Conspicuous consumption: characterizing high users of physician services in one Canadian province.
OBJECTIVE
To examine medical care use and costs, patterns of morbidity and co-morbidity, and other patient characteristics of high users of physician services in British Columbia.


METHODS
This population-based study uses physician claims, hospital discharge summaries and vital statistics data linked at the level of the individual to compare characteristics of high users, other users and non-users of physician services in the Province of British Columbia, Canada. The study included all enrolled adults in the universal health care plan during fiscal year 1996/97. High users were defined as the most costly 5% of users of fee-reimbursed services. Key variables included age, sex, an ecological socio-economic status indicator and a comprehensive set of morbidity indicators, derived from the diagnoses recorded on the utilization records.


RESULTS
The top 5% of users consumed a disproportionate 30% of spending on physician services. High users were overwhelmingly characterized by a significant burden of morbidity. Over 80% had at least six different types of morbidity during the study year compared with fewer than 20% of other users. High users were also much more likely to have major diagnoses that were both acute and chronic in nature. Co-morbidity involving psychosocial and chronic medical conditions was also very common.


CONCLUSIONS
High users of physician services are overwhelmingly characterized by multiple and complex health problems. Policy tools based on a philosophy of deterrence such as cost-sharing are unlikely to have much impact on their costs and will likely do considerable harm.
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.
Robert
R
Reid
Robert
R
Evans
Morris
M
Barer
Samuel
S
Sheps
Kerry
K
Kerluke
Kimberlyn
K
McGrail
Clyde
C
Hertzman
Nino
N
Pagliccia
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D001955:British Columbia / Q000453:epidemiology*; D015897:Comorbidity; D003953:Diagnosis-Related Groups / Q000145:classification / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors