UBC Reports | Vol. 49 | No. 9 | Sep.
Seriously Sick or Simply Sniffling?
Health policy researchers target heavy service users
By Hilary Thomson
Are the people receiving the most health-care services really
ill or are they healthy people overusing the system?
A group of UBC researchers at the Centre for Health Services
and Policy Research recently answered this question in the
first study in B.C. to look at how high users of health care
differ from other residents. It is the first study in Canada
in the last several decades to look at the issue in a comprehensive
way, rather than analyzing costs of particular types of services.
We wanted to provide policy-makers with a better understanding
of high users of physician services, says Rob Reid,
assistant professor of health care and epidemiology and lead
author on the study. If we have details about the users
we should be able to draft better strategies to care for this
group and save health care dollars.
The research team analyzed data on nearly three million adults
registered in the B.C. Medical Services Plan (MSP) in 1996/97
and ranked them according to dollars spent in physician services.
These include dollars paid to general practitioners and specialists
working in offices and hospitals.
A group of 126,000 individuals were classed as high users
of services. This group saw more than three times as many
different doctors as other users and they visited their doctors
at five times the rate of other users. Also, those visits
were more costly because of the complicated nature of patients
The group accounted for more than 60 per cent of all hospital
days and almost a third of total payments made to physicians
The most striking feature of this user group was not age
but the complexity and extent of their health problems. More
than 80 per cent of high users had at least six different
types of illness and almost one-third had 10 or more.
A common perception has been that people are overusing
the system, so cutting down on services or charging more user
fees will save money, says Reid. That strategy
would hit this population hard. They are genuinely and seriously
ill and require the attention they are receiving. Extra charges
would be like a tax on illness.
The findings indicate that the system is operating fairly
because larger shares of available resources are directed
to those who need them, he adds.
The study focused on B.C. but Reid says he would expect similar
results across Canada.
The challenge to our health-care system is to provide
co-ordinated, multidisciplinary care, rather than treating
one disease at a time, he says. That way well
save money, but more importantly, well be able to give
better care to those who need the services most.
Particular savings could be found by integrating care for
major psychiatric and chronic medical conditions, he adds.
The report has been issued to provincial policy-makers. For
more information on the study, visit www.chspr.ubc.ca.