Social Determinants of Health Connection with High Costs & High Users of
The Canadian Health Care System

Fatima Zahid
HLST 2020: Power and Politics
Kimberley Sauder
March 20th 2017

It has been acknowledged for many years that a small number of individuals have been high users of the Canadian healthcare system taking up a large percentage of health care costs. This essay argues; social determinants of health is chronically linked to creating high users and high costs of the health care system. The authorities can significantly do better by sustaining strategies beyond hospital and traditional clinic setting addressing the relatively small number of individuals taking up proportion of health spending. Improving conditions of social determinants of health and enhancing our primary care department can limit levels of hospitalization.
High users are often classified as the top 1%, 5%, or 10% of users. If the patient had experienced minimum of 3-times acute care hospital admission within the span of a year, along with cumulative length of stay longer than the period of 30 days he/she is a high user of the healthcare system. The Canadian Institute for Health Information has reported, 11% of individuals are hospitalized for 3+ days for acute care along with 10% for 30+ days of acute care (Defining High Users in Acute Care, pg. 7). To address the issue its important to identify the type of users involved including their socio-economic characteristics, sex, age, geography, a family physician, and the type of condition. In Canada, mainly the upper North provinces contain a lot of remote areas resulting to easier access towards hospitals rather than accessing primary care. Other groups of individuals that are high users of the health care system include seniors, children and people who are homeless. As stated in a three-year high user study published in The Canadian Medical Association Journal, the reason why children that are high users of the health care system is due to pre-mature birth, mental health disorders, and cancer chemotherapy (A 3-year study of high-cost users of health care, Walter P. Wodchis, Peter C. Austin, David A. Henry, 2016). In terms of adults and seniors the frequent diagnoses where chronic diseases such as atherosclerosis, chronic lung disease, pneumonia, heart failure, and the need for palliative care. Looking at the population of high users, as indicated by a table published in BioMed Central, high cost users (HCU) share characteristics of being physically inactive, current/formers drinkers or smokers, and over weight (BMC Health Services Research, 2014). That makes an individual think why do these high users share similar characteristics? There could be many answers to that questions for example stress and no time to exercise due to work however the main root is social determinants of health further discussed in the paper. High users tend to have lower house income along with poor self-perceived health. Those with lower socio economic status, low income, facing food insecurity along with housing issues are likely to become high users within the next five years. To prove that statement The Canadian Institute for Health Information stated, approximately 34,100 individuals were hospitalized due to chronic illnesses which could have been avoided through primary care (Early Identification of People At-Risk of Hospitalization, pg.4). Not only are chronic diseases one of the leading cause of death in Ontario in addition also extremely costly. An average of 5% of the Ontario population takes account for about 85% of the total provincial spending addition to hospital and home care. That of course, is tonnes of dollars, to reduce costs and save money it's important to minimize costs by investing into primary care. This topic of primary care being effective will go more into depth on page six.
Social determinants of health are a form of prerequisite for the overall health of an individual. When an individual or family accesses the health care system, they do not just arrive with their mental or physical health concern, they arrive with intersections of their identification (example, gender, social class, and age). Along with the intersection of the level of social determinants of health (example, income, employment and early childhood development) which are all interlinked with their level of health concern. According to a report released by the Toronto Central