Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
BMJ Open. 2019 Oct 28;9(10):e028637. doi: 10.1136/bmjopen-2018-028637.
To describe healthcare use and spending before and on becoming a new (incident) senior high-cost user (HCU) compared with senior non-HCUs; to estimate the incremental costs, overall and by service category, attributable to HCU status; and to quantify its monetary impact on the provincial healthcare budget in Ontario, Canada.
We conducted a retrospective, population-based comparative cohort study using administrative healthcare records. Incremental healthcare utilisation and costs were determined using the method of recycled predictions allowing adjustment for preincident and incident year values, and covariates. Estimated budget impact was computed as the product of the mean annual total incremental cost and the number of senior HCUs.
Incident senior HCUs were defined as Ontarians aged ≥66 years who were in the top 5% of healthcare cost users during fiscal year 2013 (FY2013) but not during FY2012. The incident HCU cohort was matched with senior non-HCUs in a ratio of 1 HCU:3 non-HCU.
Senior HCUs (n=175 847) reached the annual HCU threshold of CAD$10 192 through different combinations of incurred costs. Although HCUs had higher healthcare utilisation and costs at baseline, HCU status was associated with a substantial spike in both, with prolonged hospitalisations playing a major role. Twelve per cent of HCUs reached the HCU expenditure threshold without hospitalisation. Compared with non-HCUs (n=5 27 541), HCUs incurred an additional CAD$25 527 per patient in total healthcare costs; collectively CAD$4.5 billion or 9% of the 2013 Ontario healthcare budget. Inpatient care had the highest incremental costs: CAD$13 427, 53% of the total incremental spending.
Costs attributable to incident senior HCU status accounted for almost 1/10 of the provincial healthcare budget. Prolonged hospitalisations made a major contribution to the total incremental costs. A subgroup of patients that became HCU without hospitalisation requires further investigation.
描述新（新发）高级高成本使用者（HCU）成为 HCU 之前和之后的医疗保健使用和支出情况；估计与 HCU 状态相关的增量成本，包括总体成本和服务类别成本；并量化其对加拿大安大略省省级医疗保健预算的货币影响。
我们使用行政医疗记录进行了回顾性、基于人群的比较队列研究。使用循环预测法确定了增量医疗保健利用和成本，该方法允许调整发病前和发病当年的值以及协变量。估计的预算影响是平均年总增量成本与高级 HCU 数量的乘积。
新发高级 HCU 定义为在 2013 财年（FY2013）医疗费用使用者中排名前 5%但在 FY2012 年中不属此类的安大略省≥66 岁的老年人。新发 HCU 队列与高级非 HCU 按 1：3 的比例匹配。
高级 HCU（n=175847）通过不同的费用累计组合达到了每年 10192 加元的 HCU 门槛。尽管 HCU 在基线时具有更高的医疗保健利用率和成本，但 HCU 状态与两者都有显著的增加有关，其中住院时间延长起着主要作用。12%的 HCU 在没有住院的情况下达到了 HCU 支出门槛。与非 HCU（n=527541）相比，HCU 患者的总医疗保健费用增加了 25527 加元/人；总计 45 亿加元或 2013 年安大略省医疗保健预算的 9%。住院治疗的增量成本最高：13427 加元，占总增量支出的 53%。
与新发高级 HCU 状态相关的成本占省级医疗保健预算的近 1/10。延长住院时间对总增量成本做出了重大贡献。需要进一步调查没有住院而成为 HCU 的患者亚组。
