CHARACTERIZATION OF INCIDENT SENIOR HIGH-COST HEALTHCARE USERS IN ONTARIO: POLICY AND RESEARCH IMPLICATIONS

Abstract

Background and Objectives: High-cost health care users (HCU) represent a minority of patients who consume a large proportion of health care resources. Due to their high burden on the healthcare system and internal heterogeneity, a better understanding of various segments of the HCU population is needed. The general objective was to advance our understanding of incident senior HCUs in the Canadian context so that we can advise health policy makers on potential strategies to prevent seniors transitioning to HCU and to identify priorities for further investigation. Methods: A retrospective population-based matched cohort study was conducted using province-wide linked administrative data. The research employed a spectrum of advanced methods to accomplish the general objective, including the method of recycled predictions, random intercept two-part multi-level models, and stratified logistic regression. Results: Total costs attributable to incident senior HCU status accounted for almost one-tenth of the provincial healthcare budget, with prolonged hospitalizations making a major contribution. Unplanned first (index) hospitalizations (IHs) in the incident year were considerably more common among HCUs, with ten conditions accounting for one third of their total costs. A lower risk of IH among HCUs was associated with residence in long-term care (LTC), attachment to a primary care provider, and recent consultation by a geriatrician. Although there was little variation in costs incurred by Ontario seniors for healthcare services they receive, access to the healthcare services varied greatly. The traditional drivers of costs and mortality (e.g., age, sex, health status) played little role in driving the observed variation in HCUs’ outcomes. Conclusions: By answering research questions, this thesis advances our knowledge of the HCU population in Canada. Further exploration of the nature and quality of care that may be associated with HCU conversion and investigation of the regional variation in accessing specific healthcare services is warranted.