Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria

Abstract

ObjectivesThe efficiency of a gatekeeping system for a health system, as in Germany, remains unclear particularly as access to specialist ambulatory care is not restricted. The aim was to compare the costs of coordinated versus uncoordinated patients (UP) in ambulatory care; with additional subgroup analysis of patients with mental disorders.DesignRetrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory Health Insurance Physicians. A patient was defined as uncoordinated if he or she visited at least 1 specialist without a referral from a general practitioner within a quarter. Outcomes were compared with propensity score matching analysis.ParticipantsThe study encompassed all statutorily insured patients in Bavaria contacting at least 1 ambulatory specialist in the first quarter of 2011 (n=3 616 510).Primary and secondary outcome measuresPrimary outcome was total costs of ambulatory care; secondary outcomes were financial claims of general physicians, specialists and for medication.ResultsThe average age was 55.3 years for coordinated patients (CP, n=1 629 302), 48.3 years for UP (n=1 825 840). CP more frequently had chronic diseases (85.4%) as compared with UP (67.5%). The total unadjusted financial claim per patient was higher for UP (€234.52) than for CP (€224.41); the total adjusted difference was −€9.65 (95% CI −11.64 to −7.67), indicating lower costs for CP. The cost differences increased with increasing age. Total adjusted difference per patient with mental diseases as documented with an International Classification of Diseases (ICD)-10 F-diagnosis, was −€20.31 (95% CI −26.43 to −14.46).ConclusionsCoordination of care is associated with lower ambulatory healthcare expenditures and is of particular importance for patients who are more vulnerable to medical interventions, especially for elderly and patients with mental disorders. The role of general practitioners as coordinators should be strengthened to improve care for these patients as this could also help to frame a more efficient health system.

Regional and patient-related factors influencing the willingness to use general practitioners as coordinators of the treatment in northern Germany - results of a cross-sectional observational study

“…This role of general medicine is also referred to as gatekeeping. Studies indicate that a well-functioning GP coordination might reduce, among others, healthcare spending and inequalities in the healthcare system [4][5][6][7].…”

How Effective Are Care Plans in Primary Care?

“…Comparison with other studies carried out within the German healthcare system may aid interpretation of Freytag et al's findings. In an analysis of Bavarian data from the first quarter of 2011, my co-authors and I compared 1 229 372 patients who were referred to specialists by their GPs with a similarly high number of patients who consulted specialists on their own initiative (5). We found that coordination of care is cost efficient-all the more so in older patients and in With this comprehensive approach, general medicine helps to ensure effective healthcare of the population.…”

Regional and patient-related factors influencing the willingness to use general practitioners as coordinators of the treatment in northern Germany - results of a cross-sectional observational study

“…Studies indicate that a well-functioning GP coordination might reduce, among others, healthcare spending and inequalities in the healthcare system [4][5][6][7].…”