Characteristics of patients with mental illness and persistent high-cost status: a population-based analysis

Oliveira, Claire de; Mason, Joyce; Kurdyak, Paul

doi:10.1503/cmaj.200274

Cited by 10 publications

(12 citation statements)

References 31 publications

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“…Few studies have examined children and adolescents with high health care costs, and even fewer have specifically examined those with mental disorders, which is likely why the latter have been termed as “unseen high-cost users.” This is not surprising as some of the mental health care that children and adolescents receive falls outside the health care system. Our results are in line with prior work by some of us on adults with high health care costs . That work also revealed that adult patients with high mental health care costs had 30% higher mean costs than adult patients with high non–mental health care costs and a higher proportion of mental disorders than the latter.…”

Section: Discussionsupporting

confidence: 92%

“…However, an important finding is that few children and adolescents persisted in the high-cost state for many years, contrary to what has been found for adults with high costs. 14…”

Section: Discussionmentioning

confidence: 99%

“…Our results are in line with prior work by some of us on adults with high health care costs. 9,10,14 That work also revealed that adult patients with high mental health care costs had 30% higher mean costs than adult patients with high non-mental health care costs and a higher proportion of mental disorders than the latter.…”

Section: Jama Network Open | Pediatricsmentioning

confidence: 90%

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Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada

2023

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ImportanceResearch on patients with high health care costs has examined mainly adults, with little focus on mental health care use.ObjectiveTo examine the characteristics and costs of children and adolescents with high health care costs who use mostly mental health care and whether and why they persist in the high-cost state.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used health care records from Ontario, Canada, on all children and adolescents (age 0-17 years) covered under a universal health care system from January 1, 2012, to December 31, 2019. All children and adolescents in and above the 90th percentile of the cost distribution in 2012 for whom costs related to mental health care accounted for 50% or more of their costs were defined as patients with high mental health care costs. Data were analyzed from August 2019 to December 2022.ExposuresHigh health care costs.Main Outcomes and MeasuresPatients with high mental health care costs were characterized in terms of their sociodemographic characteristics; chronic physical health, mental health, and behavioral conditions; and health care costs (in 2021 Canadian dollars) by health service and type of care (mental health care vs non–mental health care). Patients were followed up until 2019 to assess whether they persisted in the high-cost state and to examine factors associated with persisting in that state.ResultsIn 2012, there were 273 490 children and adolescents with high health care costs (mean [SD] age, 6.43 [5.99] years; 55.8% male; mean cost, $7936.40; 95% CI, $7850.30-$8022.40). Of these, 20 463 (7.5%) were classified as having high mental health care costs (mean cost, $10 040.20; 95% CI, $9822.80-$10 257.50). Asthma (30.3%), attention-deficit/hyperactivity disorder (35.8%), and mood and/or anxiety disorders (94.9%) were the most common chronic physical, behavioral, or mental health conditions. Few patients with high mental health care costs persisted in the high-cost state beyond 3 years (19.0%). Mood and/or anxiety disorders (relative risk ratio [RRR], 6.17; 95% CI, 3.19-11.96) and schizophrenia spectrum disorders (RRR, 2.98; 95% CI, 2.14-4.14) were identified as the main factors associated with persistence in the high-cost state.Conclusions and RelevanceIn this cohort study of children and adolescents with high health care costs, some patients had high levels of mental health care use and high costs of care, but few of these persisted in the high-cost state for 3 or more years. These findings may help inform the development of care coordination interventions and service delivery models, such as youth integrated services, to reduce costs and improve outcomes for children and adolescents.

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Section: Discussionsupporting

confidence: 92%

“…However, an important finding is that few children and adolescents persisted in the high-cost state for many years, contrary to what has been found for adults with high costs. 14…”

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Pediatricsmentioning

confidence: 90%

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Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada

2023

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“…Previous literature exploring the persistently high-cost population has focused on specific subgroups (e.g., severe mental health 26 ) rather than on creating clear classifications of the broader population. Efforts have been made to classify nonpersistent (i.e., episodic) high-cost populations; however, because most high-cost users in any given year are not highcost users in subsequent years, interventions targeting these groups are less feasible.…”

Section: Discussionmentioning

confidence: 99%

Identifying subgroups of adult high-cost health care users: a retrospective analysis

Wick

Campbell

McAlister

et al. 2022

cmajo

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A small proportion of patients account for a disproportionate amount of health care spending in developed countries with advanced health care systems. Specifically, patients in the top 1% of health care spending in North America account for 25% to 40% of total health care expenditures in a given year. 1,2 Increasing age, receipt of end-of-life care, multimorbidity, mental health conditions and social disadvantage are each associated with high-cost health system use. 2 However, the heterogeneous nature of this patient population makes it difficult to develop and implement strategies to improve care and curb health care spending for all high-needs, high-cost patients. 3,4 Further complicating this goal, two-thirds of the high-cost population in a given fiscal year are not high-cost in the following year, making it difficult to identify the appropriate target population for intervention. 1

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“…Meanwhile, the sample range of persistently high-cost patients is limited. Previous studies selected different sample domains, such as patients with certain diseases or specific insurance beneficiaries ( 8 , 9 ). Furthermore, high-cost status is highly correlated with hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Drivers of high-cost persistence in rural China: A population-based retrospective study

Wang

Shunhua

Zhang

2022

Front. Public Health

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PurposeHigh-cost patients account for over 70% of total health expenditures in rural China and have become a key focus of health insurers. Persistently high-cost patients constitute a substantial proportion of medical resources. Hence, exploring high-cost persistence (HCP) and what drives it is considered meaningful and necessary.Patients and methodsA population-based retrospective study was carried out. The annual healthcare utilization data of Dangyang New Rural Cooperative Medical Scheme from 2012 to 2017 were analyzed. Patients in the top 10% of spending in a given year were considered high-cost patients. Persistence level was estimated using Markov matrices. A total of 19,405 patients categorized as high-cost patients in 2016 were divided into two groups according to whether or not they kept high-cost status in 2017. Finally, a multilevel logistic regression model was used in examining the determinants of HCP.ResultsOn average, about 31.48% of high-cost patients each year still maintained high-cost status in the subsequent year from 2012 to 2017. The elderly (OR = 2.150), families with more non-labor members (OR = 2.307), families applying for subsistence allowances (OR = 1.245), and patients with blood and immune diseases (OR = 2.614) or malignant tumors (OR = 2.077) were more likely to maintain high-cost status. Hospitalization frequency was found to be a mediator.ConclusionAbout one-third of high-cost patients in a given year had persistently high cost status in the subsequent year. Health status and family support were considered the main drivers of HCP. High inpatient service utilization as a mediator was a prominent manifestation of persistently high-cost patients. The accurate identification of persistently high-cost patients is the basis for our management.

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Characteristics of patients with mental illness and persistent high-cost status: a population-based analysis

Cited by 10 publications

References 31 publications

Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada

Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada

Identifying subgroups of adult high-cost health care users: a retrospective analysis

Drivers of high-cost persistence in rural China: A population-based retrospective study

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