High Health Care Utilization and Costs Associated with Lower Socio-economic Status: Results from a Linked Dataset

Abstract

Objective: The purpose of this paper was to use a linked dataset to compare health care utilization rates and costs between income groups in Saskatoon, Canada. Methods: The Canadian Community Health Survey was linked to hospital, physician and medication data in Saskatoon. Results: Of 3,688 eligible participants, 3,433 agreed to the health survey and data linkage with health records (83.7% overall response). Low-income residents were 27-33% more likely to be hospitalized and 36-45% more likely to receive a medication than middle-and higher-income residents, but were 5-7% less likely to visit a physician over a one-year period. In comparison to middle-income residents, low-income residents had 56% more high users of hospitals, 166% more high users of physicians and 90% more high users of medications. Low-income residents had 34-35% higher health care costs overall than middle-and high-income residents. After multivariate adjustment for increased disease prevalence, low income had a reduced association with high health care utilization. Conclusions: The results demonstrate that residents with lower income are responsible for disproportionate usage of hospitals, physicians and medications; due mainly (but not entirely) to higher disease prevalence.

What's cost got to do with it? Association between hospital costs and frequency of admissions among “high users” of hospital care

“…Given that hospital costs account for the single largest category of total national health costs, we expect that future studies examining total health costs will show similar findings. Fourth, our data did not include measures of health status, socioeconomic status, housing, or mental health comorbidities to permit an analysis of these factors, which have been previously related to frequent hospitalizations and high costs . Fifth, due to resource constraints, we were unable to conduct a longitudinal analysis to examine the extent to which individuals are consistently high users over time.…”

Online communities of practice as a communication resource for community health nurses working with homeless persons

“…Low health status is intimately connected to access to social, economic, political and health resources in addition to environmental conditions, rather than being attributable to individual shortcomings or refusal to adopt required health norms. Research suggests that those in lower socioeconomic positions have higher rates of hospitalization compared with the general population (Lemstra et al. 2009).…”

“…Low health status is intimately connected to access to social, economic, political and health resources in addition to environmental conditions, rather than being attributable to individual shortcomings or refusal to adopt required health norms. Research suggests that those in lower socioeconomic positions have higher rates of hospitalization compared with the general population (Lemstra et al 2009). Homeless persons have higher rates of service use such as emergency care; this is thought to be in part due to the exacerbation through neglect of minor health conditions, poor living conditions and access barriers to primary healthcare services (Bottomley 2001, Frankish et al 2005, Gundlapalli et al 2005.…”

Impact of Socioeconomic Adjustment on Physicians’ Relative Cost of Care

“…Previous studies have mostly focused on the total cost of care over a defined period (typically a year) and found that lower SES patients have higher costs of care, 9-11 but that much of the impact of SES on resource use is diminished or eliminated entirely after adjusting for comorbidities. 10 Also, previous analyses that have examined the relationship between SES and cost used relatively basic approaches for modeling the relationship between SES and cost and did not examine the impact of SES adjustment on physician relative cost rankings. 9 We examined various model specifications including the inclusion of linear and quadratic interaction terms to allow a flexible relationship between episode type and SES and our analysis specifically focused on a profiling context.…”