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APHA Scientific Session and Event Listing

Recorded presentation

Robert Phillips, MD, MPH, Stephen Petterson, PhD, and Martey Dodoo, PhD. Robert Graham Center, American Academy of Family Physicians, 1350 Connecticut Avenue, N.W., Suite 201, Washington, DC 20036, 202-331-3360, BPhillips@aafp.org

Background Studies of variation in health care expenditures often focus on comparisons of regions of the country or hospitals. Examination of a fundamental organizing principal of healthcare--patients' usual source of care (USC)—is notably lacking. Previous studies have found significant differences within primary care and between them and subspecialists, but most are now decades old. We sought to examine and quantify differences in health care expenditures by specialty of peoples' USC.

Methods 2002 and 2003 Medical Expenditure Panel Survey data were used to compare expenditure estimates based on the specialty of self-reported USC. A logistic regression model was used to analyze expenditure probability determinants. After a log transformation of the dependent variable, a regression model was used to analyze the expenditure determinants for persons with any expenditure (controlling for sex, race, ethnicity, marital status, income, education, insurance status, age and health status).

Results There were significant expenditure differences for adults based on whether they had a USC, and whether the USC was a family physician (FP/GP), a general internist (GIM) or a sub-specialist. These differences remained after controlling for sex, race, ethnicity, marital status, income, education, insurance status, age and health status (measured by SF12 and EQ 5D). Adults with a GIM as their USC spent $1,139 more on annual total health care, $234 more on office-based physician services, and $226 more on prescription drugs, compared to adults with FP/GP as their USC.

There were significant expenditure differences for children based on whether they had a USC, and whether the USC was a family physician (FP/GP), a general internist (GIM) or a sub-specialist. These differences remained after controlling for sex, race, ethnicity, marital status, income, education, insurance status, age and health status (measured by SF12 and EQ5D). Children with a general pediatrician as their USC spent $129 more on annual total health care, $49 more on office-based physician services, and $31 more on prescription drugs, compared to children with FP/GP as their USC.

Conclusions Significant variation in expenditures associated with physician specialty is not explained by differences in self-rated physical or mental health or personal characteristics. We could not adjust for diagnoses, however this is unlikely to change our findings since patients of FP/GPs rated their baseline health as being poorer than those of other specialties. These variations suggest further research on potential reasons for differences, and have potential implications for training and health care financing.

Learning Objectives:

• Attendees will learn about variation in healthcare expenditures that warrant further research and policy consideration
• Attendees will learn about the benefits and limitations of using the Medical Expenditure Panel Survey to conduct research on health economic questions

Keywords: Access and Services, Economic Analysis

Related Web page: www.graham-center.org

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation