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UBC Reports | Vol. 49 | No. 9 | Sep. 4, 2003

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’ conditions.

The group accounted for more than 60 per cent of all hospital days and almost a third of total payments made to physicians by MSP.

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 we’ll save money, but more importantly, we’ll 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.

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Last reviewed 22-Sep-2006

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