Literature and original analysis of healthcare costs have shown that a small proportion of patients consume the majority of healthcare resources. A proactive approach is to target interventions towards those patients who are at risk of becoming high-cost users (HCUs). This approach requires identifying high-risk patients accurately before substantial avoidable costs have been incurred and health status has deteriorated further. We developed a predictive

Approximately 1.5% of Ontario' s population, represented by the top 5% highest cost-incurring users of Ontario' s hospital and home care services, account for 61% of hospital and home care costs. Similar studies from other jurisdictions also show that a relatively small number of people use a high proportion of health system resources. Understanding these high-cost users (HCUs) can inform local healthcare planners in their efforts to improve the quality of care and reduce burden on patients and the healthcare system. To facilitate this understanding, we created a profile of HCUs using demographic and clinical characteristics. The profile provides detailed information on HCUs by care type, geography, age, sex and top clinical conditions. RésuméEnviron 1,5 % de la population ontarienne, qui correspond à 5 % des usagers qui génèrent le plus de coûts pour les services hospitaliers et les soins à domicile en Ontario, comptent pour 61 % des frais hospitaliers et de frais pour les soins à domicile. Des études semblables menées ailleurs montrent également qu'un nombre relativement petit de personnes utilisent une grande partie des ressources du système de santé. Une meilleure compréhension des usagers qui coûtent cher peut aider les planificateurs à améliorer la qualité des services et à réduire le fardeau sur les patients et sur le système de santé. Afin de faciliter cette compréhension, nous avons brossé un profil des usagers qui coûtent cher à l' aide de caractéristiques cliniques et démographiques. Ce profil donne des renseignements détaillés sur ces patients, en fonction du type de soins, de la géographie, de l' âge, du sexe et des principaux états cliniques.

In 2004, we tested all patients with newly diagnosed tuberculosis (TB) for HIV in Kiev City. The results were compared to information from medical records of 2002, when co-infection prevalence was 6.3%. Of 968 TB patients, 98 (10.1%) were HIV infected. TB-HIV co-infection is increasing, especially in injecting drug users.

The period of economic transition has had severe consequences for health and health systems in Ukraine. The tuberculosis (TB) situation illustrates this. The strategy recommended by the World Health Organization (WHO) for TB, directly observed treatment short-course (DOTS), has the potential to provide real improvements in TB services, forming the basis of the response to the growing epidemic. In 2002, Ukraine, financially supported by USAID and the European Community (EC), began to introduce DOTS through pilot projects in Mariupol and Kyiv City. The aim of this study is to assess the feasibility, effectiveness, health service cost, patient cost, and the cost-effectiveness of these pilots, in order to inform the national scale-up of DOTS. The study finds that DOTS is feasible and has the potential to be both effective and cost-effective in Ukraine. Following this study, Ukraine adopted DOTS as a national TB control strategy in 2005. However, the pilots also found that there are several evidence-related concerns and perverse economic incentives to both providers and patients that will need to be addressed if national scale-up is to be successful. These include concerns related to the treatment of MDR-TB, economic benefits to some patients to remain hospitalized, and payments to providers and health facilities that support current practices. These will need to be addressed if Ukraine is to develop an effective response to its emerging TB epidemic.

This is a Health Evidence Network (HEN) synthesis report on the advantages and disadvantages of restructuring a health care system to be more focused on primary care services.The available evidence demonstrates some advantages for health systems that rely relatively more on primary health care and general practice in comparison with systems more based on specialist care in terms of better population health outcomes, improved equity, access and continuity and lower cost.This report is HEN's response to a question from a decision-maker. It provides a synthesis of the best available evidence, including a summary of the main findings and policy options related to the issue.HEN, initiated and coordinated by the WHO Regional Office for Europe, is an information service for public health and health care decision-makers in the WHO European Region. Other interested parties might also benefit from HEN.This HEN evidence report is a commissioned work and the contents are the responsibility of the authors. They do not necessarily reflect the official policies of WHO/Europe. The reports were subjected to international review, managed by the HEN team.When referencing this report, please use the following attribution: