THE EFFECT OF FIRST-CONTACT CARE WITH PRIMARY-CARE CLINICIAN ON AMBULATORY HEALTH-CARE EXPENDITURES

Background. A study was undertaken to examine the relationship between first-contact care, an essential feature of primary care, and expendi tures for frequent ambulatory episodes of care in a nationally represe ntative sample. Methods. A nonconcurrent cohort study was conducted us ing data from the 1987 National Medical Expenditure Survey. Ambulatory claims data of respondents with an identified primary care source wer e used to develop 20,282 episodes of care for 24 preventive and acute illness conditions. The study examined the relationship of first-conta ct care, defined as the use of an identified primary care source for t he first visit in an episode, and am bulatory episode-of-care expendit ures. Results. Episodes that began with visits to an individual's prim ary care clinician, as opposed to other sources of care, were associat ed with reductions in expenditures of 53% overall ($63 vs $134, P <.00 1), 62% for acuteillnesses ($62 vs $164, P < .001), and 20% for preven tive care ($64 vs $80, P < .001). For 23 of the 24 health problems stu died, first-contact care was associated with reductions in expenditure s. Multivariate regression analyses that controlled for sociodemograph ic characteristics, health status, case-mix, length of the episode, an d number of visits to the emergency room did not substantively alter t hese results. Conclusions. First-contract care was associated with red uctions in ambulatory episode-of-care expenditures of over 50% in a na tionally representative sample. These findings suggest that systems of care that promote the first-contact aspect of primary care may reduce ambulatory expenditures.