Does better disease management in primary care reduce hospital costs? Evidence from English primary care

Abstract

We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

“…In studies of the UK Quality and Outcomes Framework, in which incentives were directly tied to measured quality of care, any observed decreases in hospital admissions accompanying observed changes in quality were small, [25][26][27] and some studies found no association between measured quality and hospital admissions. 28,29 Research to date, largely from the United Kingdom and United States, has provided mixed evidence of the effectiveness of these programs.…”

“…39 Most research in this area focuses on care for individual diseases, using the delivery of specific services as indicators of quality. 24,[30][31][32][33][34] Evidence of the effect of incentive-based programs on broader outcomes such as access to primary care, continuity of care, 40 hospital admissions [25][26][27][28][29]41,42 and overall resource use 30,34,43 has been inconclusive.…”

Do doctors charge high income patients more?

“…Hence, it must be shown that such a fee gap exists, conditional on doctors' quality. Quality is not observed, however the literature (e.g., Dusheiko et al, 2011) has used a doctor's participation chronic disease management programs as an indicator for quality primary care. This is also consistent with the hospital performance literature (e.g., Geweke, 2003) in which high quality hospitals are often observed to have poor performance, like higher mortality rate, because they tend to attract sicker/more complex patients.…”

Does the extension of primary care practice opening hours reduce the use of emergency services?

“…Secondly, our work adds to the literature that studies whether the strengthened role of primary care policies and GPs can foster a more appropriate utilisation of hospital services by containing admission rates (e.g. Dusheiko et al, 2011;McCormick and Nicodemo, 2014).…”