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papers

Conspicuous consumption: characterizing high users of physician services in one Canadian province

Published: October 1, 2003
Category: Papers
Authors: Barer M, Evans R, Hertzman C, Kerluke K, McGrail K, Pagliccia N, Reid R, Sheps S
Country: Canada
Language: null
Type: Care Management
Settings: Academic, Hospital

J Health Serv Res Policy 8:215-224. http://www.ncbi.nlm.nih.gov/pubmed/14596756.

Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada

OBJECTIVES: To examine medical care use and costs, patterns of morbidity and co-morbidity, and other patient characteristics of high users of physician services in British Columbia.

METHODS: This population-based study uses physician claims, hospital discharge summaries and vital statistics data linked at the level of the individual to compare characteristics of high users, other users and non-users of physician services in the Province of British Columbia, Canada. The study included all enrolled adults in the universal health care plan during fiscal year 1996/97. High users were defined as the most costly 5% of users of fee-reimbursed services. Key variables included age, sex, an ecological socio-economic status indicator and a comprehensive set of morbidity indicators, derived from the diagnoses recorded on the utilization records.

RESULTS: The top 5% of users consumed a disproportionate 30% of spending on physician services. High users were overwhelmingly characterized by a significant burden of morbidity. Over 80% had at least six different types of morbidity during the study year compared with fewer than 20% of other users. High users were also much more likely to have major diagnoses that were both acute and chronic in nature. Co-morbidity involving psychosocial and chronic medical conditions was also very common.

CONCLUSIONS: High users of physician services are overwhelmingly characterized by multiple and complex health problems. Policy tools based on a philosophy of deterrence such as cost-sharing are unlikely to have much impact on their costs and will likely do considerable harm.

PMID: 14596756

Medical Conditions,Cost Burden Evaluation,Practice Patterns Comparison,Total Morbidity Burden,Canada,Adolescent,Adult,Age Factors,Aged,Ambulatory Care/economics,Ambulatory Care/utilization,Co-morbidity,Diagnosis-Related Groups/classification,Diagnosis-Related Groups/statistics & numerical data,Fee-for-Service Plans/utilization,Health Services Needs and Demand/economics,Hospitalization/economics,Hospitalization/statistics & numerical data,International Classification of Diseases,Middle Aged,National Health Programs/economics,Physicians/economics,Socioeconomic Factors

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