Abstract
Background
High users (HU) of primary care account for a disproportionate share of health expenditure, yet the magnitude and drivers of cost differences across utilisation profiles remain insufficiently characterised in integrated care settings.
Objectives
To quantify and compare healthcare costs across utilisation profiles (consistent HU, occasional HU, and non-HU) and assess cost composition and potential savings in a local health unit (ULS) of the Portuguese National Health Service.
Methods
A retrospective study using an administrative patient-year dataset (110,300 individuals) from ULS Almada-Seixal (2021–2024) was used, linking primary and hospital care, including primary care consultations, diagnostic and therapeutic procedures (MCDTs), prescribed pharmaceuticals, emergency department (ED) episodes, and inpatient admissions. Costs were estimated using a bottom-up micro-costing based on official tariffs and price lists (SNS perspective). Descriptive and stratified analyses were performed across utilisation profiles and cost components.
Results
Mean cost per patient-year was €1,928, with a clear cost gradient: consistent HU (€4,413), occasional HU (€2,683), and non-HU (€771). MCDTs were the main cost driver, followed by pharmaceuticals and inpatient care, while primary care consultations and ED episodes represented a minor share of total costs. Costs were unevenly distributed, with occasional HU (38.4% of total individuals) accounting for the highest spending, while consistent HU, the smaller proportion (11.6%), exceeded the total costs of non-HU (50.0%). Simulating consistent HU behaving as occasional HU would lower expenditure by 9.6%, and as non-HU, by 61.9%, corresponding to total savings between €81.9 and €526.6 million over 4 years.
Conclusions
Costs are substantially higher in HU profiles, driven mainly by diagnostic procedures and pharmaceuticals rather than primary care, highlighting the potential savings of targeted interventions in HU.
Key messages
• Mean patient-year cost for consistent high users of primary care is nearly six times higher than non-high users (€4,413 vs €771), with diagnostic procedures and pharmaceuticals as main cost drivers.
• Shifting consistent high users toward occasional or non-user profiles could reduce expenditure by 9.6–61.9%, saving €81.9–526.6 million over 4 years, supporting targeted interventions.