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Studying Effects of Primary Care Physicians and Patients on the Trade-Off Between Charges for Primary Care and Specialty Care Using a Hierarchical Multivariate Two-Part Model

Author

Listed:
  • John Robinson

    (Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics)

  • Scott Zeger

    (The Johns Hopkins Bloomberg School of Public Health)

  • Christopher Forrest

    (Johns Hopkins Bloomberg School of Public Health, Department of Health Policy & Management)

Abstract

Objective. To examine effects of primary care physicians (PCPs) and patients on the association between charges for primary care and specialty care in a point-of-service (POS) health plan.Data Source. Claims from 1996 for 3,308 adult male POS plan members, each of whom was assigned to one of the 50 family practitioner-PCPs with the largest POS plan member-loads.Study Design. A hierarchical multivariate two-part model was fitted using a Gibbs sampler to estimate PCPs' effects on patients' annual charges for two types of services, primary care and specialty care, the associations among PCPs' effects, and within-patient associations between charges for the two services. Adjusted Clinical Groups (ACGs) were used to adjust for case-mix. Principal Findings. PCPs with higher case-mix adjusted rates of specialist use were less likely to see their patients at least once during the year (estimated correlation: .40; 95% CI: .71, .008) and provided fewer services to patients that they saw (estimated correlation: .53; 95% CI: .77, .21). Ten of 11 PCPs whose case-mix adjusted effects on primary care charges were significantly less than or greater than zero (p < .05) had estimated, case-mix adjusted effects on specialty care charges that were of opposite sign (but not significantly different than zero). After adjustment for ACG and PCP effects, the within-patient, estimated odds ratio for any use of primary care given any use of specialty care was .57 (95% CI: .45, .73).Conclusions. PCPs and patients contributed independently to a trade-off between utilization of primary care and specialty care. The trade-off appeared to partially offset significant differences in the amount of care provided by PCPs. These findings were possible because we employed a hierarchical multivariate model rather than separate univariate models.

Suggested Citation

  • John Robinson & Scott Zeger & Christopher Forrest, 2004. "Studying Effects of Primary Care Physicians and Patients on the Trade-Off Between Charges for Primary Care and Specialty Care Using a Hierarchical Multivariate Two-Part Model," Johns Hopkins University Dept. of Biostatistics Working Paper Series 1051, Berkeley Electronic Press.
    • Handle: RePEc:bep:jhubio:1051
    Note: oai:bepress.com:jhubiostat-1051
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    References listed on IDEAS

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