Vergleich der ambulanten Versorgungskosten bei Patienten mit und ohne hausärztliche Steuerung: Ergebnisse einer Routinedatenanalyse aus Bayern

Background: The efficiency of a gatekeeping system for health systems such as the German one remains unclear, in particular as access to specialist ambulatory care is not restricted. The aim of this study was to compare the costs in ambulatory care of those patients whose treatment was versus those whose treatment was not coordinated by a family practitioner; with an additional subgroup analysis of patients with mental disorder. Methods: Retrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory Health Insurance Physicians (routine data of 8.607.191 patients who had contact with a specialist practice with or without referral). Detailed analysis of 3.623.831 patients who visited specialists within the first quarter of 2011. A patient was defined as uncoordinated if he or she visited at least one specialist without referral. Main target parameter were the total costs of ambulatory care. Secondary target parameters were cost of specialist treatment, and cost of medication. Results: The average age of coordinated patients (CP) (n = 1.632.800) was 55.3 years, and 48.4 years in uncoordinated patients (UP) (n = 1.829.411). CP had more chronic diseases (85.5 %) than UP (67.6 %). The total financial claim per patient was higher for the UP (234.94 euros) than for the CP (224.66 euros); total adjusted difference -9.65 euros (95 % CI: -11.64; -7.67). The cost differences increased with age. The total adjusted difference per patient with mental diseases as documented with an ICD-10 F-diagnosis was -20.31 euros (95 % CI: -26.43; -14.46). Conclusions: Coordination of care is of particular importance for elderly and for patients with mental disorders, who are more vulnerable to medical interventions. The role of family practitioners as coordinators should be strengthened to improve care for these patients, which could also help to frame a more efficient health system.