Economic evaluation of a multimorbidity patient centered care model implemented in the Chilean public health system

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dc.article.number1041
dc.catalogadorpau
dc.contributor.authorZamorano Pichard, Paula Francisca
dc.contributor.authorEspinoza Sepúlveda, Manuel Antonio
dc.contributor.authorVarela, Teresita
dc.contributor.authorAbbott, Tomás
dc.contributor.authorTellez, Alvaro
dc.contributor.authorArmijo Escalona, Nicolás Andrés
dc.contributor.authorSuarez, Francisco
dc.date.accessioned2023-10-03T20:12:13Z
dc.date.available2023-10-03T20:12:13Z
dc.date.issued2023
dc.description.abstractMultimorbidity and patient-centered care approaches are growing challenges for health systems and patients. The cost of multimorbidity patients and the transition to a new care strategy is still sightly explored. In Chile, more than 70% of the adult population suffer from multimorbidity, opening an opportunity to implement a Multimorbidity patient-centered care model. The objective of this study was to perform an economic evaluation of the model from the public health system perspective. The methodology used a cost-consequence evaluation comparing seven exposed with seven unexposed primary care centers, and their reference hospitals. It followed three steps. First, we performed a Time-Driven Activity-Based Costing with routinely collected data routinely collected. Second, we run a comparative analysis through a propensity score matching and an estimation of the attributable costs to health services utilization at primary, secondary and tertiary care and health outcomes. Third, we estimated implementation and transaction costs. Results showed savings in aggregate costs of the total population (-0.12 (0.03) p?<?0.01) during the period under evaluation. Costs in primary care showed a significant increase, whereas tertiary care showed significant savings. Health outcomes were associated with higher survival in patients under the new care model (HR 0.70 (0.05) p?<?0.01). Implementation and transaction costs increased as the number of pilot intervention centers increased, and they represented 0,07% of the total annual budget of the Servicio de Salud Metropolitano Sur Oriente. After three years of piloting, the implementation and transaction cost for the total period was USD 1,838,767 and 393,775, respectively. The study’s findings confirm the purpose of the new model to place primary health care at the center of care for people with non-communicable chronic diseases. Thus, it is necessary to consider implementation and transaction costs to introduce a broad health system multimorbidity approach. The health system should assume some of them permanently to guarantee sustainability and facilitate scale-up.
dc.fechaingreso.objetodigital03-10-2023
dc.format.extent9 páginas
dc.fuente.origenBiomed Central
dc.identifier.doi10.1186/s12913-023-09970-y
dc.identifier.issn1472-6963
dc.identifier.urihttps://doi.org/10.1186/s12913-023-09970-y
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/74905
dc.information.autorucFacultad de Economía y Administración; Zamorano Pichard, Paula Francisca; S/I; 230522
dc.information.autorucEscuela de Medicina; Espinoza Sepúlveda, Manuel Antonio; 0000-0001-9564-9512; 10720
dc.information.autorucEscuela de Medicina; Varela, Teresita; S/I; 149031
dc.information.autorucEscuela de Medicina; Abbott, Tomás; S/I; 203717
dc.information.autorucEscuela de Medicina; Tellez, Alvaro; 0000-0003-1667-6243; 99828
dc.information.autorucEscuela de Medicina; Armijo Escalona, Nicolás Andrés; S/I; 233953
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final9
dc.pagina.inicio1
dc.revistaBMC Health Services Research
dc.rightsacceso abierto
dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectMultimorbidity
dc.subjectEconomic evaluation
dc.subjectImplementation science
dc.subjectTransactional analysis
dc.subjectChile
dc.subject.ddc610
dc.subject.deweyMedicina y salud
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleEconomic evaluation of a multimorbidity patient centered care model implemented in the Chilean public health system
dc.typeartículo
dc.volumen23
sipa.codpersvinculados230522
sipa.codpersvinculados10720
sipa.codpersvinculados149031
sipa.codpersvinculados203717
sipa.codpersvinculados99828
sipa.codpersvinculados233953
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