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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

doi: 10.1097/MLR.0b013e318293c2df
Original Articles

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.

*Ecola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal

Inter-disciplinary Center in Health Economics, Institute for Health and Society, Université catholique de Louvain, Bruxelles

Ecole de Santé Publique, Université Libre de Bruxelles, Brussels

§Department of Public Health, Faculty of Medicine, Ghent University, Gent, Belgium

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.lww-medicalcare.com.

Funding for this project was provided by the Belgian Health Care Knowledge Centre (KCE). Publication of the study’s results was not contingent upon the sponsor’s approval.

I.H. is currently the general secretary of the French-speaking Medical Home and Health Groups Federation. C.M. has worked as general practitioner in a medical home. The remaining authors declare no conflict of interest.

Reprints: Julian Perelman, PhD, Escola Nacional de Saúde Pública, Avenida Padre Cruz, 1600-560 Lisbon, Portugal. E-mail: jperelman@ensp.unl.pt.

© 2013 by Lippincott Williams & Wilkins.