Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: a record linkage study between patient data and reimbursements data

BMC Family Practice

Research Article

Aeilko H Zwinderman¹  Frans T Smits²  Gerben ter Riet²  Henk C Van Weert²  Jacob Mohrs²  Henk J Brouwer²  Judith E Bosmans³  Aart H Schene⁴  Hugo M Smeets⁵ 

[1] Department of Clinical Epidemiology, Biostatistics and Bioinformatics - Academic Medical Center, University of Amsterdam, 1100 DD, Amsterdam, The Netherlands;Department of General Practice - Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands;Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, 1081 BT, Amsterdam, The Netherlands;Department of Psychiatry, Academic Medical Center, 1100 DD, Amsterdam, The Netherlands;Julius Centre for Health Sciences and Primary Care, University Medical Center, 3584 CG, Utrecht, The Netherlands;Agis Health Database, Agis Zorgverzekeringen, 3800 HA, Amersfoort, The Netherlands;

关键词: (Persisting) frequent attender;    High utilizer;    Healthcare expenditure;    Primary care;    General practice;    Primary care physician;    General practitioner;    Linkage study;    Reimbursements data;    Multimorbidity;   

DOI  :  10.1186/1471-2296-14-138

 received in 2013-05-24, accepted in 2013-09-06,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundFrequently attending patients to primary care (FA) are likely to cost more in primary care than their non-frequently attending counterparts. But how much is spent on specialist care of FAs? We describe the healthcare expenditures of frequently attending patients during 1, 2 or 3 years and test the hypothesis that additional costs can be explained by FAs’ combined morbidity and primary care physicians’ characteristics.MethodsRecord linkage study. Pseudonymised clinical data from the medical records of 16 531 patients from 39 general practices were linked to healthcare insurer’s reimbursements data. Main outcome measures were all reimbursed primary and specialist healthcare costs between 2007 and 2009. Multilevel linear regression analysis was used to quantify the effects of the different durations of frequent attendance on three-year total healthcare expenditures in primary and specialist care, while adjusting for age, sex, morbidities and for primary care physicians characteristics. Primary care physicians’ characteristics were collected through administrative data and a questionnaire.ResultsUnadjusted mean 3-year expenditures were 5044 and 15 824 Euros for non-FAs and three-year-FAs, respectively. After adjustment for all other included confounders, costs both in primary and specialist care remained substantially higher and increased with longer duration of frequent attendance. As compared to non-FAs, adjusted mean expenditures were 1723 and 5293 Euros higher for one-year and three-year FAs, respectively.ConclusionsFAs of primary care give rise to substantial costs not only in primary, but also in specialist care that cannot be explained by their multimorbidity. Primary care physicians’ working styles appear not to explain these excess costs. The mechanisms behind this excess expenditure remain to be elucidated.

【 授权许可】

CC BY   
© Smits et al.; licensee BioMed Central Ltd. 2013