Patient Characteristics and Healthcare Use for High-cost Patients with Musculoskeletal Disorders in Norway: A Cohort Study

Abstract

Background: A high proportion of healthcare costs can be attributed to musculoskeletal disorders (MSDs). A small proportion of patients account for most of the costs, and there is increasing focus on addressing service overuse and high costs. We aimed to describe healthcare use contributing to high costs over a five-year period at the individual level and to examine differences between high-cost patients who use healthcare in accordance with guidelines and those who do not. These findings can contribute to the understanding of healthcare use for high-cost patients and help in planning future MSD-care. Methods: This study combines Norwegian registries on healthcare use, diagnoses, demographic, and socioeconomic factors. Patients (≥ 18 years) were included by their first MSD-contact in 2013–2015. We analysed healthcare use during the subsequent five years. Descriptive statistics are used to compare high-cost (≥95th percentile) and non-high-cost patients, and to describe the most expensive specialist healthcare contact and healthcare care use prior to this contact. Logistic regression was used to assess factors associated with having seen healthcare personnel delivering conservative treatment prior to the most expensive specialist care contact. Results: High-cost patients were responsible for 60% of costs, with 90% related to hospital treatment. Seventy-seven percent of high-cost patients had one specialist healthcare contact responsible for more than half of their total costs, predominantly related to surgical treatment. Fractures/injuries were the most common diagnosis for these contacts, while osteoarthritis and spinal, shoulder and knee disorders accounted for 42%. Less than half had seen a healthcare service delivering conservative treatment, other than GPs, the year before this contact. Being male, from a small municipality, lower education and higher comorbidity were associated with lower odds of having been to healthcare services focused on conservative treatment prior to the most expensive specialist care contact. Conclusion: Most health care costs are concentrated among a small proportion of patients. In contrast to recommendations, less than half had been to a healthcare service focused on conservative management prior to specialist care treatment. This could indicate that there is room for improvement, and that ensuring sufficient capacity for conservative care can be beneficial for reducing overall costs.