Aims: The aim was to compare a new strategy for rehabilitation based on coordinated teamwork with traditional health care activities for patients with longterm illnesses in primary health care with respect to costs and health related quality of life.
Methods and data: This was a 3-month, prospective, controlled study in primary health care where a trial group of health care centers with rehabilitation teams (n=665) was compared with a control group of health care centers working with traditional health care activities without co-ordinated teams (n=665). The data collection was carried out for 12 months during the years 1993 and 1994 in 6 geographically defined areas. All individuals in the regions were consecutively included after being on sick leave for more than 30 days. The patients were followed upduring a period of three months using postal questionnaires. The analytical method was cost-utility analysis.
Results: The team based rehabilitation strategy did not improve health related quality of life (p=0.46) compared with traditional rehabilitation. The total costs for health care was 9% lower (p=0.51) and the indirect costs for loss of production was 8% higher (p=0.02) for the trial group. Social insurance expenditures were 9% higher for the trial group (p=0.14).
Discussion: It was not possible to form any reliable conclusions from this short term study about whether rehabilitation teams reduced health status and health related quality of life, as the differences were small but also negative. The perspective of analysis is important, from a health care perspective the teams were cost saving but from a broader socioeconomic perspective the teams lead to increased costs for society. The inclusion of indirect costs in cost-effectiveness analyses andcost-utility analyses requires further exploration. The time period was probably too short for capturing long-term effects.
Conclusions: Rehabilitation teams in primary health care do not improve health related quality of life within a short-term perspective, reduce costs for health care but increase indirect costs and social insurance expenditures compared with traditional health care activities. In order to improve quality of life for those with longterm illnesses and decrease society's costs for rehabilitation, rehabilitation strategiesfor people with different illnesses may be developed into more specialized strategies for specific patient groups, defined into homogenous treatment groups that matchwell-defined rehabilitation. For further research long-term studies are needed.