The effect of direct charges on consultations in family practice: a study of a doctors' strike

Experience accumulated during the doctors' strike of 1983 in Israel was analysed to compare the effect on the work of the family doctor of direct-charge as against pre-paid insurance arrangements, in three different settings--suburban, rural and working-class small town. The imposition of direct charges greatly reduced the consultation rate; more of the patients consulting received prescriptions, especially for antibiotics; laboratory investigation, referral and admission to hospital were unchanged, but referral for specialist consultation was reduced; the most frequently seen diagnostic categories remained respiratory diseases and undefined signs or symptoms, but pneumonia was seen much more frequently; there was no change in the proportion of follow-up visits, but house calls were more frequent. These trends were stable over the four-month period of the strike, and partial reimbursement of the fee did not change the picture significantly. The evidence did not conclusively support the hypothesis that direct charges selectively deter trivial complainers.