Research Snapshot: Socioeconomic status predicts future high-cost patients with mental health and addiction needs

What you need to know

Researchers conducted a study to understand the relationships between various socioeconomic factors and the likelihood of becoming a high-cost health care patient among people with mental illness and/or addiction. They found that lower personal income, lower household income, food insecurity and not owning a home all were associated with higher likelihood of becoming a high-cost patient within five years. Living in an area with higher residential instability was also associated with a higher likelihood of becoming a high-cost patient.

 

This Research Snapshot is based on the article, “Looking beyond administrative health care data: The role of socioeconomic status in predicting future high-cost clients with mental health and addiction” published in The Canadian Journal of Psychiatry in 2021. https://doi.org/10.1177/07067437211004882

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

What is this research about?

Research has shown that a small proportion of patients account for a disproportionately large share of health care costs. For example, 1% of patients in Ontario account for almost a third of the costs of public health care. In addition, socioeconomic status can influence health care use.

High-cost patients with mental illness and/or addiction tend to have higher health care costs than those high-cost patients who don’t have mental illness and/or addiction.

In a new study, researchers tried to understand the links between socioeconomic status characteristics and the likelihood of becoming a high-cost patient among individuals with mental illness and/or addiction.

What did the researchers do?

The researchers linked survey data from three cycles of the Canadian Community Health Survey to Ontario administrative health care data. They identified survey participants (ages 18 and older) with mental illness and/or addiction based on use of public mental health and addiction services. All individuals were tracked in the administrative data for up to five years.

To be included in the analysis, participants had to have one or more mental health and/or addiction-related health care encounter in the two years before they responded to the survey. These encounters included any psychiatric hospitalization, emergency department visit for a mental health and/or addiction reason, or two or more visits to a physician no more than two years apart that included a mental health and/or addiction diagnostic code.

There were 13,861 participants in the analysis. Of these, 1,424 became high-cost clients within five years of completing the survey.

What did the researchers find?

The study findings suggest that people with mental illness and/or addiction who had a lower individual or household income were more likely to become high-cost patients within five years. This was consistent even after the researchers controlled for characteristics such as sex, age and any co-occurring diagnosis.

Income was the strongest predictor that a person would become a high-cost patient. The researchers also found that respondents with no post-secondary education were more likely to become high-cost clients within five years compared to those with post-secondary education.

Also, study participants who lived in households with high levels of food insecurity and those who rented were more likely to become high-cost clients than those who had the lowest levels of food insecurity and owned a home.

The researchers also found that participants who lived in neighbourhoods with the most residential instability were more likely to become high-cost patients than those living in neighbourhoods with the least residential instability.

Limitations of the research

There were a few limitations related to this work, namely around the Canadian Community Health Survey, such as who is included in the survey and the fact that it likely captured individuals with less severe forms of mental illness. Also, the researchers were only able to examine individuals who access the health care system and were not able to capture all costs covered under the public health care system.

How can you use this research?

This work has important implications for program planners and policymakers as it suggests that high-cost patients who receive mental illness and/or addiction services may require more tailored strategies than the general high-cost population. For example, it provides support for implementing programs to identify health care people who need mental illness and/or addiction services who may be experiencing poverty and provide them with assistance. The findings also suggest that municipalities and sectors beyond health care may play an important role in addressing residential instability and food insecurity.

About the researchers

Claire de Oliveira,1,2,3,4,5,6 Luke Mondor,5,6 Walter P. Wodchis,4,5,6,7 and Laura C. Rosella4,5,7,8,9,10

  1. Centre for Health Economics, University of York, United Kingdom
  2. Hull York Medical School, University of York, United Kingdom
  3. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
  5. ICES, Toronto, Ontario, Canada
  6. Health System Performance Network, Toronto, Ontario, Canada
  7. Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
  8. Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
  9. Population Health Analytics Laboratory, Toronto, Ontario, Canada 10 Public Health Ontario, Toronto, Ontario, Canada
  10. Public Health Ontario, Toronto, Ontario, Canada