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Association between fee-for-service expenditures and morbidity burden in primary care
Troels Kristensen1, Kim Rose Olsen, Henrik Schroll
1Faculty of Health Sciences, COHERE-Centre of Health Economics Research, Institute of Public Health, University of Southern Denmark, Windsløwparken 9A, J.B. Winsløws Vej 9, 5000, Odense C, Denmark, trkristensen@health.sdu.dk.
Summary
Patient morbidity significantly influences fee-for-service (FFS) expenditures in primary care, explaining up to 44% of costs. Clinic characteristics also play a role, highlighting potential improvements for negotiated FFS payments.
Area of Science:
- Health Economics
- Primary Care Research
- Health Services Research
Background:
- Fee-for-service (FFS) primary care payments are often politically negotiated, not cost-based.
- The explanatory power of patient morbidity on FFS expenditure variation is understudied.
Purpose of the Study:
- To assess how patient morbidity and general practice (GP) clinic factors explain FFS expenditure variations.
- To compare the explanatory power of morbidity measures versus clinic characteristics.
Main Methods:
- Multilevel analysis of patient and GP clinic data from 2010.
- Inclusion of patient diagnostic markers, multimorbidity, and resource utilization bands (RUB).
- Analysis of 139,527 patient visits to GP clinics.
Main Results:
- Age, gender, and RUB explained 31.6% of expenditures; RUB alone explained 18%.
- Patient-specific morbidity measures increased explanatory power to 44%.
- GP clinic characteristics accounted for 3.8-9.4% of expenditure variation.
Conclusions:
- Morbidity is a key driver of patient-related FFS expenditures.
- FFS expenditure-morbidity association in primary care may be improvable compared to hospital costing.
- Findings suggest opportunities to refine FFS payment models in primary care.
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