Medical Care

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Medical Care:
doi: 10.1097/MLR.0b013e318293c2df
Original Articles

Medical Homes Versus Individual Practice in Primary Care: Impact on Health Care Expenditures

Perelman, Julian PhD*; Roch, Isabelle BA; Heymans, Isabelle BA; Moureaux, Catherine BA; Lagasse, Raphael PhD; Annemans, Lieven PhD§; Closon, Marie-Christine PhD

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Background: The medical home (MH) model has prompted increasing attention given its potential to improve quality of care while reducing health expenditures.

Objectives: We compare overall and specific health care expenditures in Belgium, from the third-party payer perspective (compulsory social insurance), between patients treated at individual practices (IP) and at MHs. We compare the sociodemographic profile of MH and IP users.

Research Design: This is a retrospective study using public insurance claims data. Generalized linear models estimate the impact on health expenditures of being treated at a MH versus IP, controlling for individual, and area-based sociodemographic characteristics. The choice of primary care setting is modeled using logistic regressions.

Subjects: A random sample of 43,678 persons followed during the year 2004.

Measures: Third-party payer expenditures for primary care, secondary care consultations, pharmaceuticals, laboratory tests, acute and long-term inpatient care.

Results: Overall third-party payer expenditures do not differ significantly between MH and IP users (€+27). Third-party payer primary care expenditures are higher for MH than for IP users (€+129), but this difference is offset by lower expenditures for secondary care consultations (€−11), drugs (€−40), laboratory tests (€−5) and acute and long-term inpatient care (€−53). MHs attract younger and more underprivileged populations.

Conclusions: MHs induce a shift in expenditures from secondary care, drugs, and laboratory tests to primary care, while treating a less economically favored population. Combined with positive results regarding quality, MH structures are a promising way to tackle the challenges of primary care.

© 2013 by Lippincott Williams & Wilkins.


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