The effect of socio-demographic factors on mental health and addiction high-cost use : a retrospective, population-based study in Saskatchewan

Anderson, Maureen and Revie, Crawford W. and Quail, Jacqueline M. and Wodchis, Walter and de Oliveira, Claire and Osman, Meriç and Baetz, Marilyn and McClure, J. and Stryhn, Henrik and Buckeridge, David and Neudorf, Cordell (2018) The effect of socio-demographic factors on mental health and addiction high-cost use : a retrospective, population-based study in Saskatchewan. Canadian Journal of Public Health. pp. 1-11. ISSN 1920-7476

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    Abstract

    OBJECTIVE: A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan. METHODS: We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009-2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study ('persistent high-cost use'). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents. RESULTS: The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased. CONCLUSION: Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.