Transcript: High-Care High-Cost Patients | Jan 20, 2016

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and blue tie.

A caption on screen reads “High-care high-cost patients.”

He says HEALTHCARE ACCOUNTS
FOR MORE THAN 40 percent OF THE
PROVINCIAL BUDGET.
AND ACCORDING TO A NEW STUDY, A
THIRD OF THAT SPENDING GOES TO
TREAT JUST 1 percent OF PATIENTS.
HEALTH ECONOMIST WALTER WODCHIS
JOINS US NOW TO BREAK DOWN THE
NUMBERS.
HE IS AN ASSOCIATE PROFESSOR AT
THE INSTITUTE OF HEALTH POLICY,
MANAGEMENT AND EVALUATION AT THE
UNIVERSITY OF TORONTO.

Walter is in his thirties, clean-shaven and balding. He’s wearing a gray suit, blue shirt, and checked blue tie.

Steve continues WALTER, IT'S GOOD TO HAVE YOU
HERE AT TVO.

Walter says THANK YOU VERY MUCH.

Steve says WE ARE GOING TO
BRING UP A GRAPHIC TO START WITH
HERE WHICH YOU ARE GOING TO TAKE
US THROUGH -- ACTUALLY, WHY
DON'T WE DO IT.
THERE IT IS THERE.
THIS LOOKS MORE COMPLICATED THAN
IT REALLY IS.

A chart pops up with the title “Health Care concentration.”
It shows two stacked bars. The one on the right explains a small fraction of the one on the left.

Steve continues IF YOU TAKE THE LEFT, YOU'LL SEE
THE PERCENTAGE OF THE
POPULATION.
IF YOU TAKE THE RIGHT, YOU'LL
SEE WHAT WE'RE SPENDING ON THEM.
YOU CAN TAKE US THROUGH THIS,
WALTER, STARTING WITH THAT TOP
BAND, WHICH IS THE RED, THE TOP
RED BAND IS VERY SMALL, BUT THE
AMOUNT OF MONEY WE'RE SPENDING
ON THAT SMALL GROUP IS VERY LARGE.
TAKE US THROUGH IT.

Walter says SURE.
SO THIS DOES TAKE THE ENTIRE
POPULATION OF ONTARIO, OVER
13 MILLION PEOPLE, AND THE
PEOPLE WHERE THEY CONSUMED ZERO
DOLLARS IN HEALTH CARE RESOURCES
ON THAT LEFT BAR ARE AT THE
BOTTOM.
PEOPLE WITH THE HIGHEST
SPENDING, HUNDREDS OF THOUSANDS,
ARE AT THAT TOP LEFT.
THAT'S THAT 1 percent.
WHEN WE LOOK AT HOW MUCH OF THE
TOTAL EXPENDITURES THAT ARE
ALLOCATED, SO 1 percent OF THE
POPULATION THERE, WE SEE IT
THERE, CONSUMING A THIRD OF ALL
HEALTH CARE COSTS AND JUST 5 percent
CONSUME TWO-THIRDS OF ALL HEALTH
CARE COSTS.
ANOTHER VERY INTERESTING FEATURE
IS THAT THE MEDIAN COSTS, SO
HALF OF THE POPULATION ONLY USE
UP 2 percent OF THE TOTAL HEALTH SYSTEM
SPENDING.

The caption changes to "The one percent."

Steve says WE NEED TO KNOW MORE
ABOUT THIS 1 percent AT THE TOP THAT
ARE TAKING SUCH A
DISPROPORTIONATE SHARE OF THE
HEALTH CARE DOLLAR.
WHO ARE THEY?

The caption changes to "Walter Wodchis. University of Waterloo."

Walter says THEY HAVE A
NUMBER OF DIFFERENT CONDITIONS,
BUT THEY ARE REALLY VERY, VERY
ILL PEOPLE WHO REQUIRE A LOT OF CARE.
SURPRISINGLY MANY OF THEM HAVE
CHRONIC -- OR NOT SURPRISINGLY,
PERHAPS MANY HAVE CHRONIC
CONDITIONS BUT THEY HAVE
MULTIPLE CHRONIC CONDITIONS AND
THEY SPEND A LOT OF TIME IN
HOSPITAL AND THEY'RE
REHOSPITALIZED AND THEY COME
BACK TO THE COMMUNITY AND TRY TO
GET STABLE BUT THEN THEY COME
BACK INTO THE HOSPITAL AGAIN.
SOME OF THEM HAVE VERY SEVERE
ACCIDENTS AND THEY MIGHT REQUIRE
INPATIENT CARE FOLLOWED BY WEEKS
OR MONTHS OF REHABILITATION CARE
FOLLOWED BY MORE HOME CARE AND
ALL THE WAY ALONG PHYSICIAN
VISITS.

Steve says THE ASSUMPTION IS
THAT THESE ARE OVERWHELMINGLY
PEOPLE IN THEIR 90s WHO ARE
NOT LONG FOR US; IS THAT ACCURATE?

Walter says NO, THAT IS
NOT ENTIRELY ACCURATE.
THERE ARE SOME OF THOSE PEOPLE,
IT'S TRUE.
BUT WE HAVE CHILDREN WHO ARE LOW
BIRTH WEIGHT CHILDREN WHO
HAVE -- OTHER PEOPLE WHO HAVE
CHILDREN WITH COMPLICATIONS AND
THEN WE HAVE ADULTS, ADULTS GET
CANCER, SOME ARE VERY
COMPLICATED CANCERS, SOME HAVE
MULTIPLE CHRONIC CONDITIONS,
EVEN IN THEIR 40s AND 50s.
SOME PEOPLE DON'T HAVE VERY
HEALTHY LIFE.
AND THEN THERE ARE THE MAJORITY
OF THEM STILL ARE THE OLDER
PEOPLE, 65 AND OLDER.
BUT IT'S NOT ALL END OF LIFE.
NOT A HIGH PROPORTION OF THESE
PEOPLE DIE AT THE END OF THE YEAR.

Steve says WE SPEND 50 BILLION
ROUGHLY A YEAR, 50 BILLION IN
THE PROVINCE OF ONTARIO THIS
FISCAL YEAR ON HEALTH.
CAN YOU SAY HOW MUCH OF THAT
50-PLUS BILLION ACTUALLY GOES TO
TREATING PATIENTS DIRECTLY AS
OPPOSED TO ADMINISTRATION, ALL
OF THE OTHER STUFF?

Walter says SURE.
SO THERE'S NOT ONLY
ADMINISTRATION, THERE ARE
GENERAL PROGRAMS.
SO ADMINISTRATION IN ONTARIO IS
GENERALLY BELOW 5 percent.
THEN WE HAVE A LOT OF COMMUNITY
TYPE PROGRAMS, SO PUBLIC HEALTH
PROGRAMS, PUBLIC HEALTH UNITS,
AND CENTRES SUCH AS THAT THAT
PROVIDE GENERAL POPULATION
HEALTH, AND THAT CONSUMES ABOUT
ANOTHER 15 percent OF THE HEALTH CARE
BUDGET.
AND THEN ABOUT 80 percent IS SPENT ON
INDIVIDUAL CARE.

Steve says BUT THAT PUBLIC
HEALTH IS IMPORTANT STUFF, RIGHT?

Walter says IT'S
ABSOLUTELY IMPORTANT STUFF AND
THOSE COMMUNITY PROGRAMS AND
RESOURCES.
PEOPLE USE THEM.
THEY'RE NOT JUST FOR SPECIFIC
PEOPLE.

Steve says I DON'T KNOW THIS,
YOU TELL ME.
IF WE SPEND MORE ON THAT 15 percent, WE
MIGHT BE SPENDING MORE ON THE
80 percent.
IS THAT POSSIBLE?

Walter says IT'S POSSIBLE.
THERE'S NOT HARD EVIDENCE TO
SUGGEST THERE'S A DIRECT
RELATIONSHIP.
HOWEVER, IT IS SHOWN THAT
COUNTRIES THAT HAVE HIGHER
SOCIAL SPENDING PROGRAMS TEND TO
HAVE BETTER HEALTH.

Steve says LET'S GO THROUGH A
SECOND CHART HERE AND AGAIN
TALKING ABOUT THOSE VERY
HIGH-COST PATIENTS, THAT 1 percent THAT
TAKE UP A THIRD OF THE BUDGET.

A new chart pops up with the title “Types of high cost patients.”
It shows that 12 percent have no condition, 15 percent have 1 condition, 17 percent have 2 conditions, 16 percent have 3 conditions, 14 percent have 4 conditions, and 26 percent have 5 conditions or more.

Steve continues I GATHER THE TECHNICAL TERM FOR
THAT IS MULTI-MORBIDITY.
YOU WANT TO TAKE US THROUGH THIS
CHART AND GIVE US A SENSE OF HOW
MULTI-MORBIDITY SHOWS UP ON THE
BOTTOM LINE?

Walter says ABSOLUTELY.
THIS CHART SHOWS US, AMONG
PEOPLE WHO DON'T REALLY HAVE ANY
CONDITIONS AT ALL, THEY MAKE UP
ABOUT HALF OF THE ENTIRE
POPULATION OF ONTARIO, BUT THEY
CONSUME RELATIVELY FEW RESOURCES.
AND THEN INCREMENTALLY, AS WE
ADD EACH ONE CONDITION, WE SEE
THAT COSTS ON AVERAGE GO UP
INCREMENTALLY AND THAT THE
AMOUNT OF THE TOTAL BUDGET THAT
IS GOING TO CARE FOR THOSE
PEOPLE INCREASES A LOT.
SO THERE'S ONLY ABOUT 500 AND
SOME ODD THOUSAND PEOPLE WHO
HAVE FIVE OR MORE CHRONIC
CONDITIONS.
WE HAVE A SUB-SET OF 17 THAT
WE'RE LOOKING AT HERE.
THEY'RE THE MOST COMMON
CONDITIONS.

Steve says I THINK WE HAVE THE
LIST OF THAT HERE.
YOU'VE POINTED TO 17 MEDICAL
CONDITIONS MOST OFTEN FOUND.
IT GOES FROM “A,” ALMOST ALL THE WAY TO “Z.”
“A” FOR ACUTE MYOCARDIAL
INFARCTION, KEEPING GOING,
DEPRESSION, RENAL FAILURE,
STROKE.
HOW DID YOU MANAGE TO IDENTIFY
THESE 17?

As Steve and Walter speak, a slide shows a rolling list of conditions.

Walter says THESE ARE
ACTUALLY BASED ON INTERNATIONAL
WORK ON NON-COMMUNICABLE
DISEASES.
THESE ARE DISEASES THAT APPEAR
ALL OVER THE WORLD TO BE
HIGH-BURDEN CONDITIONS BECAUSE
THEY EITHER COST A LOT AT AN
INDIVIDUAL LEVEL, SUCH AS
SOMETHING LIKE STROKE, WHICH CAN
BE VERY DEBILITATING.
IT ALSO LEADS TO LONG-TERM
CONSEQUENCES.
PEOPLE ARE OFTEN SUFFERING FROM
THEIR STROKE CONDITIONS FOR LONG
PERIODS OF TIME.
OR REALLY HIGH PREVALENCE.
THINGS LIKE HYPERTENSION FOR ONE
PERSON ARE NOT THAT EXPENSIVE,
BUT SO MANY PEOPLE HAVE THE
CONDITION THAT AT A SOCIETAL
LEVEL, IT'S A VERY HIGH BURDEN
CONDITION.
ALL OF THESE FOR ONE REASON OR
ANOTHER ARE VERY HIGH BURDEN.

The caption changes to "Costly conditions."

Steve says I'M LOOKING AT THE
LIST, WALTER, AND THERE'S ONE
THING NOT ON THE LIST THAT I
WOULD HAVE THOUGHT WOULD BE ON
THE LIST AND YOU CAN TELL ME WHY
IT'S NOT ON THE LIST AND THAT
IS -- I GUESS YOU CALL IT
TRAUMA.
YOU GET HIT BY A CAR, YOU WOULD
THINK YOU ARE A VERY EXPENSIVE
PROSPECT FOR THE HEALTH CARE
SYSTEM AFTER THAT.
NOT THE CASE?

Walter says TWO THINGS.
SOME OF THOSE PEOPLE ARE.
BUT THEIR CARE IS RELATIVELY
UNPREDICTABLE, IS A VERY SHORT
PERIOD OF TIME.
NOT ALWAYS.
SOME PEOPLE DO SUFFER FROM
CONDITIONS FOR A LONG PERIOD OF
TIME BUT MANY OF THOSE PEOPLE
ARE TREATED IN ACUTE CARE BUT
THEY'LL GO OUT AND LIVE THE REST
OF THEIR LIVES WITHOUT ANY
PROBLEMS.
ALL OF THE CONDITIONS WE'RE
CONSIDERING IN THIS STUDY AND
ALL OF THIS WORK ARE CONDITIONS
THAT ACTUALLY LAST OVER LONG
PERIODS OF TIME AND SO NOT ONLY
ARE THEY HIGH COST THIS YEAR BUT
THEY ACTUALLY CONTINUE TO BE
HIGH COST INDIVIDUALS OVER
MULTIPLE YEARS.

Steve says WHEREAS PRESUMABLY
IF YOU GET HIT BY A CAR YOU WILL
AT SOME POINT BE BETTER?

Walter says FOR THE
MOST PART, YES.
THERE'S A VERY SMALL PERCENTAGE
OF THAT POPULATION HAVE
DEBILITATING CONDITIONS.
MOST PEOPLE RECOVER.

Steve says WE HAVE ANOTHER GRAPHIC.

Another slate pops up showing a list of top reasons for hospital admission among children.

Steve continues WE WANT TO LOOK AT CONDITIONS
THAT ARE HOSPITAL ADMISSIONS BY
STAGES IN PEOPLE'S LIVES.
FOR EXAMPLE, WE HAVE LOW BIRTH
weight, PRE-TERM INFANTS,
DEPRESSIVE EPISODES,
CHEMOTHERAPY FOR NEOPLASM.
BRONCHIOLITIS.
WHAT IS THAT?

Walter says IT'S A LUNG INFECTION.

Steve says WHY CAN'T YOU SAY IT?
OH, MY GOODNESS, YOU PEOPLE IN MEDICINE.

Walter says WE DEFINE
CHILDREN UP TO AGE 18.
YOU MAY HAVE ACTUALLY HEARD,
YOUTH MENTAL HEALTH ISSUES ARE A
SIGNIFICANT CONCERN AND AN
INCREASING CONCERN AND HOW TO
ADDRESS THEIR ISSUES REQUIRES
NOT ONLY -- AND WE'LL GET INTO
SOME OF THIS LATER AGAIN, I
HOPE, THE HEALTH CARE SYSTEM,
BUT ALSO THE SCHOOL SYSTEM, THE
SOCIAL CARE SYSTEM, A BROAD
SOCIAL NETWORK.
BECAUSE IT'S NOT NECESSARILY
SOMETHING A PHYSICIAN ENTIRELY
ON THEIR OWN CAN MANAGE.

Another list pops up.

Steve says THAT'S CHILDREN.
LET'S NOW TAKE A LOOK AT THE
NEXT CHART.
THESE ARE THE TOP REASONS FOR
HOSPITAL ADMISSIONS IF YOU ARE
AN ADULT.
ATHEROSCLEROSIS, PALLIATIVE
CARE, CONGESTIVE HEART FAILURE,
CHEMOTHERAPY -- AGAIN, THAT LAST
ONE, WHAT DOES THAT MEAN?

Walter says CANCER.

Steve says AGAIN, YOU COULDN'T
JUST SAY THAT, EH?
HELP ME OUT A LITTLE BIT, WALTER.
SHALL WE DO THE --

Walter says ONE COMMENT
ABOUT THOSE CONDITIONS IS HOW
DISPARATE THEY ARE.
SO EVERYTHING FROM CANCER TO
HEART SURGERIES.
THERE ARE MANY -- WHAT WE FOUND
WITH THE ADULT POPULATION, SO 18
TO 64, IS THAT THERE ARE MANY
DIFFERENT KINDS.
SOME OF THEM ARE CHRONIC BUT
MANY OF THEM ARE ACUTE
CONDITIONS AS WELL.
IT'S DIFFICULT TO KNOW, HOW DO
YOU HAVE A POPULATION RESPONSE
TO A SPECIFIC CONDITION?
YOU CAN'T REALLY.
YOU HAVE TO HAVE A BROAD HEALTH
CARE SYSTEM AND THAT MAKES
HEALTH CARE VERY COMPLEX AS WELL.

Another list pops up.

Steve says LET'S DO THE THIRD
CHART IN THESE REASONS WHY
PEOPLE GO TO HOSPITAL.
WE'VE DONE KIDS, WE'VE DONE
ADULTS.
THIS IS AMONG OLDER ADULTS.
CONGESTIVE HEART FAILURE,
C.O.P.D., URINARY TRACT
INFECTIONS.
HIP FRACTURES.
PNEUMONIA.
OKAY.
A FEW OBVIOUS ONES THERE.
HEART FAILURE, C.O.P.D.
I UNDERSTAND WHY YOU'RE GOING TO
HOSPITAL.
URINARY TRACT INFECTION AND
PNEUMONIA CAN PUT YOU IN
HOSPITAL FOR A LONG TIME?

Walter says THESE
PEOPLE HAVE LOW CAPABILITY AND
RESILIENCE BECAUSE THEY HAVE
MULTIPLE CHRONIC CONDITIONS.
SOMEONE WHO 4 NO CONDITIONS AND
ONLY PNEUMONIA WOULD STAY AT
HOME AND THEY'D BE FINE.
PEOPLE WHO HAVE THREE OR FOUR
CHRONIC CONDITIONS, THAT MAKES
THEM AT HIGHER RISK.
WHEN THEY GET PNEUMONIA, IT'S A
VERY SERIOUS ILLNESS.

Steve says LET ME ASK THE
OVERARCHING QUESTION.
WELL, THIS IS WHY YOU'RE HERE.
IT'S INTERESTING TO KNOW WHY
PEOPLE GO INTO THE HOSPITAL, FOR
HOW LONG THEY GO INTO THE
HOSPITAL, THE AMOUNT OF MONEY
EACH SEGMENT OF THE POPULATION
ENDS UP COSTING.
THAT'S ALL INTERESTING TO KNOW.
WHY IS IT IMPORTANT TO KNOW?

Walter says SO IT'S
REALLY IMPORTANT IN TERMS OF HOW
WE MANAGE AND ORIENT THE HEALTH
CARE SYSTEM.
DO WE JUST TREAT THESE PEOPLE IN
THE HOSPITAL AND THAT'S ALL WE
NEED TO DO?
OR IF WE FIND, FOR EXAMPLE, THAT
THE PEOPLE WITH HIGH SUSTAINED
COSTS HAVE CHRONIC DISEASE, THEN
WE NEED TO THINK ABOUT HOW DO WE
MANAGE THEIR CHRONIC DISEASE
BEFORE THE HOSPITAL?
AND WHAT WE'RE REALLY FINDING IN
A LOT OF OUR WORK IS THAT IT'S
MULTIPLE CHRONIC CONDITIONS AND
WE DON'T HAVE SYSTEMS THAT
MANAGE MULTIPLE CHRONIC
CONDITIONS.
WE HAVE A DIABETES STRATEGY.
WE HAVE CARDIAC PROGRAMS.
BUT WE DON'T HAVE PROGRAMS FOR
PEOPLE WHO HAVE DEMENTIA WITH
ARTHRITIS AND THEY'RE DEPRESSED.

Steve says SO PRESUMABLY THE
IDEA BEHIND GETTING ALL THIS
INFORMATION IS TO IMPROVE THE
CARE OF THESE PEOPLE AT A LOWER
COST TO THE TAXPAYER; IS THAT
THE IDEA?

Walter says ABSOLUTELY.
AND WHAT KIND OF CARE THAT NEEDS
TO BE.
IT'S NOT JUST A DISEASE
MANAGEMENT PROGRAM.

Steve says TO THAT END, THE
ONTARIO GOVERNMENT IN ITS
WISDOM, SEVERAL YEARS AGO, I
THINK WITHIN THE PAST DECADE,
BROUGHT IN SOMETHING CALLED
HEALTH LINKS.
WHAT ARE THEY?

The caption changes to "Health links."

Walter says HEALTH
LINKS ARE REALLY BROUGHT IN TO
MANAGE THIS ISSUE.
THEY'RE BROUGHT IN VERY
SPECIFICALLY TO MANAGE THE CARE
FOR THE TOP 5 percent OF HEALTH CARE
USERS WHO HAVE MULTIPLE CHRONIC
CONDITIONS AND TO ORGANIZE
INTEGRATED CARE THAT HAS
PHYSICIANS AND COMMUNITY CARE,
HOME CARE, AND HOSPITALS ALL
INVOLVED TO SHARE THE CARE FOR
THOSE INDIVIDUALS.

Steve says HOW DOES IT ACTUALLY WORK?

Walter says AT THE
FRONT LINES, IT REALLY WORKS
WITH CARE COORDINATORS
IDENTIFYING PATIENTS, PHYSICIANS
REFERRING THEM, COMING UP WITH A
CARE PLAN THAT IS TAILORED TO
THE INDIVIDUAL, UNDERSTANDS
THEIR CONDITIONS, AND STARTS TO
PUT MORE OF A MANAGEMENT AROUND
THE PERSON INSTEAD OF THE DISEASE.

Steve says THE NAME ITSELF,
HEALTH LINKS, WOULD SUGGEST THAT
THE DISPARATE ASPECTS OF THE
HEALTH CARE SYSTEM ARE SOMEHOW
LINKED UP TO TREAT THIS ONE
PERSON.
DOES THAT ACTUALLY HAPPEN?

Walter says WHEN
THEY'RE HIGH-PERFORMING HEALTH
LINKS, THAT ABSOLUTELY HAPPENS.
PEOPLE ARE COMING TOGETHER TO
SHARE CARE AROUND PATIENTS THAT
HAVE NEVER HAD THOSE EXPERIENCES
BEFORE.

Steve says AND IS HEALTH LINKS
ACTUALLY SAVING THE TAXPAYER MONEY?

Walter says I THINK
HEALTH LINKS ARE STILL -- SO THE
ANNOUNCEMENTS WERE MADE A FEW
YEARS AGO, BUT THERE'S PROBABLY
ONLY ABOUT -- THERE'S 76 HEALTH
LINKS IN THE PROVINCE.
I WOULD SAY A THIRD ARE QUITE
MATURE AND THEY REALLY ARE
BETTER MANAGING THEIR CARE AND
THERE'S EVALUATION WORK GOING ON
THAT HAS INITIAL IDEAS ALONG
THOSE.
THEY WON'T TURN DOWN TOTAL
HEALTH SYSTEM COSTS BUT THEY
WILL BETTER MANAGE THE COSTS FOR
THOSE PATIENTS.
IT'S HARD WORK TO GET PEOPLE TO
COLLABORATE WHO HAVE NEVER MET
BEFORE.

Steve says THIS WAS EXACTLY THE
POINT I WAS GOING TO MAKE.
YOU TALKED IN THE PAST HOW THE
HEALTH CARE SYSTEM WORKS IN
SILOS, THE DIABETES STRATEGY.
HOW DO YOU GET THE DIFFERENT
ELEMENTS OF THE HEALTH CARE
SYSTEM TO WORK TOGETHER?

Walter says THAT IS A
REALLY CHALLENGING ASPECT.
SOME HAVE A VERY NATURAL
TENDENCY TO WANT TO COLLABORATE.
I THINK THE MORE THAT WE PUT
PATIENTS AT THE FRONT OF ALL OF
THIS, THE MORE EVERYBODY IS
WILLING TO COME AROUND AND HAVE
A DISCUSSION.
SO PHYSICIANS REALLY WANT THE
BEST FOR THEIR PATIENTS AND
THEY'RE HAPPY TO COME AND HAVE A
DISCUSSION ABOUT HOW THEIR
PATIENT CARE -- THEIR PATIENTS
CAN BE BETTER MANAGED AND BETTER
CARED FOR.
IF WE JUST THINK ABOUT IT AS, WE
NEED TO HAVE A MEETING TO HAVE A
NEW COORDINATED TEAM, THEY MIGHT
BE LESS INTERESTED AND WILLING.

Steve says GOTCHA.
DO YOU WANT TO DO THIS CLIP NOW?
IN JANUARY, EARLIER IN JANUARY,
WE HAD AN INTERVIEW WITH A GUY
WHO WROTE A BOOK CALLED THE
WELLNESS SYNDROME.
THE AUTHOR IS SWEDISH.
HERE IS WHAT HE HAD TO SAY ABOUT
SOME OF WHAT WE'RE TALKING ABOUT
RIGHT NOW.
ROLL THE CLIP.

A clip plays in which a man in his thirties speaks on a previous edition of The Agenda.

He says THERE WAS A DUTCH STUDY A FEW
YEARS AGO THAT SUGGESTED THAT
THE PEOPLE WHO ARE REALLY
COSTING SOCIETY MOST ARE PEOPLE
LIKE, I SUPPOSE YOURSELF, YOU
LOOK LIKE A VERY HEALTHY MAN,
AND MYSELF, YOU KNOW, I'M A
REASONABLY HEALTHY PERSON.
WE ARE THE PEOPLE WHO COST
SOCIETY MOST BECAUSE WHEN WE
RETIRE, WE KEEP ON LIVING
FOREVER AND EVER.
YOU KNOW, A SMOKER, OBESE PEOPLE
TEND TO WORK AND THEN THEY DIE.
FROM A STRICTLY -- YOU KNOW,
FROM A STRICTLY ECONOMIC POINT
OF VIEW, THEY COST SOCIETY
LESS --

Steve says THEY'RE NOT GOING TO
COLLECT THEIR PENSIONS AND
THEREFORE THEY'LL COST US LESS
IN THE END.
IS THAT THE IDEA?

The man says THAT'S RIGHT.
PEOPLE LIKE US, I DON'T KNOW --
AT LEAST I HOPE WE WILL BE A BIG
BURDEN TO SOCIETY AND KEPT OUT
OF HOSPITAL UNTIL WE'RE VERY OLD.

The clip ends.

Steve says AMEN TO THAT.
LET ME PLUCK A QUESTION OUT OF THAT.
IS THAT THE APPROPRIATE THING TO
DO HERE?

Walter says I REALLY
DON'T THINK THAT'S THE
APPROPRIATE THING TO DO HERE.
PEOPLE WHO ARE PRESENTING TO THE
HEALTH CARE SYSTEM NEED CARE AND
THE SYSTEM NEEDS TO RESPOND AS
BEST THEY CAN.

Steve says EVEN IF THEY ARE THE
AUTHORS OF THEIR OWN MISFORTUNE.

Walter says THERE ARE
MANY SOCIAL CIRCUMSTANCES THAT
LEAD PEOPLE DOWN A WHOLE
TRAJECTORY OF LIFE THAT LEADS
THEM TO POOR HEALTH OUTCOMES,
NOT TO MENTION, AND THERE HAS
BEEN QUITE A BIT OF DEBATE ABOUT
CANCER, ARE THEY TOTALLY GENETIC
OR BY BEHAVIOUR?
I THINK THE ANSWER IS THEY'RE
NOT EITHER-OR, THEY'RE A
COMBINATION OF MANY THINGS THAT
GO ON AND MANY PEOPLE'S
BEHAVIOUR ARE BROUGHT UP BY
UPBRINGING --

Steve says ABSOLUTELY.
AND THE POVERTY THEY HAVE TO
EXPERIENCE AND SO ON AND SO
FORTH.
DO YOU HAVE THE SLIGHTEST BIT
LESS SYMPATHY FOR THE PEOPLE
SMOKING THREE PACKS A DAY FOR
LIFE KNOWING THAT THAT'S KILLING THEM?

Walter says I DON'T
HAVE LESS SYMPATHY WHEN THEY
PRESENT TO THE HEALTH CARE
SYSTEM.
THESE ARE PEOPLE WHERE WE NEED
TO HAVE BETTER BEHAVIOURAL
MODIFICATION PROGRAMS -- IT'S
NOT MODIFICATION IN TERMS OF
SOMEBODY ELSE DOING SOMETHING TO
THEM BUT HELPING THEM, RIGHT?
THEY NEED TO REALIZE AND ALL
PEOPLE HAVE TO REALIZE THEY CAN
BE MORE ACTIVE.
WE CAN ALL DO BETTER.
I CAN EAT BETTER.
I CAN BE MORE ACTIVE, LESS
SEDENTARY TOO.
SO EVEN JUST SITTING AT MY DESK
AT THE UNIVERSITY FOR TOO LONG
OF A PERIOD, EVEN IF I AM AN
ACTIVE PERSON, CAN BE HARMFUL.
THERE'S ALWAYS ROOM FOR
IMPROVEMENTS AND I THINK WE JUST
NEED TO HELP PEOPLE GET TO WHERE
THEY WANT TO BE.

Steve says WE ON THIS PROGRAM
LIKE PEOPLE LEADING ACTIVE LIVES
AS WELL EXCEPT OF COURSE BETWEEN
8:00 AND 9:00 AT NIGHT WHEN
WE'RE HAPPY TO HAVE THEM SIT ON
THEIR COUCH AND WATCH
TELEVISION, IF THAT'S WHAT THEY
WANT TO DO, AS LONG AS THEY'RE
WATCHING US.
IF YOU'RE WATCHING THIS RIGHT
NOW AND A VIEWER SUSPECTS THEY
ARE PART OF THIS HIGH-CARE,
HIGH-COST SEGMENT OF THE PATIENT
POPULATION, WHAT'S YOUR ADVICE?

Walter says FIRST, IF
THEY THINK THEY'RE HAVING
CHALLENGES OR THEY COULD USE
SOME MORE HELP IN HELPING TO
COORDINATE THAT THEY HAVE MANY
DIFFERENT PROVIDERS AND IT'S
DIFFICULT TO FOLLOW, THEN THEY
SHOULD ASK THEIR PHYSICIAN ABOUT
HEALTH LINKS.
AND THEIR PHYSICIAN SHOULD BE
ABLE TO LET THEM KNOW IF THERE'S
A HEALTH LINK -- THERE SHOULD BE
A HEALTH LINK IN THEIR
NEIGHBOURHOOD AND HOW THEY WOULD
GET CONNECTED.
THERE ARE ALSO WEB SITES, IF
THEY WERE TO LOOK THIS UP
ONLINE, IT WON'T BE HARD TO
FIND, BY LOCAL AREA.
THESE ARE GEOGRAPHICALLY
DETERMINED.
AND THINK ABOUT WAYS -- WHERE DO
THEY NEED HELP?
AND TO ASK FOR THAT KIND OF HELP.

Steve says DO YOU NEED TO GET
INTO HEALTH LINKS OR CAN YOU DO
IT ON YOUR OWN?

Walter says HEALTH
LINKS ARE MEANT FOR PEOPLE WHO
HAVE A LOT OF REALLY SIGNIFICANT
CHALLENGES, THEY HAVE MULTIPLE
CHRONIC CONDITIONS.
I THINK BOTH THEY AND SOME
PEOPLE WHO ARE NOT QUITE THAT
ILL YET NEED HELP IN MANY
REGARDS, RIGHT?
SO COACHING -- THAT'S WHERE
PRIMARY CARE AND GOOD
COMMUNITY-BASED CARE CAN REALLY
BE VERY HELPFUL IN HELPING
PEOPLE TO MANAGE AND UNDERSTAND
THEIR OWN CONDITIONS.

Steve says IT GOES WITHOUT
SAYING THAT IF THE WHOLE IS
SOCIETY IS HEALTHIER, WE ALL DO BETTER.

Walter says EXACTLY.

The caption changes to "Producer: Sandra Gionas, @sandragionas"

Steve says GOTCHA.
WALTER, GOOD OF YOU TO COME INTO
TVO TONIGHT AND SHARE YOUR
THOUGHTS ON THIS.

Walter says THANKS VERY MUCH.

Watch: High-Care High-Cost Patients