Lower fragmentation of coordination in primary care is associated with lower prescribing drug costs-lessons from chronic illness care in Hungary

A shorter version of this paper is published in the European Journal of Public Health: Ágnes Lublóy, Judit Lilla Keresztúri, Gábor Benedek; Lower fragmentation of coordination in primary care is associated with lower prescribing drug costs-lessons from chronic illness care in Hungary. European Journal of Public Health 2017, published online ahead of print 09 July 2017. doi: https://doi.org/10.1093/eurpub/ckx096

Abstract

Improved patient care coordination is critical for achieving better health outcome measures at reduced cost. Better integration of primary and secondary care in chronic illness care and utilizing the advantages of better collaboration between general practitioners and specialists may support these conflicting goals. Assessing patient care coordination at system level is, however, as challenging as achieving it. Based on prescription data from a private data vendor company, we develop a provider-level care coordination measure to assess the function of primary care at system level. We aim to provide empirical evidence for the possible impact of patient care coordination in chronic illness care—we investigate whether the type of collaborative relationship general practitioners have built up with specialists is associated with prescription drug costs. To our knowledge, no large-scale quantitative study has ever investigated this association. We find that prescription drug costs for patients treated by general practitioners who build up strong collaborative relationships with specialists are significantly lower than for patients treated by general practitioners characterized by fragmented collaborative structures. If future system-level studies in other settings confirm that total healthcare costs are indeed lower for patients treated in strong collaborative structures, then healthcare strategists need to advocate a healthcare system with lower care fragmentation on the interface of primary and secondary care. Regulating access to secondary care might result in significant cost savings through improved care coordination.