Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.

To strengthen the coordinating function of general practitioners (GPs) in the German healthcare system, a copayment of €10 was introduced in 2004. Due to a perceived lack of efficacy and a high administrative burden, it was abolished in 2012. The present cohort study investigates characteristics and...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Michaela Olm, Ewan Donnachie, Martin Tauscher, Roman Gerlach, Klaus Linde, Werner Maier, Lars Schwettmann, Antonius Schneider
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a9722dbf197049d9912064695c52a9f5
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:a9722dbf197049d9912064695c52a9f5
record_format	dspace
spelling	oai:doaj.org-article:a9722dbf197049d9912064695c52a9f52021-12-02T20:09:53ZAmbulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.1932-620310.1371/journal.pone.0253919https://doaj.org/article/a9722dbf197049d9912064695c52a9f52021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253919https://doaj.org/toc/1932-6203To strengthen the coordinating function of general practitioners (GPs) in the German healthcare system, a copayment of €10 was introduced in 2004. Due to a perceived lack of efficacy and a high administrative burden, it was abolished in 2012. The present cohort study investigates characteristics and differences of GP-coordinated and uncoordinated patients in Bavaria, Germany, concerning morbidity and ambulatory specialist costs and whether these differences have changed after the abolition of the copayment. We performed a retrospective routine data analysis, using claims data of the Bavarian Association of the Statutory Health Insurance Physicians during the period 2011-2012 (with copayment) and 2013-2016 (without copayment), covering 24 quarters. Coordinated care was defined as specialist contact only with referral. Multinomial regression modelling, including inverse probability of treatment weighting, was used for the cohort analysis of 500 000 randomly selected patients. Longitudinal regression models were calculated for cost estimation. Coordination of care decreased substantially after the abolition of the copayment, accompanied by increasing proportions of patients with chronic and mental diseases in the uncoordinated group, and a corresponding decrease in the coordinated group. In the presence of the copayment, uncoordinated patients had €21.78 higher specialist costs than coordinated patients, increasing to €24.94 after its abolition. The results indicate that patients incur higher healthcare costs for specialist ambulatory care when their care is uncoordinated. This effect slightly increased after abolition of the copayment. Beyond that, the abolition of the copayment led to a substantial reduction in primary care coordination, particularly affecting vulnerable patients. Therefore, coordination of care in the ambulatory setting should be strengthened.Michaela OlmEwan DonnachieMartin TauscherRoman GerlachKlaus LindeWerner MaierLars SchwettmannAntonius SchneiderPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253919 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Michaela Olm Ewan Donnachie Martin Tauscher Roman Gerlach Klaus Linde Werner Maier Lars Schwettmann Antonius Schneider Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.
description	To strengthen the coordinating function of general practitioners (GPs) in the German healthcare system, a copayment of €10 was introduced in 2004. Due to a perceived lack of efficacy and a high administrative burden, it was abolished in 2012. The present cohort study investigates characteristics and differences of GP-coordinated and uncoordinated patients in Bavaria, Germany, concerning morbidity and ambulatory specialist costs and whether these differences have changed after the abolition of the copayment. We performed a retrospective routine data analysis, using claims data of the Bavarian Association of the Statutory Health Insurance Physicians during the period 2011-2012 (with copayment) and 2013-2016 (without copayment), covering 24 quarters. Coordinated care was defined as specialist contact only with referral. Multinomial regression modelling, including inverse probability of treatment weighting, was used for the cohort analysis of 500 000 randomly selected patients. Longitudinal regression models were calculated for cost estimation. Coordination of care decreased substantially after the abolition of the copayment, accompanied by increasing proportions of patients with chronic and mental diseases in the uncoordinated group, and a corresponding decrease in the coordinated group. In the presence of the copayment, uncoordinated patients had €21.78 higher specialist costs than coordinated patients, increasing to €24.94 after its abolition. The results indicate that patients incur higher healthcare costs for specialist ambulatory care when their care is uncoordinated. This effect slightly increased after abolition of the copayment. Beyond that, the abolition of the copayment led to a substantial reduction in primary care coordination, particularly affecting vulnerable patients. Therefore, coordination of care in the ambulatory setting should be strengthened.
format	article
author	Michaela Olm Ewan Donnachie Martin Tauscher Roman Gerlach Klaus Linde Werner Maier Lars Schwettmann Antonius Schneider
author_facet	Michaela Olm Ewan Donnachie Martin Tauscher Roman Gerlach Klaus Linde Werner Maier Lars Schwettmann Antonius Schneider
author_sort	Michaela Olm
title	Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.
title_short	Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.
title_full	Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.
title_fullStr	Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.
title_full_unstemmed	Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.
title_sort	ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: a cohort analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a9722dbf197049d9912064695c52a9f5
work_keys_str_mv	AT michaelaolm ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis AT ewandonnachie ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis AT martintauscher ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis AT romangerlach ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis AT klauslinde ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis AT wernermaier ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis AT larsschwettmann ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis AT antoniusschneider ambulatoryspecialistcostsandmorbidityofcoordinatedanduncoordinatedpatientsbeforeandafterabolitionofcopaymentacohortanalysis
_version_	1718375083794235392

Ambulatory specialist costs and morbidity of coordinated and uncoordinated patients before and after abolition of copayment: A cohort analysis.

Ejemplares similares