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Measuring Primary Care Expenses

Department of Family Medicine, Virginia Commonwealth University, Richmond (AK)
Department of Family Medicine, University of Colorado Denver, Aurora (MC, LAG)
The Robert Graham Center, Washington, D.C. (MSD)

Correspondence: Corresponding author: Alex H. Krist, MD, MPH, PO Box 980251, Richmond, VA 23298-0251 (E-mail: ahkrist{at}vcu.edu)

Background: Significant investments and effort are being devoted to health care reform, yet little is known about the costs of improvements. Practical tools are needed to allow for systematic assessment of practice expenses. We report here a field trial of a standardized expenditure data collection instrument.

Methods: Combining economic and primary care practice consultation, an expenditure data collection instrument was created. The instrument underwent observed feasibility testing and was fielded by 10 practice-based research networks in 30 practices conducting 10 different health behavior change interventions.

Results: Start-up and operating expenses were successfully collected for 87% and 97% of the practices, respectively. Data collection time and effort were considerable but acceptable. Three elements were necessary to collect expenditure data: (1) an intervention-specific data collection instrument, (2) a field guide, and (3) economic oversight and assistance. Fully 90% of networks reported that they planned to collect expenditure data in the future and study participation increased the likelihood of their participation in a future expenditure study.

Conclusions: It is feasible to systematically collect intervention-specific expenses in primary care using formal expenditure methods. However, most practices and researchers lack the knowledge, expertise, and resources to collect such data independently. Further assistance and education is necessary to obtain reliable information about the expenses to transform and improve primary care.

Key Words: Primary Health Care • Health Care Economics and Organizations

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