Primary-care-based episodes of care and their costs in a three-month follow-up in Finland

Abstract

Objective To explore patient characteristics, resource use, and costs related to different episodes of care (EOC) in Finnish health care.

Design Data were collected during a three-month prospective, non-randomized follow-up study (Effective Health Centre) using questionnaires and an electronic health record.

Setting Three primary health care practices in Pirkanmaa, Finland.

Subjects Altogether 622 patients were recruited during a one-week period. Inclusion criteria: the patient had a doctor’s or nurse’s appointment on the recruiting day and agreed to participate. Exclusion criteria: patients visiting a specialized health guidance clinic for pregnant women, children, and mothers.

Main outcome measures Patient characteristics, resource use, and costs based on the ICPC-2 EOC classification.

Results On average, the patients had 1.22 EOCs during the three months. Patient characteristics and resource use differed between the EOC chapters. Chapter L, “Musculoskeletal”, had the most episodes (17%). The most common (8%) single EOC was “upper respiratory infection”. The mean cost of an episode (COE) was €389.56 (standard error 61.11) and the median COE was €165.00 (interquartile range €118.46–288.56) during the three-month follow-up. The most expensive chapter was K, “Circulatory”, with a mean COE of €909.85. The most expensive single COE was in chapter K, €32 545.56. The most expensive 1% of the COEs summed up covered 36% of the total COEs.

Conclusion Patient characteristics, resource use, and costs differed between the ICPC-2 chapters, which could be taken into account in service planning and pricing. Future studies should incorporate more specific diagnoses, larger data sets, and longer follow-up times.

Key points

• The most common episodes were under the ICPC-2 “Musculoskeletal” chapter, but the highest mean and single-episode costs were related to the “Circulatory” chapter.

• The mean (median) cost of episodes that started in primary care was €390 (€165) during the three-month follow-up.

• Patient characteristics, resource use, and costs differed significantly between the ICPC-2 chapters. The most expensive 1% of the episodes covered 36% of the total costs of all the episodes.

Keywords:

• Costs and cost analysis
• episode of care (EOC)
• Finland
• general practice
• health care costs
• primary health care (PHC)
• resource allocation

Acknowledgements

The authors would like to thank MD Noora Seilo for collecting data from EHRs, and the chief physicians Kati M. Myllymäki, Liisa Länsipuro and Pirkko Ranki for their kind help in data collection. They would also like to thank the Finnish Association for General Practice (SYLY) for financing this article. Selected parts of the results were presented as a research abstract and poster during the International Society for Pharmacoeconomics and Outcomes Research Annual European Congress 2014 (Value Health 2014;A549), and as a podium at the 15th Biennial Society for Medical Decision Making European Meeting 2014.

Declaration of interest

Tuomas Koskela has been granted financial support for this project from the Pirkanmaa Hospital District and is a shareholder of Pihlajalinna Ltd. The other authors have no relevant conflict of interest related directly to the scope of this work. The authors alone are responsible for the content and writing of the paper.