title: A 3-year study of high-cost users of health care.
abstract: BACKGROUND
  Characterizing high-cost users of health care resources is essential for the development of appropriate interventions to improve the management of these patients. We sought to determine the concentration of health care spending, characterize demographic characteristics and clinical diagnoses of high-cost users and examine the consistency of their health care consumption over time.
  
  
  METHODS
  We conducted a retrospective analysis of all residents of Ontario, Canada, who were eligible for publicly funded health care between 2009 and 2011. We estimated the total attributable government health care spending for every individual in all health care sectors.
  
  
  RESULTS
  More than $30 billion in annual health expenditures, representing 75% of total government health care spending, was attributed to individual costs. One-third of high-cost users (individuals with the highest 5% of costs) in 2009 remained in this category in the subsequent 2 years. Most spending among high-cost users was for institutional care, in contrast to lower-cost users, among whom spending was predominantly for ambulatory care services. Costs were far more concentrated among children than among older adults. The most common reasons for hospital admissions among high-cost users were chronic diseases, infections, acute events and palliative care.
  
  
  CONCLUSIONS
  Although high health care costs were concentrated in a small minority of the population, these related to a diverse set of patient health care needs and were incurred in a wide array of health care settings. Improving the sustainability of the health care system through better management of high-cost users will require different tactics for different high-cost populations.
authors.affiliation: Institute for Health Policy Management and Evaluation (Wodchis, Austin, Henry), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Austin, Henry); Toronto Rehabilitation Institute (Wodchis); Dalla Lana School of Public Health (Henry), University of Toronto, Toronto, Ont. walter.wodchis@utoronto.ca.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
authors.affiliation: Institute for Health Policy Management and Evaluation (Wodchis, Austin, Henry), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Austin, Henry); Toronto Rehabilitation Institute (Wodchis); Dalla Lana School of Public Health (Henry), University of Toronto, Toronto, Ont.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Institute for Health Policy Management and Evaluation (Wodchis, Austin, Henry), University of Toronto; Institute for Clinical Evaluative Sciences (Wodchis, Austin, Henry); Toronto Rehabilitation Institute (Wodchis); Dalla Lana School of Public Health (Henry), University of Toronto, Toronto, Ont.
authors.forename: David A
authors.initials: DA
authors.lastname: Henry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D005380:Financing, Government / Q000191:economics; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics*; D055815:Young Adult