Comparison of Service Usage and Costs of Patients With Long Term Conditions in the Public Sector, Occupational Care and the Private Sector
Abstract
Background
The primary care service system in Finland is based on publicly arranged services that patients can supplement with privately purchased services. In addition, employed people have access to occupational healthcare services. The financing structure of the services as well as the patients’ co-payments differ between the sectors. The current social and healthcare reform may potentially change the way primary care services are arranged and produced. Private producers will be more widely eligible to provide publicly funded services alongside public producers. This study analyzes the differences between the service usage and costs of patients with certain long term conditions in the different sectors: public, private and occupational healthcare.
Methods
The study is a retrospective registry study in which we used patient level data retrieved from the electronic medical records of service producers and the registry of the Social Insurance Institution of Finland. The study included all 30-64–year-old citizens of the city of Oulu who had one of six common long term conditions: type 2 diabetes, asthma or COPD, rheumatism, hypertension, back pain or depression (in total 13,865 patients). Data was collected from 2013. Differences between sectors were analyzed with descriptive and statistical methods.
Results
Patients who used occupational healthcare used more primary care services and their costs were higher compared to patients in the public or private sectors. The differences between the private and public sectors were small. The number of contacts directly related to the long term condition was similar in all sectors.
Conclusions
The differences in service usage between the three sectors were surprisingly small considering the different funding and provision logics. One reason for this may be that physicians and nurses follow national treatment guidelines. Therefore, economic incentives may not be as strong as incentive theories might predict. Also, the high service usage of patients in occupational healthcare is partly due to special needs such as sick leave certificates, mandatory check-ups in physically demanding jobs, and due to the fact that there is no co-payment for the patient and availability of appointments is usually better.
Authors
Riikka-Leena Leskelä, Tommi Uimonen, Lauri Virta, Sirkku Pikkujämsä, Tuomas Kopperoinen, Hennamari Mikkola
Additional Information
- Peer-Reviewed: yes.
- Open Access: yes.
- Cite as: Leskelä, R., Uimonen, T., Virta, L., Pikkujämsä, S., Kopperoinen, T., & Mikkola, H. (2017). Peruspalvelujen käyttö ja kustannukset pitkäaikaissairailla: Julkisten, yksityisten ja työterveyshuollon palvelujen vertailu. Suomen lääkärilehti, 72(6), 355–59.
https://www.laakarilehti.fi/pdf/2017/SLL62017-355.pdf
