Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore.
10.47102/annals-acadmedsg.2022165
- Author:
Grace SUM
1
;
Mumtaz Mohamed KADIR
;
Soon Hoe HO
;
Joanne YOONG
;
Junxing CHAY
;
Chek Hooi WONG
Author Information
1. Geriatric Education and Research Institute, Singapore.
- Publication Type:Journal Article
- MeSH:
Aged;
Health Care Costs;
Humans;
Independent Living;
Patient-Centered Care;
Prospective Studies;
Singapore
- From:Annals of the Academy of Medicine, Singapore
2022;51(9):553-566
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:The Patient-Centred Medical Home (PCMH) demonstration in Singapore, launched in November 2016, aimed to deliver integrated and patient-centred care for patients with biopsychosocial needs. Implementation was based on principles of comprehensiveness, coordinated care and shared decision-making.
METHOD:We conducted a prospective single-arm pre-post study design, which aimed to perform cost analysis of PCMH from the perspectives of patients, healthcare providers and society. We assessed short-to-intermediate-term health-related costs by analysing data on resource use and unit costs of resources.
RESULTS:We analysed 165 participants enrolled in PCMH from November 2017 to April 2020, with mean age of 77 years. Compared to the 3-month period before enrolment, mean total direct and indirect participant costs and total health system costs increased, but these were not statistically significant. There was a significant decrease in mean cost for primary care (government primary care and private general practice) in the first 3-month and second 3-month periods after enrolment, accompanied by a significant decrease in service utilisation and mean costs for PCMH services in the second 3-month period post-enrolment. This suggested a shift in resource costs from primary care to community-based care provided by PCMH, which had added benefits of both clinic-based primary care and home-based care management. Findings were consistent with a lower longer-term cost trajectory for PCMH after the initial onboarding period. Indirect caregiving costs remained stable.
CONCLUSION:The PCMH care model was associated with reduced costs to the health system and patients for usual primary care, and did not significantly change societal costs.
