Health care inequality in free access health systems: The impact of non-pecuniary incentives on diabetic patients in Danish general practices

Olsen, Kim Rose; Laudicella, Mauro

doi:10.1016/j.socscimed.2019.03.005

Cited by 12 publications

(10 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Use of this EHR/DMP has previously been shown to be associated with a reduction in inequality of access in general practice among patients with diabetes. 17 The finding of a negative association between EHR/DMP use and mean annual emergency hospital costs but no association with differences in total hospital costs suggests that hospital visits were more likely to have been planned rather than emergency. That is, using the EHR/DMP may have been associated with GPs more effectively referring patients with diabetes to the hospital as appropriate.…”

Section: Discussionmentioning

confidence: 97%

“…A likely explanation is that most patients did not receive any increase in attention, but a small percentage who had been undertreated received additional appropriate attention. Use of this EHR/DMP has previously been shown to be associated with a reduction in inequality of access in general practice among patients with diabetes 17. The finding of a negative association between EHR/DMP use and mean annual emergency hospital costs but no association with differences in total hospital costs suggests that hospital visits were more likely to have been planned rather than emergency.…”

mentioning

confidence: 82%

“…The national contract agreed in December 2010 required GPs to enroll in the GP-facing EHR/DMP within a 3-year period (2011-2013). 16,17 In brief, the system required GPs to code patient visits (using the International Classification of Primary Care, version 2 standard) and also took other clinical information as inputs (eg, laboratory results, prescriptions). All patient visits to the GP were meant to be coded in the registry.…”

Section: Ehr/dmpmentioning

confidence: 99%

“…Previous research identified the GPs that achieved highlevel use of the system in 2011 as highly selected (ie, early adopters) that were believed to have a particular interest in diabetes treatment, and participation in the EHR/DMP in 2012 was believed to be random and largely determined by the information technology system used. 17 Restricting analysis of the treated group to those attending GPs meeting criteria in 2012 minimized selection bias.…”

Section: Study Populationmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of an Electronic Health Record System With a Disease Management Program and Health Care Treatment Costs for Danish Patients With Type 2 Diabetes

2020

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Electronic health record (EHR) systems and disease management programs (DMP) are often promoted, but associated health care cost changes are not well understood. OBJECTIVE To evaluate the association between annual health care costs of patients with type 2 diabetes and the use of an electronic health record system with a disease management program (EHR/DMP) in general practice. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined patients with type 2 diabetes in Denmark between January 1, 2008, and December 31, 2014, who attended practices that either used an EHR/DMP at a high level or never used the disease management system. An EHR/DMP system was rolled out across general practices in Denmark beginning in 2011 and was discontinued in 2014. Data were analyzed between March 2019 and March 2020. MAIN OUTCOMES AND MEASURES The main outcome was total health care costs, and the secondary outcomes were primary care, medication, nonhospital specialist, and hospital (total, outpatient, inpatient, and emergency) costs. Regression models were used to estimate EHR/DMPassociated percentage differences in patients' annual health care treatment costs across health care treatment categories. All models included general practice-level fixed effects and patient-level controls. Two-part models examined robustness of estimated associations for hospital cost categories. RESULTS Of 33 970 patients included in the analysis, 15 953 (8016 [50.2%] male; mean [SD] age, 59.9 [13.3] years) attended 244 general practices that used the system at a high level, and 18 017 (9291 [51.6%] male; mean [SD] age, 60.0 [12.9] years) attended 344 general practices that had never used the system. Use of the EHR/DMP was associated with 3.2% higher (95% CI, 0.9%-5.6%) annual general practice treatment costs and with 6.4% lower (95% CI,-11.6% to-1.2%) annual hospital emergency visit costs. The associations between EHR/DMP use and annual total hospital (percentage difference, −0.8%; 95% CI, −7.5% to 5.7%) and total health care (percentage difference, −0.1%; 95% CI, −2.1% to 1.9%) cost changes were not statistically significant. CONCLUSIONS AND RELEVANCE Among patients with type 2 diabetes, attendance at general practices that used an EHR/DMP was associated with a moderate increase in primary care costs and a reduction in emergency hospital visit costs but no significant change in total health care costs. Large health care cost savings associated with improved use of EHR-based disease management systems should not be expected to be realized in the short term.

show abstract

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 82%

Section: Ehr/dmpmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of an Electronic Health Record System With a Disease Management Program and Health Care Treatment Costs for Danish Patients With Type 2 Diabetes

2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Compared to specialized services, primary healthcare services are relatively low cost and sometimes provided free of charge; nevertheless, inequalities in community-level healthcare may still exist even for people living in generous welfare states with universal health coverage (15). It is an undisputed fact that communities of different socioeconomic status (SES) have varying levels of access to health-promoting resources and services (16), particularly in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Inequalities in access to community-based diabetes examination and its impact on healthcare utilization among middle-aged and older adults with diabetes in China

Deng

Wei

Chen

2022

Front. Public Health

View full text Add to dashboard Cite

show abstract

Teleretinal Diabetic Retinopathy Screening in Primary Care Settings—Considerations for Safety Net Organizations

Cuadros

Daskivich

2023

Digital Eye Care and Teleophthalmology

View full text Add to dashboard Cite

Health care inequality in free access health systems: The impact of non-pecuniary incentives on diabetic patients in Danish general practices

Cited by 12 publications

References 30 publications

Evaluation of an Electronic Health Record System With a Disease Management Program and Health Care Treatment Costs for Danish Patients With Type 2 Diabetes

Evaluation of an Electronic Health Record System With a Disease Management Program and Health Care Treatment Costs for Danish Patients With Type 2 Diabetes

Inequalities in access to community-based diabetes examination and its impact on healthcare utilization among middle-aged and older adults with diabetes in China

Teleretinal Diabetic Retinopathy Screening in Primary Care Settings—Considerations for Safety Net Organizations

Contact Info

Product

Resources

About