Evidence of Overlapping Roles Between Clinics and Hospitals in Primary Care.

Background: Clinics and hospitals in South Korea are often perceived as competitors to each other. This study examines the overlapping roles in providing primary care provision between clinics and hospitals by analyzing the healthcare facility type where patients first receive diagnoses of hypertension (HTN) or diabetes mellitus (DM). We also explore the characteristics of patients that influence their choice of healthcare facility and compare healthcare utilization patterns in the first year post-diagnosis by facility type.

Methods: Using 2021 claims data from the Health Insurance Review and Assessment Service, we included data from 599,955 patients with newly diagnosed HTN and 195,668 patients with newly diagnosed DM. We analyzed the distribution of new diagnoses by facility type, characteristics of patients who chose hospitals, average number of facility visits and medical expenses in the first year following the initial diagnosis, and continuity of care index.

Results: Among the newly diagnosed patients, 82.5% of HTN and 66.6% of DM cases were diagnosed in clinics, whereas 17.5% and 33.4%, respectively, occurred in hospitals. Younger patients, those with comorbidities, and those residing outside Seoul were more likely to receive care at hospitals. Compared to those diagnosed in hospitals, patients diagnosed in clinics visited healthcare facilities more frequently and incurred greater total medical expenses but demonstrated higher continuity of care.

Conclusion: These findings indicate that both clinics and hospital-level healthcare facilities, excluding general hospitals, play significant roles in providing primary care. Strengthening the clinic-based primary care system and ensuring the quality of primary care provided by hospitals are crucial. Policies that promote transparency in the quality assessments of healthcare facilities can help patients make informed decisions when choosing between clinics and hospitals.