Small Area Rate Variation in High-cost Healthcare Use in Prince Edward Island

Small Area Rate Variation in High-cost Healthcare Use in Prince Edward Island


A small percentage of the population accounts for the majority of public health care costs. These high-cost patients typically have multiple, complex chronic health conditions, such as diabetes, heart disease, respiratory diseases, and mental health conditions. Inadequate disease management and care coordination leads to avoidable and expensive contact with the health care system, such as trips to the Emergency Department and hospitalizations. Improving the efficiency and effectiveness of health service delivery to this high-cost population would have a significant impact on the overall fiscal sustainability of the provincial health care system. Analysis of small area variations in rates of health services and outcomes has considerable potential to support health care planning and management by informing targeted high-yield interventions to reduce costs and improve patient outcomes. Small area rate variation (SARV) enables communication of geographic rate variations through easy to understand graphic maps. Making this information available through web-based applications has proven to be a powerful way to inform stakeholders and has facilitated greater accountability for more efficient and high-quality health care services in many jurisdictions in the world. As a first step to generating evidence on small area variations in rates of health service needs, uses and outcomes in Prince Edward Island (PEI), the Maritime SPOR SUPPORT Unit (MSSU) aims to assess geographic variations in the prevalence and characteristics of high-cost health care users.

In July 2016, the MSSU produced a report examining the nature of health care spending in Nova Scotia. The Small-Area Rate Variation (SARV) study found that two-thirds of health care spending is accounted for by just five percent of health care users (high-cost users). The SARV study also found that these high-cost users are geographically clustered in rural and urban communities of the province. Demographics and disease patterns explained some, but not all of this variation in health care spending. It is clear that more research needs to be done in order to identify the underlying causes of high-cost health care use in Nova Scotia. The PEI node of MSSU aims to replicate this study using PEI health data. This will not only characterise the variation in health care cost in PEI but it may also be compared with the results from the other two Maritime provinces and may aid in developing future Maritime initiatives to address these costs.


This study will examine SARV in high-cost use of health services among persons aged 30 and above residing in all areas of PEI. The primary objectives of the study are to:

  • Estimate rates of high- and low-cost use in areas of PEI.
  • Identify the known contributors to SARV in high-cost use, including demographics, disease patterns, and multi-morbidity.
  • Identify additional factors that may account for SARV in high-cost use. These include health care access and quality factors, such as continuity of primary care and resources to support patients upon discharge from hospital, and social and economic characteristics.