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Hepatitis C Virus Antibody Testing Among 13- to 21-Year-Olds in a Large Sample of US Federally Qualified Health Centers

2019; American Medical Association; Volume: 322; Issue: 22 Linguagem: Inglês

10.1001/jama.2019.16196

1538-3598

Rachel Epstein, Jianing Wang, Liesl M. Hagan, Kenneth H. Mayer, Jon Puro, Benjamin P. Linas, Sabrina A. Assoumou,

Hepatitis B Virus Studies

to $538 among 11 608 038 individuals in 2017 (Table 1), but declined as a share of total spending from 8.97% to 8.04% (difference, -0.93% [95% CI, -0.95% to -0.91%]; P < .001)(Table 2).Mean total spending increased from $5701 to $6688.Children had the highest primary care spending as a share of their total health care spending, with 20.33% in 2013 and 19.54% in 2017 (P < .001),and individuals aged 55 to 64 years had the lowest, with 7.25% in 2013 and 6.33% in 2017 (P < .001).Under the narrow definition, the primary care spending share declined from 4.60% to 4.35% (difference, -0.25% [95% CI, -0.27% to -0.23%]; P < .001).This decline was accounted for by children, for whom the share decreased from 13.68% to 12.51% (P < .001).The primary care spending share under this definition did not change substantially for any other age group.The share of individuals utilizing a PCC increased from 78.35% in 2013 to 79.65% in 2017 (difference, 1.30% [95% CI, 1.27%-1.34%];P < .001)and varied across age groups (Table 2).Discussion | From 2013 to 2017, the share of total spending attributed to primary care declined among individuals covered by employer-sponsored insurance despite an increase in PCC utilization and spending on primary care because total spending grew more quickly.Primary care may be both a substitute for and complement to non-primary care services. 3 As a substitute, primary care may decrease spending for specialty and inpatient care, where services are more expensive. 4 As a complement, it may increase utilization of more expensive care because patients are referred to a broader network of clinicians. 5A better understanding of the relationship between primary care and specialty utilization and spending is needed.The estimates of primary care spending share are higher than estimates among Medicare fee-for-service beneficiaries, 1 and fall between other estimates of individuals covered by employer-sponsored insurance using a convenience sample of insurers 2 and Medical Expenditure Panel data. 6 Factors affecting primary care spending, such as patient and PCC demographics and insurance plan benefit design, were not studied.The data may not be representative of the entire employer-sponsored insurance population.