Counting the cost of social disadvantage in primary care: retrospective analysis of patient data

Abstract

Objective: To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. Design: Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. Setting: Inner city group practice with a socioeconomically diverse population. Subjects: 382 male and female subjects of all ages, with a total of 1296 person years of observation. Main outcome measures: Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. Results: Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about £150 per person year at risk (£47 for workload and £103 for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. Conclusions: The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increases as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

Dying in the Margins: Understanding Palliative Care and Socioeconomic Deprivation in the Developed World

“…The limited resources available for the socioeconomically deprived highlights the potential burden of a terminal diagnosis for this group. Evidence supports the notion that the healthcare needs of the socioeconomically deprived are greater than those of the general healthcare population [4][5][6]. Recognizing socioeconomic disadvantage as a significant factor in influencing health outcomes, underscores the importance of focusing of the distinctive characteristics that the illness and death experience has for this group.…”

“…High costs of end of life care for the uninsured and underinsured in the US are well described in the literature [43,45,48,58,59]. Countries that have universal health coverage also identified financial burdens for the poor accessing end of life care services [5,17,[60][61][62]. Expenses included bridging costs of the gap payments and costs of services and goods exceeding those provided by a government health service.…”

“…It found that EOL care expenditure for high poverty ZIP codes were 20 percent higher than for ZIP codes with the lowest poverty rates [68]. Higher healthcare costs for lower socioeconomic groups may reflect the costs of managing the health outcomes for late presentation with malignant disease [69], the existence of multiple co-morbidities [68], lack of uptake of services and support payments [61], the lack of attention to social factors, not amenable to current models of care [70], the increased support required from primary care providers [5,44,71], and a higher percentage of acute admissions and hospital deaths for low socioeconomic groups [18]. Two studies from Sweden contrasted these findings with Felder et al [72] and Hanratty et al [73] identifying increased healthcare expenditure for higher income groups at the EOL.…”

Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

“…44 Additional targeted and tailored interventions may be needed to address other mediators of disparities including financial barriers, health lit- eracy, and cultural beliefs and attitudes among others. Newer reimbursement models are needed that take into account the increased costs of caring for poor patients, 45 to avoid the unintended consequences of pay-for-performance. 46 These findings are subject to several limitations.…”

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

“…112 Practices serving disadvantaged populations tend to have both greater workload and costs, neither of which is fully compensated by deprivation payments. 113,114 Such practices may be less likely to offer an expensive additional service such as chlamydia screening.…”