title: Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: a record linkage study between patient data and reimbursements data.
abstract: BACKGROUND
  Frequently attending patients to primary care (FA) are likely to cost more in primary care than their non-frequently attending counterparts. But how much is spent on specialist care of FAs? We describe the healthcare expenditures of frequently attending patients during 1, 2 or 3 years and test the hypothesis that additional costs can be explained by FAs' combined morbidity and primary care physicians' characteristics.
  
  
  METHODS
  Record linkage study. Pseudonymised clinical data from the medical records of 16 531 patients from 39 general practices were linked to healthcare insurer's reimbursements data. Main outcome measures were all reimbursed primary and specialist healthcare costs between 2007 and 2009. Multilevel linear regression analysis was used to quantify the effects of the different durations of frequent attendance on three-year total healthcare expenditures in primary and specialist care, while adjusting for age, sex, morbidities and for primary care physicians characteristics. Primary care physicians' characteristics were collected through administrative data and a questionnaire.
  
  
  RESULTS
  Unadjusted mean 3-year expenditures were 5044 and 15 824 Euros for non-FAs and three-year-FAs, respectively. After adjustment for all other included confounders, costs both in primary and specialist care remained substantially higher and increased with longer duration of frequent attendance. As compared to non-FAs, adjusted mean expenditures were 1723 and 5293 Euros higher for one-year and three-year FAs, respectively.
  
  
  CONCLUSIONS
  FAs of primary care give rise to substantial costs not only in primary, but also in specialist care that cannot be explained by their multimorbidity. Primary care physicians' working styles appear not to explain these excess costs. The mechanisms behind this excess expenditure remain to be elucidated.
authors.affiliation: Department of General Practice - Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands. f.t.smits@amc.uva.nl.
authors.forename: Frans T
authors.initials: FT
authors.lastname: Smits
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Brouwer
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Jacob
authors.initials: J
authors.lastname: Mohrs
authors.forename: Hugo M
authors.initials: HM
authors.lastname: Smeets
authors.forename: Judith E
authors.initials: JE
authors.lastname: Bosmans
authors.forename: Aart H
authors.initials: AH
authors.lastname: Schene
authors.forename: Henk C
authors.initials: HC
authors.lastname: Van Weert
authors.forename: Gerben
authors.initials: G
authors.lastname: ter Riet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D015999:Multivariate Analysis; D009426:Netherlands; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics*; D012189:Retrospective Studies; D063127:Secondary Health Care / Q000191:economics; D063128:Tertiary Health Care / Q000191:economics; D055815:Young Adult
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