Abstract
Objectives: We have only a little information about the differences between urban and rural primary care practices in Central Europe. In this article, we seek to explore these differences between general practices in Czechia using the cost data of the largest domestic health insurance provider, amounting altogether to 69.7 billion CZK (2.57 billion euros).
Methods: We have analysed the total annual costs per registered insurance holder /patient/ (using age indexation) in 2016 (for 4.69 million adults) in the selected segments directly impacted by GPs. We used our typology to assort individual practices, which based on the OECD principles of territorial division (urban, intermediate, rural practices).
Results: In total, general practices in urban areas report the highest costs of patient care, the costs are lower in peripheries, primarily with the intermediate type of practices (by 7%). Non-urban practices perform more procedures (6-18%). They use radio diagnostics and laboratories more and prescribe more medications (18-32%). On the other hand, they use fewer specialist and home care services and have lower costs in all items with respect to care indicated by other doctors than GPs (non-GPs). In prescriptions by units of per cent (5-6%), and in other items under review by tens of per cent (11-41%). Conclusions: Non-urban GP practices in Czechia have lower total costs per registered insurance holder while having the same level of capitation. The critical issue for the subsequent research remains whether non-urban practices really work more effectively or reflect worse care resulting from the uneven spatial distribution of healthcare services.