De Maeseneer Jan M, De Prins Lutgarde, Gosset Christiane, Heyerick Jozef
Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium.
Ann Fam Med. 2003 Sep-Oct;1(3):144-8. doi: 10.1370/afm.75.
International comparisons of health care systems have shown a relationship at the macro level between a well-structured primary health care plan and lower total health care costs. The objective of this study was to assess whether provider continuity with a family physician is related to lower health care costs using the individual patient as the unit of analysis.
We undertook a study of a stratified sample of patients (age, sex, region, insurance company) for which 2 cohorts were constructed based on the patients' utilization pattern of family medicine (provider continuity or not). Patient utilization patterns were observed for 2 years. The setting was the Belgian health care system. The participants were 4,134 members of the 2 largest health insurance companies in 2 regions (Aalst and Liège). The main outcome measures were the total health care costs of patients with and without provider continuity with a family physician, controlling for variables known to influence health care utilization (need factors, predisposing factors, enabling factors).
Bivariate analyses showed that patients who were visiting the same family physician had a lower total cost for medical care. A multivariate linear regression showed that provider continuity with a family physician was one of the most important explanatory variables related to the total health care cost.
Provider continuity with a family physician is related to lower total health care costs. This finding brings evidence to the debate on the importance of structured primary health care (with high continuity for family practice) for a cost-effective health policy.
医疗保健系统的国际比较显示，在宏观层面上，结构完善的初级医疗保健计划与较低的总体医疗保健成本之间存在关联。本研究的目的是以个体患者为分析单位，评估与家庭医生保持医疗服务连续性是否与较低的医疗保健成本相关。
我们对患者（年龄、性别、地区、保险公司）的分层样本进行了研究，根据患者对家庭医学的利用模式（是否有医疗服务连续性）构建了两个队列。观察患者的利用模式达两年。研究背景为比利时医疗保健系统。参与者是两个地区（阿尔斯特和列日）两家最大的健康保险公司的4134名成员。主要结局指标是有和没有与家庭医生保持医疗服务连续性的患者的总体医疗保健成本，同时控制已知会影响医疗保健利用的变量（需求因素、易患因素、促成因素）。
双变量分析表明，就诊于同一位家庭医生的患者医疗总费用较低。多元线性回归显示，与家庭医生保持医疗服务连续性是与总体医疗保健成本相关的最重要解释变量之一。
与家庭医生保持医疗服务连续性与较低的总体医疗保健成本相关。这一发现为关于结构化初级医疗保健（家庭医疗具有高连续性）对具有成本效益的卫生政策的重要性的辩论提供了证据。
