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The conflicting challenges of increased patient demand and decreased health care resources require a partial shift in responsibility from the health care system back to the individual. Our objective was to see if participation in a group program (mindfulness-based stress reduction (MBSR)) that reduces stress and fosters self-care impacted health care utilization. We did a prospective study of 1730 patients participating in an MBSR program comparing their health care utilization for 1- and 2-year pre-/post-periods with three different matched comparison groups. In both pre-intervention periods, cases had higher overall costs, numbers of physician claims, and utilization of lab facilities when compared with all three comparison groups. Participation in an MBSR program resulted in consistent decreases in utilization across all outcome variables at the 1-year pre/post interval. These decreases were significantly different than the patterns shown by the matched comparisons. Assuming 1500 MBSR participants (close to the number in the “closest” match) times an average savings of $250 would result in $375,000 in savings. These differences disappeared at the 2-year pre/ post interval with the exception of laboratory utilization. Our findings suggest that mindfulness training is effective for short-term reductions in health care use among a group of complex and heavy users. Anecdotal reports suggest MBSR participants stop their formal mindfulness practice within months of completing the program. It may well be that continuing the formal practice of mindfulness is a necessary prerequisite for maintaining the reductions in health care utilization.
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Brown, R. A. (Ed.). (1987). The essential Reinhold Niebuhr: selected essays and addresses. New Haven: Yale University Press.
Canadian Institute for Health Information. (2014). National health expenditure trends, 1975 to 2014. Ottawa: Author.
Chan, B. T., & Schultz, S. E. (2005). Supply and utilization of general practitioner and family physician services in Ontario. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences. Also available at http://www.ices.on.ca/~/media/Files/Atlases-Reports/2005/Supply-and-utilization-of-GP-and-FP-services-in-Ontario/Full%20report.ashx.
Gross, C. R., Kreitzer, M. J., Russas, V., Treesak, C., Frazier, P. A., & Hertz, M. I. (2004). Mindfulness meditation to reduce symptoms after organ transplant: a pilot study. Advances in Mind-Body Medicine, 20(2), 20–29. PubMed
Health Canada. (1997). Supporting self-care: the contribution of nurses and physicians, an exploratory study. Ottawa: Minister of Public Works and Government Services Canada.
Herron, R. (2011). Changes in physician costs among high-cost transcendental meditation practitioners compared with high-cost non-practitioners over 5 years. American Journal of Health Promotion, 26(1), 56–60.
Kabat-Zinn, J. (1987). Six-month hospital visit cost reductions in medical patients following self-regulatory training. Washington, D.C.: Poster presented at Society of Behavioral Medicine.
Kabat-Zinn, J. (1990). Full catastrophe living. New York: Delta.
Kabat-Zinn, J., Lipworth, L., Burney, R., & Sellers, W. (1986). Four year follow-up of a meditation-based program for the self-regulation of chronic pain: treatment outcomes and compliance. Clinical Journal of Pain, 2, 159–173. CrossRef
Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. B., Fletcher, K. E., Pbert, L., Lenderking, W. R., & Santorelli, S. F. (1992). Effectiveness of meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychology, 149, 936–943. CrossRef
Kurdyak, P., Newman, A., & Segal, Z. (2014). Impact of mindfulness-based cognitive therapy on health care utilization: a population-based controlled comparison. Journal of Psychosomatic Research, 77(2), 85–89. PubMed
Lin, E., Diaz-Granados, N., Stewart, D. E., Rhodes, A. E., Yerritsyan, N., Johns, A., Minh, D.-H., & Bierman, A. S. (2009). Depression. In A. S. Bierman (Ed.), Project for an Ontario women’s health evidence-based report, volume 1. Toronto: St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences. Also available at: http://powerstudy.ca/power-report/volume1/depression/.
Mirolla, M. (2004). The cost of chronic disease in Canada. Report to The Chronic Disease Prevention Alliance of Canada. Retrieved from http://www.gpiatlantic.org/pdf/health/chroniccanada.pdf.
Nakagawa, S., & Cuthill, I. C. (2007). Effect size, confidence interval and statistical significance: a practical guide for biologists. Biological Review, 82, 591–605. CrossRef
Patra, J., Popova, S., Rehm, J., Bondy, S., Flint, R., & Giesbrecht, N. (2007). Economic cost of chronic disease in Canada 1995–2003, Report to the Ontario Chronic Disease Prevention Alliance and the Ontario Public Health Association. Retrieved from http://www.ocdpa.on.ca/sites/default/files/publications/OCDPA_EconomicCosts.pdf.
Reid, R., MacWilliam, L., Roos, N.P., Bogdanovic, B., & Black, C. (1999). Measuring morbidity in populations: performance of the Johns Hopkins Adjusted Clinical Group (ACG) Case-mix Adjustment System in Manitoba. Report to the Manitoba Centre for Health Policy and Evaluation and the Centre for Health Services and Policy Research, University of British Columbia. Retrieved from http://mchp-appserv.cpe.umanitoba.ca/reference/acg.pdf.
Robinson, F. P., Mathews, H. L., & Witek-Janusek, L. (2003). Psycho-endocrine-immune response to mindfulness-based stress reduction in individuals infected with the human immunodeficiency virus: a quasiexperimental study. Journal of Alternative and Complementary Medicine, 9(5), 683–694. CrossRefPubMed
Rosenzweig, S., Reibel, D. K., Greeson, J. M., Brainard, G. C., & Hojat, M. (2007). Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative Therapies in Health and Medicine, 13(5), 36–37. PubMed
Roth, B., & Stanley, T. (2002). Mindfulness-based stress reduction and healthcare utilization in the inner city: preliminary findings. Alternative Therapies in Health and Medicine, 8(1), 60–66. PubMed
Ruff, K. M., & MacKenzie, E. R. (2009). The role of mindfulness in healthcare reform: a policy paper. Explore, 5(6), 313–323. CrossRef
SAS Institute Inc. (2011). Base SAS® 9.3 procedures guide: statistical procedures. Cary: SAS Institute Inc.
Segal, Z., Williams, M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford Press.
Sephton, S. E., Lynch, G., Weissbecker, I., Ho, I., & Salmon, P. (2001). Effects of a meditation program on symptoms of illness and neuroendocrine responses in women with fibromyalgia. [Conference abstract]. Psychosomatic Medicine, 63(1), 91–92. CrossRef
Sobel, D. (2000). Mind matters, money matters: the cost-effectiveness of mind/body medicine. Journal of the American Medical Association, 284(13), 1704. CrossRef
Statistics Canada (2007). Standard geographical classification (SGC). Volume I. The classification. Ottawa, ON, Canada. Retrieved from http://www.statcan.gc.ca/pub/12-571-x/12-571-x2006001-eng.pdf.
Statistics Canada (2010). Population and dwelling counts, for Canada, provinces and territories, census metropolitan areas and census agglomerations, 2006 and 2001 censuses—100% data. Retrieved from http://www12.statcan.gc.ca/census-recensement/2006/dp-pd/hlt/97-550/Index.cfm?TPL=P1C&Page=RETR&LANG=Eng&T=202&PR=35&S=0&O=D&RPP=50.
Wilkins, R., & Khan, S. (2010). PCCF + Version 5H User’s Guide. Automated geographic coding based on the Statistics Canada Postal Code Conversion files, including postal codes through October 2010. Retrieved from http://abacus.library.ubc.ca/jspui/bitstream/10573/42833/3/msword.pccf5j.pdf.
Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 211–228. CrossRef
- Cost-Effectiveness of the Mindfulness-Based Stress Reduction Methodology
Royce William Knight
Andrew S. Wilton
- Springer US