthcare spending, characterize demographic characteristics and clinical diagnoses of high-cost users and examine the consistency of their healthcare consumption over time.

Methods — We conducted a retrospective analysis of all residents of Ontario, Canada, who were eligible for publicly funded healthcare between 2009 and 2011. We estimated the total attributable government healthcare spending for every individual in all healthcare sectors.

Results — More than $30 billion in annual health expenditures, representing 75% of total government healthcare 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 healthcare costs were concentrated in a small minority of the population, these related to a diverse set of patient healthcare needs and were incurred in a wide array of healthcare settings. Improving the sustainability of the healthcare system through better management of high-cost users will require different tactics for different high-cost populations.



Wodchis WP, Austin PC, Henry DA. CMAJ. 2016; 188(3):182-8. Epub 2016 Jan 11.

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