Provider continuity in family medicine: does it make a difference for total health care costs?
BACKGROUND
International comparisons of health care systems have shown a relationship at the macro level between a well-structured primary health care plan and lower total health care costs. The objective of this study was to assess whether provider continuity with a family physician is related to lower health care costs using the individual patient as the unit of analysis.


METHODS
We undertook a study of a stratified sample of patients (age, sex, region, insurance company) for which 2 cohorts were constructed based on the patients' utilization pattern of family medicine (provider continuity or not). Patient utilization patterns were observed for 2 years. The setting was the Belgian health care system. The participants were 4,134 members of the 2 largest health insurance companies in 2 regions (Aalst and Liège). The main outcome measures were the total health care costs of patients with and without provider continuity with a family physician, controlling for variables known to influence health care utilization (need factors, predisposing factors, enabling factors).


RESULTS
Bivariate analyses showed that patients who were visiting the same family physician had a lower total cost for medical care. A multivariate linear regression showed that provider continuity with a family physician was one of the most important explanatory variables related to the total health care cost.


CONCLUSIONS
Provider continuity with a family physician is related to lower total health care costs. This finding brings evidence to the debate on the importance of structured primary health care (with high continuity for family practice) for a cost-effective health policy.
De Maeseneer
Jan M
JM
Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium. jan.demaeseneer@rug.ac.be
De Prins
Lutgarde
L
Gosset
Christiane
C
Heyerick
Jozef
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000191:economics* / Q000592:standards; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics* / Q000592:standards; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics*; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics* / Q000592:standards; D010817:Physician-Patient Relations; D011785:Quality Assurance, Health Care