Commission on the Reform of Ontario's Public Services

Chapter 5: Health
However, this is only part of the answer to the one per cent question. Analysis of a Local
Health Integration Network’s (LHIN) 2006–07 billing data done on behalf of MOHTLC revealed
that one subset of hospital inpatients accounted for 40 per cent of all hospital bed days. 47
These patients were identified as “complex inpatients,” meaning they did not have just one
health condition but many at once, often including mental health or addiction issues. Strikingly
similar results are found in British Columbia. “Remarkably, over 80 per cent of frequent users
of BC’s health care system had at least six different types of illness, and almost one third
actually had ten or more illnesses, compared with only a small minority of other users.” 48 In
Ontario, 80 per cent of all ALC bed days were used by these complex patients, spending an
average of 72.9 days in hospital in 2006–07. As a comparison, the average stay for a noncomplex
patient was 6.3 days over the same period. Over half of these patients also tend to be
over age 75 and one-third are discharged from the hospital to another facility (most likely a
long-term care home). Another third are discharged to the community without support
services. 49 Similar interventions to those mentioned above could have a great impact when
caring for these patients. Adding to this issue are other social determinants of health such as
poverty, social isolation and illiteracy, which can further increase the need for intervention.
Interestingly, when you look at the patients that used emergency rooms (ERs) most often in
the LHIN analyzed by MOHLTC the profile changes significantly. More than half were under
age 45. These “at-risk” patients accounted for 20 per cent of all ER visits and made over four
visits a year, some over 20 in one year. Even more intriguing is the level of severity of their
medical issues (also known as “acuity” in ERs). Though one might expect that the reason for
frequent visits to the ER was the need for surgery or some other complicated intervention,
these patients were no more likely to be an urgent case than an average, everyday visitor to
the ER. Instead, a strong underlying contributor to frequent visits to the ER appears to be
mental health and addiction issues. 50
47 J. Lawson, “High User Analysis,” 2008, PowerPoint deck provided by Mr. Lawson.
48 R.J. Reid, R.G. Evans, M.L. Barer, S. Sheps, K. Kerluke, K. McGrail, C. Hertzman and N. Pagliccia, “Why Do Some People Use So Much
Health Care?” 2003, University of British Columbia Research Brief downloaded from
http://www.chspr.ubc.ca/files/publications/2003/chspr03-06S.pdf.
49 It should be noted that in this group it may have been the case that support services were not needed.
50 Lawson, op. cit.
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