PRIMARY-CARE PHYSICIANS AND SPECIALISTS AS PERSONAL PHYSICIANS - HEALTH-CARE EXPENDITURES AND MORTALITY EXPERIENCE

BACKGROUND. The advent of managed care has resulted in considerable de bate regarding the relative effects of specialist and primary care on patient outcomes and costs. Studies on these subjects have been limite d to a disease-focused orientation rather than a patient-focused orien tation inherent in primary care management. We examined whether person s using a primary care physician have lower expenditures and mortality than those using a specialist as their personal physician. METHODS. U sing data on a nationally representative sample of 13,270 adult respon dents to the 1987 National Medical Expenditure Survey reporting as the ir personal physician either a primary care physician (general practit ioner, family physician, internist, or obstetrician-gynecologist) or a specialist, we examined total annual health care expenditures and 5-y ear mortality experience. RESULTS. Respondents with a primary care phy sician, rather than a specialist, as a personal physician were more li kely to be women, white, live in rural areas, report fewer medical dia gnoses and higher health perceptions and have lower annual health care expenditures (mean: $2029 vs $3100) and lower mortality (hazard ratio = 0.76, 95% confidence interval [CI], 0.64 - 0.90). After adjustment for demographics, health insurance status, reported diagnoses, health perceptions, and smoking status, respondents reporting using a primary care physician compared with those using a specialist had 33% lower a nnual adjusted health care expenditures and lower adjusted mortality ( hazard ratio = 0.81; 95% CI, 0.66 - 0.98). CONCLUSIONS. These findings provide evidence for the cost-effective role of primary care physicia ns in the health care system. More research is needed an how to optima lly integrate primary and specialty care.