title: Medical homes versus individual practice in primary care: impact on health care expenditures.
abstract: BACKGROUND
  The medical home (MH) model has prompted increasing attention given its potential to improve quality of care while reducing health expenditures.
  
  
  OBJECTIVE
  We compare overall and specific health care expenditures in Belgium, from the third-party payer perspective (compulsory social insurance), between patients treated at individual practices (IP) and at MHs. We compare the sociodemographic profile of MH and IP users.
  
  
  METHODS
  This is a retrospective study using public insurance claims data. Generalized linear models estimate the impact on health expenditures of being treated at a MH versus IP, controlling for individual, and area-based sociodemographic characteristics. The choice of primary care setting is modeled using logistic regressions.
  
  
  METHODS
  A random sample of 43,678 persons followed during the year 2004.
  
  
  METHODS
  Third-party payer expenditures for primary care, secondary care consultations, pharmaceuticals, laboratory tests, acute and long-term inpatient care.
  
  
  RESULTS
  Overall third-party payer expenditures do not differ significantly between MH and IP users (€+27). Third-party payer primary care expenditures are higher for MH than for IP users (€+129), but this difference is offset by lower expenditures for secondary care consultations (€-11), drugs (€-40), laboratory tests (€-5) and acute and long-term inpatient care (€-53). MHs attract younger and more underprivileged populations.
  
  
  CONCLUSIONS
  MHs induce a shift in expenditures from secondary care, drugs, and laboratory tests to primary care, while treating a less economically favored population. Combined with positive results regarding quality, MH structures are a promising way to tackle the challenges of primary care.
authors: Ecola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal. jperelman@ensp.unl.pt
authors: Julian
authors: J
authors: Perelman
authors: Isabelle
authors: I
authors: Roch
authors: Isabelle
authors: I
authors: Heymans
authors: Catherine
authors: C
authors: Moureaux
authors: Raphael
authors: R
authors: Lagasse
authors: Lieven
authors: L
authors: Annemans
authors: Marie-Christine
authors: MC
authors: Closon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008875:Middle Aged; D018802:Patient-Centered Care / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics*; D055815:Young Adult