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Does Better Disease Management in Primary Care Reduce Hospital Costs?


  • Mark Dusheiko

    (Centre for Health Economics, University of York, UK)

  • Hugh Gravelle

    (Centre for Health Economics, University of York, UK)

  • Stephen Martin

    (Department of Economics, University of York, UK)

  • Nigel Rice

    (Centre for Health Economics, University of York, UK)

  • Peter C Smith

    (Imperial College Buisiness School, UK)


We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England. The cost savings are due mainly to reductions in emergency admissions and outpatient visits, rather than to lower costs for patients treated in hospital or to reductions in elective admissions.

Suggested Citation

  • Mark Dusheiko & Hugh Gravelle & Stephen Martin & Nigel Rice & Peter C Smith, 2011. "Does Better Disease Management in Primary Care Reduce Hospital Costs?," Working Papers 065cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:65cherp

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    References listed on IDEAS

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    6. Hugh Gravelle & Matt Sutton & Ada Ma, 2010. "Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?," Economic Journal, Royal Economic Society, vol. 120(542), pages 129-156, February.
    7. Gianluca Fiorentini & Elisa Iezzi & Matteo Lippi Bruni & Cristina Ugolini, 2011. "Incentives in primary care and their impact on potentially avoidable hospital admissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(4), pages 297-309, August.
    8. Mundlak, Yair, 1978. "On the Pooling of Time Series and Cross Section Data," Econometrica, Econometric Society, vol. 46(1), pages 69-85, January.
    9. Lippi Bruni, Matteo & Nobilio, Lucia & Ugolini, Cristina, 2009. "Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care," Health Policy, Elsevier, vol. 90(2-3), pages 140-148, May.
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    11. de Bruin, Simone R. & Heijink, Richard & Lemmens, Lidwien C. & Struijs, Jeroen N. & Baan, Caroline A., 2011. "Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: A systematic review of the literature," Health Policy, Elsevier, vol. 101(2), pages 105-121, July.
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    Cited by:

    1. Lippi Bruni, Matteo & Mammi, Irene & Ugolini, Cristina, 2016. "Does the extension of primary care practice opening hours reduce the use of emergency services?," Journal of Health Economics, Elsevier, vol. 50(C), pages 144-155.

    More about this item


    Quality; disease management; primary care; hospital costs; ambulatory care sensitive conditions; preventative care.;

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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