Differences in resource use and costs of primary care in a large HMO according to physician specialty.
OBJECTIVE
To determine if primary care physician specialty is associated with differences in use of health services.


METHODS
Automated outpatient diagnostic, utilization, and cost data on 15,223 members (35-85 years of age) of a large group model HMO.


METHODS
One-year prospective comparison of primary care provided by 245 general internists (GIMs), 60 family physicians (FPs), and 55 subspecialty internists (SIMs) with case-mix assessed during a nine-month baseline period using Ambulatory Diagnostic Groups.


RESULTS
Adjusting for demographics and case mix, patients of GIMs and FPs had similar hospitalization and ambulatory visit rates, and similar laboratory and radiology costs. Patients of FPs made fewer visits to dermatology, psychiatry, and gynecology (combined visit rate ratio: 0.86, 95% CI: 0.74-0.96). However, they made more urgent care visits (rate ratio 1.19, 95% CI: 1.07-1.23). Patients of SIMs had higher hospitalization rates than those of GIMs (rate ratio 1.33, 95% CI: 1.06-1.68), greater use of urgent care (rate ratio: 1.14, 95% CI: 1.04-1.25), and higher costs for pharmacy (cost ratio: 1.17, 95% CI: 0.93-1.18) and radiologic services (cost ratio: 1.14, 95% CI: 1.01-1.30). The hospitalization difference was due partly to the inclusion of patients with specialty-related diagnoses in panels of SIMs. Radiology and pharmacy differences persisted after excluding these patients.


CONCLUSIONS
In this uniform practice environment, specialty differences in primary care practice were small. Subspecialists used slightly more resources than generalists. The broader practice style of FPs may have created access problems for their patients.
Selby
J V
JV
Kaiser Permanente Medical Care Program of Northern California, Oakland 94611, USA.
Grumbach
K
K
Quesenberry
C P
CP
Schmittdiel
J A
JA
Truman
A F
AF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D002140:California; D015331:Cohort Studies; D004470:Economics, Medical; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008511:Medicine / Q000458:organization & administration / Q000706:statistics & numerical data; D008875:Middle Aged; D016012:Poisson Distribution; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation; D012044:Regression Analysis; D013038:Specialization