New research looking at mental health and addiction clients in Saskatoon found those who did not have stable housing were more likely to be high-cost health care users, compared to clients with more secure housing arrangements. Findings of the study, which involved researchers at the province’s Health Quality Council, suggest permanent supportive housing and stronger community care could help reduce persistent high-cost use of health care services by people with mental health and addictions problems.
The study, published in the Canadian Journal of Public Health, showed that despite making up only 5% of the study population in Saskatoon (n=129,932), high-cost mental health and addiction clients (n=6,455) accounted for 35% of total health care spending. Their total health care costs were more than $150 million each year during the study period (2009-2015). The study is the first of its kind in Canada to show the association between unstable housing and persistent high-cost health care use at the individual-level using large population-based administrative health databases.
The term ‘high-cost health care use’ comes from the research literature, which has consistently found that a small proportion of the population consumes the majority of health care resources. In this study, persistent high cost users were defined as those mental health and addictions clients who were in the top percentile for total government-paid health care costs year after year.
The researchers identified a number of factors associated with persistent high-cost health care use, including having other additional medical conditions, schizophrenia, and unstable housing. Good connection to a primary care provider, particularly for individuals with more than one mental health condition, decreased the probability of persistent high-cost use.
HQC researcher Maureen Anderson, lead author on the paper, says she was surprised by the findings. “We know, from the literature and from front line health care providers, that lower socioeconomic status is linked to worse health outcomes, and therefore increased costs,” says Anderson, who is a PhD candidate in the Department of Health Management, University of Prince Edward Island.
“I thought that once we accounted for the myriad of other potentially confounding factors in our models, housing status would no longer be a statistically significant factor associated with persistent high-cost health care use,” says Anderson. “But that wasn’t the case. And in reality, we are likely underestimating the association, since we cannot fully account, at a population-level, for each individual person living with residential instability.”
The study team included patients and families and researchers from Saskatchewan, and researchers in Ontario, Quebec, and Prince Edward Island.
Acknowledgement: This report and associated research activities were funded by Canada’s Strategy for Patient-Oriented Research (Primary and Integrated Health Care Innovations Network) and the Saskatchewan Ministry of Health. The authors gratefully acknowledge data sharing from partners at the former Saskatoon Health Region (Public Health Observatory, Street Outreach program, and Mental Health and Addictions Services), eHealth Saskatchewan, and the Ministry of Health, without which this work would not have been possible. This study is based in part on de-identified data provided by the Saskatchewan Ministry of Health and eHealth Saskatchewan. Conclusions reported in this paper are those of the author and are independent from the funding sources, the Saskatchewan Health Authority, and eHealth Saskatchewan.