The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan

Abstract

ObjectiveA small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan.MethodsWe conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009–2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study (‘persistent high-cost use’). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents.ResultsThe average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased.ConclusionDespite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.Electronic supplementary materialThe online version of this article (10.17269/s41997-018-0101-2) contains supplementary material, which is available to authorized users.

Use of the Population Grouping Methodology of the Canadian Institute for Health Information to predict high-cost health system users in Ontario

“…Our estimates of total health care costs were lower than those reported in another recent study for Ontario, for which data were available from all health care settings. 1 This was most apparent for the highest-cost users, who have been shown by prior research to be heavier-than-average users of non-acute hospital care, continuing care services and mental health care, 1,17 the settings that were not available for our study. The top 1% of highcost users in the prior study had expenditures exceeding $44 906 in fiscal year 2011/12, which was more than double our result of $22 254 in fiscal year 2016/17, even without accounting for inflation.…”

Defining ‘actionable’ high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology

“…Measures of socio-economic status (SES), such as, unstable housing, and food insecurity, have previously been found to be associated with high-cost health care use, [4, 22, 28, 30], To the best of our knowledge this is the first population-based study to define high-cost users within their health profile group and consider SES in regression models. We hypothesize this method provides better specificity to understanding high-cost users of health care services.…”

Modeling socio-demographic and clinical factors influencing psychiatric inpatient service use: a comparison of models for zero-Inflated and overdispersed count data

“…The frequent use of inpatient mental health care may be attributable to the underlying lack of access to outpatient care [ 5 ] and substandard hospital care [ 6 , 7 ]. For example, a recent study conducted in Canada reported that having a good connection to a primary care provider decreased the probability of being a high-cost health service user [ 8 ]. Inpatient hospitalizations for patients with psychiatric disorders were reported that depend on the type of illness; that is, inpatient readmission is common for individuals with severe mental illness (e.g., schizophrenia, mood disorders, bipolar disorder and psychoses) [ 9 – 13 ].…”

“…Carriere et al [ 18 ] found that hospitalization rates for mental illness were higher for Aboriginals living on and off reserve, Metis, and Inuit than for the non-Aboriginal population, regardless of disease category. Females were found to have higher use of health facilities for psychiatric illness than males [ 8 ]. Geographical characteristics such as population density, place of residence and proximity to service have been identified as important factors in several studies.…”