Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.
OBJECTIVE
To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas.


METHODS
Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire.


METHODS
Inner city group practice with a socioeconomically diverse population.


METHODS
382 male and female subjects of all ages, with a total of 1296 person years of observation.


METHODS
Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions.


RESULTS
Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards.


CONCLUSIONS
The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.
Worrall
A
A
Kentish Town Health Centre, London.
Rea
J N
JN
Ben-Shlomo
Y
Y
D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health; D016527:Drug Costs; D004739:England; D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005381:Financing, Organized; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000191:economics; D000078329:Workforce; D016526:Workload / Q000191:economics