Does Better Disease Management in Primary Care Reduce Hospital Costs?

Does Better Disease Management in Primary Care Reduce Hospital Costs? CHE Research Paper 65 Does Better Disease Management in Primary Care Reduce Hospital Costs? 1Mark Dusheiko 1Hugh Gravelle 2Stephen Martin 1Nigel Rice 3Peter C Smith 1Centre for Health Economics, University of York, UK 2Department of Economics, University of York, UK 3Imperial College Business School, UK August 2011 Background to series CHE Discussion Papers (DPs) began publication in 1983 as a means of making current research material more widely available to health economists and other potential users. So as to speed up the dissemination process, papers were originally published by CHE and distributed by post to a worldwide readership. The CHE Research Paper series takes over that function and provides access to current research output via web-based publication, although hard copy will continue to be available (but subject to charge). Acknowledgements This research was funded by the Department of Health and the Health Foundation. Nigel Rice acknowledges funding support from the Economic and Social Research Council (RES-060-25-0045). The views expressed are not necessarily those of the funders. We thank Catherine Fullwood of the National Primary Care Research and Development Centre at the University of Manchester for providing us with the QOF population achievement data. We are also grateful for comments from three referees and from participants at a seminar held by the Swiss School of Public Health in Crans-Montana. A version of this paper with the same text but a more detailed appendix table of results is available at http://www.york.ac.uk/economics/research/discussion-papers/dp-2011/. Disclaimer Papers published in the CHE Research Paper (RP) series are intended as a contribution to current research. Work and ideas reported in RPs may not always represent the final position and as such may sometimes need to be treated as work in progress. The material and views expressed in RPs are solely those of the authors and should not be interpreted as representing the collective views of CHE research staff or their research funders. Further copies Copies of this paper are freely available to download from the CHE website www.york.ac.uk/che/publications/ Access to downloaded material is provided on the understanding that it is intended for personal use. Copies of downloaded papers may be distributed to third-parties subject to the proviso that the CHE publication source is properly acknowledged and that such distribution is not subject to any payment. Printed copies are available on request at a charge of £5.00 per copy. Please contact the CHE Publications Office, email che-pub@york.ac.uk, telephone 01904 321458 for further details. Centre for Health Economics Alcuin College University of York York, UK www.york.ac.uk/che © Mark Dusheiko, Hugh Gravelle, Stephen Martin, Nigel Rice, Peter C Smith Does better disease management in primary care reduce hospital costs? i Abstract We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English 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 the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions. Keywords: Quality; disease management; primary care; hospital costs; ambulatory care sensitive conditions; preventative care. JEL categories: I12, I18 ... - tailieumienphi.vn