The effect of first-contact care with primary care clinicians on ambulatory health care expenditures.
BACKGROUND
A study was undertaken to examine the relationship between first-contact care, an essential feature of primary care, and expenditures for frequent ambulatory episodes of care in a nationally representative sample.


METHODS
A nonconcurrent cohort study was conducted using data from the 1987 National Medical Expenditure Survey. Ambulatory claims data of respondents with an identified primary care source were used to develop 20,282 episodes of care for 24 preventive and acute illness conditions. The study examined the relationship of first-contact care, defined as the use of an identified primary care source for the first visit in an episode, and ambulatory episode-of-care expenditures.


RESULTS
Episodes that began with visits to an individual's primary care clinician, as opposed to other sources of care, were associated with reductions in expenditures of 53% overall ($63 vs 134, P<.001), 62% for acute illnesses ($62 vs $164, P<.001), and 20 for preventive care ($64 vs $80, P<.001). For 23 of the 24 health problems studied, first-contact care was associated with reductions in expenditures. Multivariate regression analyses that controlled for sociodemographic characteristics, health status, case-mix, length of the episode, and number of visits to the emergency room did not substantively alter these results.


CONCLUSIONS
First-contact care was associated with reductions in ambulatory episode-of-care expenditures of over 50% in a nationally representative sample. These findings suggest that systems of care may reduce ambulatory expenditures.
Forrest
C B
CB
Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA.
Starfield
B
B
D000208:Acute Disease / Q000191:economics / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000145:classification / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005194:Family Practice / Q000145:classification / Q000191:economics*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics*; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data; D014481:United States