The Impact of Change in Hospital Admissions When Primary Care Is Provided by a Single Primary Care Physician: A Cohort Study Among HMO Patients in Israel

Abstract

Objectives: An Israeli health maintenance organization (HMO) changed its policy from freedom of choice in choosing any primary care physician (PCP) to provide health care to one provider allocated to the patients. We examined outcome measures before and after the intervention in the study population. Design: During a 2.5-year period (from June 2013 to December 2015), continuity of care by PCPs was achieved by a single provider. The change was computed for each participant according to the most visited PCP in the last year. Participants: A total of 208,286 patients aged 20 and older fulfilled the inclusion criteria. Main Outcome Measures: Future likelihood of hospitalization, number of PCP visits, and medication use before and after the intervention. Results: After controlling for demographics, high continuity of care before and after intervention was associated with a lower likelihood of hospitalization for any condition (adjusted odds ratio [OR] = 0.90; 95% confidence interval [CI], 0.85–0.95; p = 0.003). No significant change was recorded for number of ambulatory visits or medication use. Conclusions: Changing Leumit HMO policy to continuity of care with a single provider is associated with a decreased future likelihood of hospitalization. This suggests that policies that encourage patients to concentrate their care with a single provider may lead to lower hospitalization rates and possibly lower healthcare costs.