Association between service scope of primary care facilities and prevalence of high-cost population: a retrospective study in rural Guizhou, China

Abstract

Background: High-cost (HC) patients, defined as the small percentage of the population that accounts for a high proportion of health care expenditures, are a concern worldwide. Previous studies have found that the occurrence of HC population is partially preventable by providing a greater scope of primary health care services. However, no study has examined the association between the service scope of primary care facilities and the prevalence of HC populations. Therefore, this study aimed to investigate the association between the service scope of primary care facilities (PCFs) and the prevalence of HC populations within the same communities. Methods: A multistage, stratified, clustered sampling method was used to identify the service scope of PCFs as of 2017 in rural Guizhou, China. The claims data of 299,633 patients were obtained from the local information system of the New Rural Cooperation Medical Scheme. Patients were sorted by per capita inpatient medical expenditures in descending order, and the top 1%, top 5% and top 10% of patients who had incurred the highest costs were defined as the HC population. Logistic regression models were used to assess the association between the service scope of PCFs and the prevalence of the HC population. Results: Compared with those in the 95% of the sample deemed as the general population, those in the top 5% of the sample deemed as the HC population were more likely to be over the age of 30 (P < 0.001), to be female (P = 0.014) and to be referred to high-level hospitals (P < 0.001). After controlling for other covariates, patients who lived in the communities serviced by the PCFs with the smallest service scope were more likely to be in the top 1%, top 5% and top 10% of the HC population. Conclusion: A greater PCF service scope was associated with a reduction in the prevalence of the HC population, which would mean that providing a broader PCF service scope could reduce some preventable costs, thus reducing the prevalence of the HC population. Future policy efforts should focus on expanding the service scope of primary care providers to achieve better patient outcomes.