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


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Publication Topics

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

Publication TypeJournal Article
Year of Publication2003
AuthorsReid R, Evans RG, Barer ML, Sheps S, Kerluke K, McGrail KM, Hertzman C, Pagliccia N
JournalJournal of health services research & policyJ.Health Serv.Res.Policy
Pages215 - 224
Date Published2003
KeywordsAdolescent, Adult, Age Factors, Aged, Ambulatory Care/economics/utilization, British Columbia/epidemiology, Comorbidity, Diagnosis-Related Groups/classification/statistics & numerical data, Fee-for-Service Plans/utilization, Female, Health Expenditures/statistics & numerical data, Health Services Needs and Demand/economics/statistics & numerical data, Hospitalization/economics/statistics & numerical data, Humans, International Classification of Diseases, Male, Middle Aged, Morbidity, National Health Programs/economics/utilization, Patient Acceptance of Health Care/statistics & numerical data, Physicians/economics/utilization, Socioeconomic Factors
AbstractOBJECTIVES: 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.
Citation Key458