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The risk of becoming a high-​cost user of health care strongly linked to socio-​economic status

May 8/2015

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

High-cost users of health care generally refer to the top five per cent of health care users. They are a small portion of the population who consume a disproportionately high share of health care 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, assistant professor at the Dalla Lana School of Public Health and an adjunct scientist at ICES.

“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 health care and that the ‘problem’ of high-cost users is rooted not only in chronic disease and suboptimal health care, but also in the growing inequities in Canadian society.

Despite high-cost users’ significant impact on the health care 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 health care 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 health care use, factors must be addressed from within and outside the health care 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 health care by aligning public health and health care goals,” added Rosella, also a scientist at PHO.

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