Impact of regional socioeconomic variation on coordination and cost of ambulatory care: investigation of claims data from Bavaria, Germany

Abstract

ObjectivesA considerable proportion of regional variation in healthcare use and health expenditures is to date still unexplained. The aim was to investigate regional differences in the gatekeeping role of general practitioners and to identify relevant explanatory variables at patient and district level in Bavaria, Germany.DesignRetrospective routine data analysis using claims data held by the Bavarian Association of Statutory Health Insurance Physicians.ParticipantsAll patients who consulted a specialist in ambulatory practice within the first quarter of 2011 (n=3 616 510).Outcomes measuresOf primary interest is the effect of district-level measures of rurality, physician density and multiple deprivation on (1) the proportion of patients with general practitioner (GP) coordination of specialist care and (2) the mean amount in Euros claimed by specialist physicians.ResultsThe proportion of patients whose use of specialist services was coordinated by a GP was significantly higher in rural areas and in highly deprived regions, as compared with urban and less deprived regions. The hierarchical models revealed that increasing age and the presence of chronic diseases are the strongest predictive factors for coordination by a GP. In contrast, the presence of mental illness, an increasing number of medical condition categories and living in a city are predictors for specialist use without GP coordination. The amount claimed per patient was €10 to €20 higher in urban districts and in regions with lower deprivation. Hierarchical models indicate that this amount is on average higher for patients living in towns and lower for patients in regions with high deprivation.ConclusionThe present study shows that regional deprivation is closely associated with the way in which patients access primary and specialist care. This has clear consequences, both with respect to the role of the general practitioner and the financial costs of care.

Regional differences in reasons for consultation and general practitioners’ spectrum of services in northern Germany – results of a cross-sectional observational study

“…As early as 1998, Boerma et al investigated regional differences in the spectrum of services provided by GPs from 30 European countries and described a more comprehensive range of services by primary care practices in rural areas and indicated a smaller role as gatekeeper of the inner city primary care practices [19]. Mehring et al also described a higher ratio of coordinated care by GPs of patients from rural areas [20]. Additionally, a study on the treatment of bowel cancer highlighted a greater involvement of GPs from rural areas in coordinating care as well as clinical and psychosocial support for patients in rural areas [21].…”

Incidence of direct oral anticoagulant use in patients with nonvalvular atrial fibrillation and characteristics of users in 6 European countries (2008–2015): A cross‐national drug utilization study

“…We conducted a longitudinal drug utilization study in 6 countries between January 2008 and December 2015. Data were retrieved from the following 8 databases: (i) the Dutch Mondriaan project, which includes the Julius General Practitioner Network (JHN) database; (ii) the Danish National Registries (DNR), which includes the Danish National Patient Register, Danish National Prescription Registry and Danish Civil Registration System; (iii) the AOK Nordwest database, Germany; (iv) the Bavarian Association of Statutory Health Insurance Physicians database, referred to here as Bavarian CD, Germany; (v) the Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), Spain; (vi) the Information System for the Development of Research in Primary Care (SIDIAP), Catalonia, Spain; (vii) the Clinical Practice Research Datalink (CPRD), UK; (viii) The Echantillon Généraliste de Bénéficiaires (EGB), France . The databases characteristics are described in Table .…”

Differences in healthcare costs in youths with conduct disorders in rural vs. urban regions: an analysis of German health insurance data

“…Vice versa, in urban areas of residence with a generally good availability of office-based child and adolescent psychiatrists, utilisation of these outpatient services is much higher than in rural regions, resulting in higher total outpatient costs, and – as timely intervention in an outpatient setting can often prevent inpatient admission – in lower inpatient costs. Higher utilisation of specialist physicians by insurees from urban areas in the presence of mental illness, together with higher associated healthcare costs, was confirmed in a recent study from Germany [ 31 ].…”