MULTUM, NON MULTA – Heavy users in Oulu university hospital emergency department services, customer profile and the cost of social and health care services

One of the purposes of the Finnish new organizing law of social and health care services is to reduce the State economy's long term sustainability. One way to do this is to reduce the cost growth of public services. The purpose of this study was to find out the profile of the customers who were heavy users of Oulu university hospital (OUH) emergency department and what were the costs of their service use in other social- and healthcare services in the year 2014. 

This retrospective register study was carried out on quantitative method that was based on the customer registers of the year 2014 from the Northern Ostrobothnia Hospital District and Oulu social- and healthcare services. The statistical analyzes were done with Excel- and SPSS-statistical programs. 

According to results heavy users have numerous of different diagnosis. There were 0.2 % heavy service users in the Oulu city district area and they used 14.9 % of all contacts that was made by Oulu city residents in OUH emergency department. Within the year 2014 these people had 5440 service events in the emergency department (average 14 service events, the least 6 service events and the most 192 service events). Mostly the reason for the entry was injuries and intoxications and over 60 % of these entries were connected with either mental problems or substance abuse problem or both. Age distribution was younger in this group than heavy users who came in the emergency department for other entry reasons. Also these customers used other social- and healthcare services during the research period 3371 visits altogether (average 9 visits, the least 1 visit and the most 27 visits). The total cost of the service use was 9 556 947 euros in the year 2014. The average cost/customer was 24 568 euros. The cost of social- and healthcare services was over eight times higher than the cost with normal customer. Over one-third (139 customers) of the heavy users reach the average cost, total of 7 128 030 euros. 

The reason for the emergency department entry of heavy users of OUH emergency department is often not the same than the real need of the service and the current social and healthcare system hasn't been able to meet the customers' needs. This research can be used to develop services in OUH emergency department and Oulu welfare services. The economic benefit could be reached by focusing resources to the customer group studied.