title: Medical specialists care and hospital costs for low back pain in the Netherlands.
abstract: To examine the organization of medical specialist care and hospital costs for low back pain (LBP) in the Netherlands.
  
  
  
  Aggregated health insurance claims data were provided on all diagnosis treatment combination (DTC) declarations for LBP patients first referred to the hospital in the 2nd half of 2008 and retrieved from Vektis, an organization that collects health insurance claims data. Data were available up to 1 January 2012. The data included patient characteristics, DTC-specific information including: neurology, neurosurgery, orthopaedic surgery, anaesthesiology and radiology.
  
  
  
  In total 80,652 LBP patients were referred to the hospital for the first time in the second half of 2008 accumulating to a total of 173,620 DTC's with total costs of €194 million. Of these patients, 56% were female and 61% aged above 50 years at first referral to the hospital. The average number of DTC's and costs per patient were 2.15 and €2410, respectively (during the follow-up period of 3.0-3.5 year). Moreover, 51% of the patients needed only one DTC; less than 10% of patients needed 5 DTC's. Following the DTC number, the share of consultations to the neurologist decreased, whereas that of the anaesthesiology specialism increased. The largest portion of costs was allocated to the anaesthesiology and neurosurgery specialisms.
  
  
  
  In the Netherlands, LBP patients consult a variety of medical specialists, in particular, the neurology, hospital costs for LBP patients are expected to increase given the rising incidence. Optimal diagnosis and tailored treatment plans might result in reduced costs and improved patient outcomes.
  
  
  
  Low back pain patients consult various specialists, with the majority first referred to the neurologist. More than half of the LBD patients require only one DTC and less than 10% needed five DTC's or more. The largest portion of the hospital costs for LBP patients is allocated to the anaesthesiology and neurosurgery specialisms.
authors.affiliation: Department of Health Service Research, Maastricht University, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Itz
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, The Netherlands.
authors.forename: B L T
authors.initials: BL
authors.lastname: Ramaekers
authors.affiliation: Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Kleef
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, The Netherlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006761:Hospitals; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019635:Neurosurgical Procedures / Q000191:economics; D019637:Orthopedic Procedures / Q000191:economics; D012017:Referral and Consultation / Q000191:economics*; D055815:Young Adult