$4.9 Billion Decrease in Health Care Expenditure: The Ten-Year Impact of Improving Smoking, Alcohol, Diet, and Physical Activity in Ontario, A

2016·2.5 MB·English

by  Manuel, Douglas C.

v
A $4.9 Billion Decrease in Health Care Expenditure:
The Ten-Year Impact of Improving Smoking,
Alcohol, Diet and Physical Activity in Ontario

April 2016

A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
A $4.9 Billion
Decrease in Health
Care Expenditure:
The Ten-Year
Impact of Improving
Smoking, Alcohol,
Diet and Physical
Activity in Ontario
Authors
Douglas G. Manuel
Richard Perez
Carol Bennett
Audrey Laporte
Andrew S. Wilton
Sima Gandhi
Erika A. Yates
David A. Henry
April 2016
Institute for Clinical Evaluative Sciences
A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
Publication Information
How to Cite This Publication
©2016 Institute for Clinical Evaluative Sciences. All Manuel DG, Perez R, Bennett C, Laporte A, Wilton AS,
rights reserved. Gandhi S, Yates EA, Henry DA. A $4.9 Billion Decrease
in Health Care Expenditure: The Ten-Year Impact of
This publication may be reproduced in whole or in part Changing Smoking, Alcohol, Diet and Physical
for noncommercial purposes only and on the Activity on Health Care Use in Ontario. Toronto, ON:
condition that the original content of the publication Institute for Clinical Evaluative Sciences; 2016.
or portion of the publication not be altered in any
way without the express written permission of ICES. ISBN: 978-1-926850-67-2 (Online)
To seek this information, please contact
[email protected].
The opinions, results and conclusions included in this
report are those of the authors and are independent
from the funding sources. No endorsement by the
Institute for Clinical Evaluative Sciences (ICES) or the
Ontario Ministry of Health and Long-Term Care (MOHLTC)
is intended or should be inferred.
Parts of this publication are based on data and
information compiled and provided by the Canadian
Institute for Health Information (CIHI). However, the
analyses, conclusions, opinions and statements
expressed herein are those of the author, and not
necessarily those of CIHI.
INSTITUTE FOR CLINICAL EVALUATIVE SCIENCES
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Toronto, ON M4N 3M5
Tel: [phone]
www.ices.on.ca
ii Institute for Clinical Evaluative Sciences
A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
Contents
ii Publication Information 1 BACKGROUND
iv Authors’ Affiliations
v Acknowledgements 3 METHODS
vi About the Organizations Involved in This Report
vii List of Exhibits 8 FINDINGS
11 DISCUSSION
13 EXHIBITS
23 REFERENCES
27 APPENDIX

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A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
Sima Gandhi, MSc
Authors’ Affiliations
Senior Epidemiologist, Institute for Clinical
Evaluative Sciences
Douglas G. Manuel, MD, FRCPC, MSc Erika A. Yates, MSc
Senior Scientist, Ottawa Hospital Research Institute Senior Research Project Manager, Institute for
/ Adjunct Scientist, Institute for Clinical Evaluative Clinical Evaluative Sciences
Sciences / Professor, Department of Family Medicine,
University of Ottawa and University of Toronto / David A. Henry, MBChB, MRCP, FRCP
Associate Scientist, C.T. Lamont Primary Health Care Senior Scientist, Institute for Clinical Evaluative
Research Centre and Bruyère Research Institute Sciences / Professor, Institute of Health Policy,
Management and Evaluation, University of Toronto
Richard Perez, MSc
Methodologist, ICES uOttawa, Ottawa Hospital
Research Institute
Carol Bennett, MSc
Epidemiologist and Senior Research Associate, ICES
uOttawa, Ottawa Hospital Research Institute
Audrey Laporte, PhD
Associate Professor of Health Economics, Institute of
Health Policy, Management and Evaluation,
University of Toronto / Director, Canadian Centre for
Health Economics
Andrew S. Wilton, MSc
Senior Research Analyst, Institute for Clinical
Evaluative Sciences
iv Institute for Clinical Evaluative Sciences
A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
Acknowledgments
Policy Advisory Committee Web Calculator Support
Bernard Choi Kasim Abdulaziz and Yulric Sequeira
Scientific Advisory Committee Public Health Agency of Canada Projectbiglife.ca
Peter Austin Prabhat Jha
Institute for Clinical Evaluative Sciences University of Toronto Editorial Support
Bernard Choi Isra Levy Nancy MacCallum
Public Health Agency of Canada Ottawa Public Health Institute for Clinical Evaluative Sciences
Claudia Sanmartin Heather Manson
Statistics Canada Public Health Ontario Financial Support
Joanne Thanos This study was supported by the Institute for Clinical
Ontario Ministry of Health and Long-Term Care Evaluative Sciences, which is funded by the Ontario
Ministry of Health and Long-Term Care.
Pegeen Walsh
Ontario Public Health Association
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A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
About the Organizations
The Ottawa Hospital
Research Institute
Involved in this Report
The Ottawa Hospital Research Institute is the
research arm of The Ottawa Hospital and an affiliated
The Institute for Clinical institute of the University of Ottawa, closely
Evaluative Sciences associated with the university’s Faculties of Medicine
and Health Sciences. OHRI includes more than 1,700
The Institute for Clinical Evaluative Sciences (ICES) is scientists, clinical investigators, graduate students,
an independent, non-profit organization that uses postdoctoral fellows and staff conducting research
population-based health information to produce to improve the understanding, prevention, diagnosis
knowledge on a broad range of health care issues. and treatment of human disease.  
ICES’ unbiased evidence provides measures of health
system performance a, a cleaner understanding of
the shifting health care needs of Ontarians, and a
stimulus for discussion of practical solutions to optimize
scarce resources.
Key to ICES’ work is its ability to link population-
based health information, at the patient level, in a
way that ensures the privacy and confidentiality of
personal health information. Linked databases
reflecting 13 million of 34 million Canadians allow
researchers to follow patient populations through
diagnosis and treatment, and to evaluate outcomes.
ICES receives core funding from the Ontario
Ministry of Health and Long-Term Care. In addition,
ICES scientists and staff compete for peer-reviewed
grants from federal funding agencies, such as the
Canadian Institutes of Health Research, and receive
project-specific funds from provincial and national
organizations. ICES’ knowledge is highly regarded in
Canada and abroad, and is widely used by government,
hospital, planners, and practitioners to make decision
about health care delivery and to develop policy.
vi Institute for Clinical Evaluative Sciences
A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
List of Exhibits
EXHIBIT 1 Definitions of behavioural health risks EXHIBIT 8 Health behaviours and socioeconomic
position attribution to health care costs for
EXHIBIT 2 Annual health care costs for Ontarians Ontarians aged 25 and older, 2004 to 2013
aged 25 and older: unhealthy behaviour and low
socioeconomic position versus healthy behaviour EXHIBIT 9 Socioeconomic position attribution to
and high socioeconomic position, 2013 health care costs for Ontarians aged 25 and older,
by sector, 2004 to 2013
EXHIBIT 3 Annual health care costs: unhealthy
behaviour and/or low socioeconomic position versus  
healthy behaviour or high socioeconomic position for
Ontarians aged 25 and older, 2013
EXHIBIT 4 Annual health care costs for Ontarians by
age category, 2004 to 2013
EXHIBIT 5 Burden of health behaviours on health care
costs for Ontarians age 25 and older, 2004 to 2013
EXHIBIT 6 Health care attributable and avoided costs
by health behaviour risk factor for Ontarians aged 25
and older, 2004 to 2013
EXHIBIT 7 Health behaviour–attributable health care
costs by sector for Ontarians aged 25 and older,
2004 to 2013
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A $4.9 BILLION DECREASE IN HEALTH CARE EXPENDITURE: THE TEN-YEAR IMPACT OF IMPROVING SMOKING, ALCOHOL, DIET AND PHYSICAL ACTIVITY IN ONTARIO
Background
Smoking, unhealthy alcohol consumption, poor diet further insights into the health care system and both the largest and most complete examination of the
and physical inactivity play an important role in the potential economic and health equity impacts of relationship between health behaviours and health care
overall health. Previously, our research team at the preventive strategies. costs. To our knowledge, this study is the first to directly
Institute for Clinical Evaluative Sciences (ICES) measure how changes in health behaviours have
examined the impact of these four health behaviours resulted in increased or decreased health care use.
on hospitalization costs. The 900,000 Days in We examined the following questions:
Breaking New Ground
Hospital report demonstrated that 32% of hospital 1. What are the direct health care costs associated
bed-days between 2001 and 2012 were attributable with smoking, unhealthy alcohol consumption, poor
to these behaviours.1 diet and physical inactivity?
Ontario policy makers and public health practitioners The study uses unique Canadian data that individually
are interested in the broader impact of health link respondents from a large population health survey, 2. What has been the change in direct health care
behaviours on health care use—the focus of this report. the Canadian Community Health Survey, to a wide costs as a consequence of recent improvements
This study is in response to requestsa to provide range of health care data in Ontario. These data provide in or worsening of health behaviours?
a Requests for information submitted through the Applied Health Research Question (AHRQ) initiative of the Ontario Ministry of Health and Long-Term Care by a health-system policy maker or care
provider seeking research evidence that will inform planning, policy and program development for the benefit the entire Ontario health system.
1 Institute for Clinical Evaluative Sciences