Critical Analysis Report
Title of Article: Does seeing the doctor more often keep you out of the hospital?
Authors’ Names: Robert Kaestner; Anthony T. Lo Sasso
Name of Journal: Journal of Health Economics
Date of Journal: January 2015
Volume: 39
Pages: 259-272
Summary
The health reform that began in the last decade and is beginning to take a firm hold of the United States has several provisions that help the utilization of primary care outpatient care for the United States population. The idea and reasoning behind these provision and ultimate goal is to improve the health of the population through primary care and this will ultimately improve healthcare costs. The article focuses on studying a health insurance company’s data in understanding the value of outpatient care and if it truly does improve healthcare costs for the employer sponsored plans that were being examined. Through this study, the authors found new causal evidence in the relationship between outpatient primary care and inpatient admissions. The results indicate that greater outpatient utilization and spending increased the probability of an inpatient admission by 1.9% and increase inpatient spending by 4.6%. It was also found that this increase in inpatient admissions as a result of outpatient spending was for conditions that it could be argued that the outpatient physician could have exercised greater discretion and curbed greater costs by exercising this discretion.
General Theme
The general theme of the article was that increased access to outpatient care and increased utilization of outpatient services by the population does not decrease health care cost. In actuality, more primary care and outpatient utilization results in greater inpatient admissions and greater cost based on the study completed.
Point of View
Based on the data collected and used by the authors through an insurer to arrive at the results of the study, I believe that their point of view was objective and based on facts. It was not a summarization of a theory that did not have any basis and was based on data from an insurance company. My only issue with the analysis was the sample size of utilizing a small Midwestern insurance company and only using data for members in a high deductible plan between 2000 and 2006, when the use of these plans was much less prevalent.
Issue Analysis
The issues that are presented in the article include:
1. Plan characteristics and outpatient spending – The study is based on high deductible plans, so the first issue brought up was the impact that the plan design, deductibles and contributions to a health fund (HRA) may have on the spending of outpatient services. It found that an increase in deductible found decreases in outpatient spending, drop in office visits and drop in pharmacy spend. An increase in HRA employer funding resulted in greater outpatient spending. The is conversely what was found with outpatient and inpatient spending later in the study.
2. Relationship between inpatient and outpatient spending – All of the statistical analysis that was completed point to estimates that outpatient spending and inpatient spending is positively correlated. This was found to be inconsistent with the argument that healthcare reform and other healthcare experts have made that outpatient spending and utilization decreases inpatient healthcare costs.

Conclusions and Recommendations
The authors came to the conclusion that the increased use of primary care physicians and outpatient treatment actually increased inpatient admissions and did not positively affect the cost of healthcare. The recent healthcare reform has placed an importance on the access to primary care physicians and the benefits of utilizing the physician in a timely manner. The argument of reform has been that this will assist in overall population health and bend the cost curve of healthcare improving overall healthcare costs and expenditures. Using the data from an insurer, the authors made