“Million-dollar patients” face unacceptable barriers to care

A recent Globe and Mail column highlights the need to pay more attention to “million-dollar patients.” These individuals have complex needs, and frequently use health services and resources – a key example being patients with multiple chronic conditions.

As discussed in our report on sicker Canadians with chronic conditions, these patients are more likely to be hospitalized, have surgery, use the ER, and take prescription medication. In fact, 90% take at least one prescription drug, and 54% take four or more for conditions like diabetes, arthritis, and heart disease.

An important finding in our report is that these patients are experiencing serious barriers to accessing the care they need. Almost one quarter (23%) of patients who were surveyed had skipped a dose of medication or did not fill a prescription due to cost. In addition, they experience barriers to co-ordinated care, with only 51% receiving help from their regular doctor’s office in coordinating their visits with specialists.

These are significant issues that need to be resolved if we hope to help our  “million-dollar patients” maintain better health and use the system less. Eliminating cost barriers that affect these patients will be key to improving their access to the system. Alternatives to face-to-face visits – like telemedicine, email and phone consultations – could help save costs on travel time and resources. To improve coordination of care, electronic medical records can be an important tool, and are long overdue on an expanded scale in Canada.

Doctors, policy-makers and patients need to work together to find solutions to barriers in the system. In this article, Mr. Picard discusses the importance of sharing innovations across the country and highlights a few that are already working. There are innovative practices producing benefits in all provinces and territories, and we can accelerate change by sharing knowledge and experiences that have worked. Through our work, we strive to inform decision-makers throughout the health system about innovative practices, in order that they may learn from one another and ensure the system’s most frequent – and vulnerable – patients do not slip between the cracks.

Key Words: Innovative Practices, Health Promotion, Million-Dollar Patients, Chronic Disease