papers

Distribution of primary care expenditure according to sex and age group: a retrospective analysis

Aten Primaria 44:145-152. Published in Spanish.

Centre d’Atenció Integral Dos de Maig, Consorci Sanitari Integral, Barcelona, Spain; Dirección de Planificación y Desarrollo Organizativo, Badalona Serveis Assistencials, Badalona, Barcelona, Spain; Gestión de Atención Primaria de Mallorca, Palma de Mallorca, Spain; Instituto de Ciencias de la Salud de Aragón, Zaragoza, Spain

OBJECTIVE: To study the primary care expenditure per person and the weight of different health resources within sex and age groups.

DESIGN: Cost analysis. Retrospective descriptive study.

SETTING: 14 urban primary care centers (assigned population: 313,000).

PARTICIPANTS: All patients who visited during 2008 (227,235).

STUDY PERIOD: January to December 2008.

MAIN MEASUREMENTS: Age, sex, visits, laboratory, radiology and complementary tests and referrals to specialists were obtained from patient electronic files. Pharmacy expenditure was obtained from invoices sent to the national health system by pharmacists. Fixed/semi-fixed costs were distributed among visits and a mean cost/visit was obtained. Costs were assigned for laboratory (mean application cost), for radiology and complementary tests (rate per type of test) and for referrals (adjusted rate). Descriptive analysis of data (median, interquartile range and coefficient of variance).

RESULTS: Median expenditure was 362 D (321 D for men and 396 D for women). For the up to 2 year-old group it was 410 D, for aged 15-44 203 D and 75 and above 1,255 D.). The up to 2 years old visits represented 81% of total cost while pharmacy was 8%, while for those aged 75 and above visits accounted for 21% of the total cost and pharmacy 63%.

CONCLUSIONS: Expenditure in primary care is higher in women, although the greatest differences were observed with age. In older than 74 years the median expenditure was six-fold higher than that for 3-44 years old group. In pediatrics the main source of expenditure was visits, representing 80% of the total in up to 2 years old. From 45 years old, pharmacy was the main source of expenditure and in those older than 74 it represented over 60% of the total.