Lower costs of care in rural GPs – a sign of effectiveness or a warning?
Authors:
J. Bělobrádek 1; L. Šídlo 2; V. Šafka 3
Authors‘ workplace:
Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Ústav preventivního lékařství, Přednostka: prof. MUDr. Lenka Borská, Ph. D.
1; Univerzita Karlova v Praze, Přírodovědecká fakulta, Katedra demografie a geodemografie, Vedoucí: doc. RNDr. Jiřina Kocourková, Ph. D.
2; Univerzita obrany, Fakulta vojenského zdravotnictví, Katedra vojenského vnitřního lékařství a vojenské hygieny Hradec Králové, Vedoucí: plk. gšt. prof. MUDr. Jan Horáček, Ph. D.
3
Published in:
Prakt. Lék. 2022; 102(4): 184-190
Category:
Of different specialties
Overview
Objectives: We have only a little information about the differences between urban and rural primary care practices in Central Europe. In this article, we seek to explore these differences between general practices in Czechia using the cost data of the largest domestic health insurance provider, amounting altogether to 69.7 billion CZK (2.57 billion euros).
Methods: We have analysed the total annual costs per registered insurance holder /patient/ (using age indexation) in 2016 (for 4.69 million adults) in the selected segments directly impacted by GPs. We used our typology to assort individual practices, which based on the OECD principles of territorial division (urban, intermediate, rural practices).
Results: In total, general practices in urban areas report the highest costs of patient care, the costs are lower in peripheries, primarily with the intermediate type of practices (by 7%). Non-urban practices perform more procedures (6–18%). They use radio diagnostics and laboratories more and prescribe more medications (18–32%). On the other hand, they use fewer specialist and home care services and have lower costs in all items with respect to care indicated by other doctors than GPs (non-GPs). In prescriptions by units of per cent (5–6%), and in other items under review by tens of per cent (11–41%). Conclusions: Non-urban GP practices in Czechia have lower total costs per registered insurance holder while having the same level of capitation. The critical issue for the subsequent research remains whether non-urban practices really work more effectively or reflect worse care resulting from the uneven spatial distribution of healthcare services.
Keywords:
Primary care – cost analysis – general practice – rural health – regional typology
Sources
1. Ono, T, Schoenstein M, Buchan J. Geographic imbalances in doctor supply and policy responses. OECD Health Working Papers 2014; 69, OECD Publishing, Paris (online). Dostupné z: www: https://doi.org/10.1787/5jz5sq5ls1wl-en (cit. 2022-08-04).
2. Mehring M, Donnachie E, Schneider A, et al. Impact of regional socioeconomic variation on coordination and cost of ambulatory care: investigation of claims data from Bavaria, Germany. BMJ Open 2017; 7(10): e016218. doi: 10.1136/bmjopen-2017-016218.
3. Varabyova Y, Müller JM. The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons. Health Policy 2016; 120(3): 252–263. doi: 10.1016/j.healthpol.2015.12.005.
4. Schneider A, Donnachie E, Tauscher M, et al. Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria. BMJ Open 2016; 6(6): e011621. doi: 10.1136/bmjopen-2016-011621.
5. Busato A, Matter P, Künzi B, Goodman D. Geographic variation in the cost of ambulatory care in Switzerland. J Health Serv Res Policy 2012; 17(1): 18–23. doi: 10.1258/jhsrp.2011.010056.
6. Camenzind PA. Explaining regional variations in health care utilization between Swiss cantons using panel econometric models. BMC Health Serv Res 2012; 12: 62. doi: 10.1186/1472-6963-12-62.
7. Kringos DS, Boerma WGW, Van der Zee J, Groenewegen PP. Europe’s strong primary care systems are linked to better population health, but also to higher health spending. Health Aff 2013; 32(4): 686–694.
8. Kringos DS, Boerma WGW, Hutchinson A, Saltman RB (Eds.) Building primary care in a changing Europe. World Health Organization 2015 (online). Dostupné z: https:// www.euro.who.int/_data/assets/pdf_file/0018/271170/ BuildingPrimaryCareChangingEurope.pdf (cit. 2022-08-04).
9. Kringos DS, Boerma WGW, Bourgueil Y, et al. The strength of primary care in Europe: an international comparative study. Br J Gen Pract 2013; 63(616): e742–e750.
10. Schäfer WL, Boerma WG, Spreeuwenberg P, et al. Two decades of change in European general practice service profiles: conditions associated with the developments in 28 countries between 1993 and 2012. Scand J Prim Health Care 2016; 34(1): 97–110.
11. OECD. Geographic variations in health care: what do we know and what can be done to improve health system performance? OECD Health Policy Studies. Paris: OECD Publishing 2014 (online). Dostupné z: https://read.oecd-ilibrary.org/social- issues-migration-health/geographic-variations-in-healthcare_ 9789264216594-en#page1 (cit. 2022-08-04).
12. OECD. Hospodářské přehledy OECD. Česká republika 2018. Strukturální kapitola Zlepšení systému zdravotní péče v České republice (online). Dostupné z: https://www.mzcr.cz/wp-content/ uploads/wepub/16384/35583/%C4%8CJ_OECD%20 Hospod%C3%A1%C5%99sk%C3%BD%20p%C5%99ehled.pdf (cit. 2022-08-04).
13. OECD/European Union. Health at a Glance: Europe 2020. State of Health in the EU Cycle. Paris: OECD Publishing 2020 (online) Dostupné z: https://read.oecd-ilibrary.org/social-issues-migration- health/health-at-a-glance-europe-2020_82129230- en#page1 (cit. 2022-08-04).
14. Hoffmann K, Stein KV, Maier M, et al. Access points to the different levels of health care and demographic predictors in a country without a gatekeeping system. Results of a cross-sectional study from Austria. Eur J Public Health 2013; 23(6): 933–939.
15. Hoffmann K, George A, Van Loenen T, et al. The influence of general practitioners on access points to health care in a system without gatekeeping: a cross-sectional study in the context of the QUALICOPC project in Austria. Croat Med J 2019; 60(4): 316–324.
16. Joumard I, André C, Nicq C. Health care systems: efficiency and institutions. OECD Economics Department Working Papers, No. 769, 2010 (online). Dostupné z: https://www.oecd-ilibrary.org/ docserver/5kmfp51f5f9t-en.pdf?expires=1659679608&id=id&a ccname=guest&checksum=6B2048042F3BD1C8DD275CFA42FBA72B (cit. 2022-08-04).
17. OECD. OECD Regions at a Glance 2016 (online). Dostupné z: https://www.oecd-ilibrary.org/sites/reg_glance-2016-en/index. html?itemId=/content/publication/reg_glance-2016-en (cit. 2022-08-04).
18. Boerma WG, Groenewegen PP, Van der Zee J. General practice in urban and rural Europe: the range of curative services. Soc Sci Med 1998; 47(4): 445–453.
19. Bělobrádek J, Šídlo L, Javorská K, Halata D. Urban or rural GP? In the Czech republic it is not just distances that matter. Acta Medica (Hradec Kralove) 2021; 64(1): 15–21. Dostupné z: https://karolinum.cz/data/clanek/8989/AM_64_1_0015.pdf (cit. 2022-08-04).
20. Všeobecná zdravotní pojišťovna ČR. Výroční zpráva VZP ČR za rok 2016 (online). Dostupné z: https://media.vzpstatic.cz/media/ Default/vyrocni-zpravy/vyrocni-zprava-vzp-2016.pdf (cit. 2022- 08-04).
21. Všeobecná zdravotní pojišťovna ČR. Věkové indexy od 1. 1. 2016 (online). Dostupné z: https://media.vzpstatic.cz/media/Default/ dokumenty/ciselniky/ostatni/vekind-895.pdf (cit. 2022-08-04).
22. OECD, Eurostat, WHO. A system of health accounts, 2011. Revised edition (online) Dostupné z: https://read.oecd-ilibrary. org/social-issues-migration-health/a-system-of-health-accounts- 2011_9789264270985-en#page1 (cit. 2022-08-04).
23. OECD. Health at a Glance: Europe 2018. State od Health in the EU Cycle (online). Dostupné z: https://read.oecd-ilibrary. org/social-issues-migration-health/health-at-a-glance-europe- 2016_9789264265592-en#page117 (cit. 2022-08-04).
24. Bonciani M, Schäfer W, Barsanti S, et al. The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries. BMC Health Serv Res 2018; 18(1): 132.
25. Rumball-Smith J, Wodchis WP, Koné A, et al. Under the same roof: co-location of practitioners within primary care is associated with specialized chronic care management. BMC Fam Pract 2014; 15: 149.
26. Šídlo L, Bělobrádek J, Maláková K. Všeobecní praktičtí lékaři v Česku: vývojové trendy a regionální rozdíly. Geografie 2021; 126(2): 169–194.
27. Göpffarth D, Kopetsch T, Schmitz H. Determinants of regional variation in health expenditures in Germany. Health Econ 2016; 25(7): 801–815.
28. Johansson N, Jakobsson N, Svensson M. Regional variation in health care utilization in Sweden - the importance of demand-side factors. BMC Health Serv Res 2018; 18(1): 403.
29. Schäfer I, Hansen H, Ruppel T, et al. Regional differences in reasons for consultation and general practitioners‘ spectrum of services in northern Germany - results of a cross-sectional observational study. BMC Fam Pract 2020; 21(1): 22.
30. Rygh EM, Hjortdahl P. Continuous and integrated health care services in rural areas. A literature study. Rural Remote Health 2007; 7(3): 766.
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General Practitioner
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