Media Releases

New study reveals Ontario’s high-cost healthcare users

March 7, 2016

Toron­to, ON – A new study exam­in­ing high-cost health­care users in Ontario released by researchers at the Uni­ver­si­ty of Toron­to has iden­ti­fied the types of patients who are high-cost users, the con­tin­u­ums of care that pro­pel these high costs, and what the costs of this care were.

“Who are the high-cost users? A method for per­son-cen­tred attri­bu­tion of health­care spend­ing” employed a new approach to deter­mine the indi­vid­ual patients who are the dri­vers of health­care spend­ing. By seek­ing to under­stand costs by fol­low­ing indi­vid­u­als who con­sume a large por­tion of the over­all costs, this infor­ma­tion can be used to inform and tar­get improve­ments in effi­cien­cy, effec­tive­ness, and enhanced qual­i­ty of care.

“In look­ing at the issue of high-cost users from this unique per­spec­tive,” said lead author Dr. Sara Guilch­er, Assis­tant Pro­fes­sor at the Leslie Dan Fac­ul­ty of Phar­ma­cy, “we were able to con­struct per­son-cen­tred episodes of care, track­ing patients’ care jour­neys from their first point of con­tact in an acute care set­ting through any sub­se­quent care until they had recov­ered and returned to the com­mu­ni­ty.”

Using data from health admin­is­tra­tion data­bas­es housed at the Insti­tute for Clin­i­cal Eval­u­a­tive Sci­ences (ICES), the study exam­ined all pub­licly fund­ed health sys­tem encoun­ters in Ontario over a one-year peri­od. Using unique encod­ed iden­ti­fiers, the study essen­tial­ly fol­lowed patients on their jour­ney through the health­care sys­tem as they received care from var­i­ous health­care providers, went through tests, and engaged in the recov­ery process. Ulti­mate­ly, this approach estab­lished broad cat­e­gories or arche­types for high-cost users.

“Because tran­si­tions involve care across dif­fer­ent providers, it is essen­tial to use a patient per­spec­tive and mea­sure indi­vid­u­als’ tran­si­tions over time,” said senior author Dr. Wal­ter Wod­chis, Asso­ciate Pro­fes­sor of the Insti­tute for Health Pol­i­cy, Man­age­ment and Eval­u­a­tion at the Uni­ver­si­ty of Toron­to.

By con­struct­ing high-cost health sys­tems users in this way, the researchers were able to iden­ti­fy the main clin­i­cal group­ings where indi­vid­u­als have inten­sive and high-cost inter­ac­tions with the health­care sys­tem.

“We dis­cov­ered that the indi­vid­u­als in the high­est fifth per­centile of health­care expen­di­tures could be mean­ing­ful­ly grouped into sev­er­al broad cat­e­gories, such as planned sur­gi­cal, unplanned med­ical, post-admis­sion events, trau­ma, men­tal ill­ness and addic­tion, and can­cer episodes,” explained Dr. Guilch­er. “In doing so, we can see how costs can be attrib­uted to indi­vid­u­als with­in the var­i­ous health­care sec­tors and use that infor­ma­tion to inform deci­sions about per­for­mance mea­sure­ment, pay­ment mod­els for high-cost patient groups, and facil­i­tate ser­vice orga­ni­za­tion, care plan­ning and pay­ment for high cost patients across all care providers.”

The study revealed that even though the num­ber of patients in some of these group­ings (for exam­ple men­tal health and addic­tions or trau­ma) may be low­er in vol­ume than oth­er group­ings (for exam­ple planned surg­eries), the costs per episode may be sig­nif­i­cant­ly more.

“Espe­cial­ly with an aging pop­u­la­tion, it is impor­tant for pol­i­cy-mak­ers to mon­i­tor the vol­ume of patients who fall into these cat­e­gories and explore new ways to pro­vide qual­i­ty ser­vices to reduce over­all episode-relat­ed costs, as even slight increas­es in vol­ume have the poten­tial to sub­stan­tial­ly increase over­all health­care costs.”

“Giv­en ris­ing health­care costs, it is increas­ing­ly impor­tant for health­care sys­tems across Cana­da to pro­vide effi­cient val­ue-based and needs-dri­ven care, espe­cial­ly for high-cost patient pop­u­la­tions,” said Dr. Guilch­er.

This study was pub­lished online in the peer-reviewed jour­nal PLOS ONE and will lat­er be pub­lished in the print edi­tion: (


 Media Con­tacts:

Jef Ekins
Man­ag­er, Mar­ket­ing & Com­mu­ni­ca­tions
Leslie Dan Fac­ul­ty of Phar­ma­cy, Uni­ver­si­ty of Toron­to
Tel: (416) 978‑7036

Sara Guilch­er, PT PhD
Assis­tant Pro­fes­sor, Uni­ver­si­ty of Toron­to
Leslie Dan Fac­ul­ty of Phar­ma­cy
Tel: 416–946-7020‑s

Wal­ter P. Wod­chis, PhD
Asso­ciate Pro­fes­sor, Uni­ver­si­ty of Toron­to
Insti­tute of Health Pol­i­cy Man­age­ment & Eval­u­a­tion
Tel: 416–946-7387