Characteristics and Health Care Utilization of Different Segments of a Multiethnic Asian Population in Singapore
Authors: Shi Yan, Yu Heng Kwan, Julian Thumboo, Lian Leng Low
Journal: JAMA Network Open (2019)

<h3>Importance</h3> Descriptive population-level health data are critical components of the evidence base for population health policy. Human populations often display marked heterogeneity in their health status among subgroups of the population. The recent widespread adoption of electronic health records provides opportunities to use routine real-world health care data to examine population health. <h3>Objective</h3> To report population sociodemographic characteristics, health conditions, health care utilization, and health care costs for different population segments of a multiethnic Asian population divided according to a modified British Columbia Population Segmentation Framework. <h3>Design, Setting, and Participants</h3> This population-based cross-sectional study used 2016 data from the Singapore Eastern Regional Health System, the largest Regional Health System in Singapore. Data were obtained from deidentified national-level electronic health records at the Ministry of Health Singapore. Participants included all residents in the Singapore Eastern Regional Health System catchment area in 2016. The descriptive analysis was conducted in August 2018. <h3>Main Outcomes and Measures</h3> Socioeconomic profiles, disease prevalence, health care utilization, and cost patterns of population segments. <h3>Results</h3> The total size of the study population in 2016 was 1 181 024 residents (576 663 [48.83%] male; median [interquartile range] age, 40 [22-57] years). The population was divided into 8 segments: healthy with no outpatient utilization (493 483 residents), healthy with outpatient utilization (259 909 residents), healthy with inpatient admissions (49 588 residents), low complex (215 134 residents), medium complex (79 350 residents), high complex (44 445 residents), cancer (34 217 residents), and end of life (4898 residents). Overall, the 3 most prevalent conditions were chronic kidney disease (31.89%), hypertension (18.52%), and lipid disorders (18.33%). Distributions of chronic conditions differed across the segments. Different segments had varying health care utilization patterns: the high-complex segment had the highest number of primary care clinic visits (mean [SD], 4.25 [5.46] visits), the cancer segment had the highest number of specialist outpatient clinic visits (mean [SD], 5.55 [8.49] visits), and the end-of-life segment had the highest numbers of accident and emergency department visits (mean [SD], 1.80 [1.88] visits) and inpatient admissions (mean [SD], 1.99 [1.89] admissions) during 2016. For health care costs, specialist outpatient clinic and inpatient care together made up more than 85% of the total cost of nearly 2 billion Singapore dollars. The end-of-life segment contributed approximately 50% of the health care cost per capita of 60 000 Singapore dollars. <h3>Conclusions and Relevance</h3> Different population segments displayed heterogeneity in sociodemographic characteristics, health conditions, health care utilization, and health care cost patterns. This critical health information can be used as baseline data to inform regional and national health priorities for health services research and policy.