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Changes in payments for general practice consultations 1989-93
M W Tilyard1, E Gurr, S M Dovey
1Department of Preventive and Social Medicine, Otago Medical School, Dunedin.
Insights
General practitioners charged regular fees less often in 1993 compared to 1989, with more patients receiving reduced fees. Public funding decreased, increasing the financial burden on patients and doctors for primary care access.
Area of Science:
- Primary Care Medicine
- Health Economics
- General Practice
Background:
- General practitioner (GP) fee structures and patient charges are crucial for understanding primary care accessibility and financial sustainability.
- Previous studies have documented GP charging practices, but recent data is needed to assess current trends.
- Changes in healthcare funding and economic factors may influence how GPs structure their fees and charge patients.
Purpose of the Study:
- To compare general practitioner fee structures and patient charges in 1993 with those reported in 1989.
- To identify shifts in the proportion of consultations charged at regular, reduced, or increased fees.
- To analyze changes in the contribution of different funding sources, such as public agencies and Accident Compensation (ACC), to GP consultations.
Main Methods:
- Analysis of computer-generated data from general practitioner systems, including General Medical Services (GMS) claims and patient consultation charges for 1993.
- Comparison of 1993 charging data with a previous study's findings from 1989, encompassing a large number of consultations (59,215 in 1993 vs. 97,869 in 1989).
- Statistical analysis to determine the significance of observed differences in fee structures and funding contributions.
Main Results:
- The proportion of consultations charged at the regular GP fee decreased significantly from 47.0% in 1989 to 34.1% in 1993 (p < 0.001).
- There was a substantial increase in consultations with reduced fees, rising 7.9-fold from 3.5% in 1989 to 27.5% in 1993 (p < 0.001).
- The contribution of Accident Compensation (ACC) funding declined from 17.5% of consultations in 1989 to 10.1% in 1993 (p < 0.001), with 19.4% of non-maternity/immunisation consultations in 1993 generating no patient fee.
Conclusions:
- Significant shifts in the funding landscape for general practice care occurred between 1989 and 1993, marked by a diminished input from public agencies.
- Both patients and general practitioners are shouldering a greater financial burden for accessing primary care services.
- These changes highlight evolving economic pressures and policy impacts on the delivery and accessibility of general practice.
Aims:
Information generated by the computer systems of general practitioners was examined to determine whether general practitioners fee structures during 1993 were different from those reported in 1989.
Methods:
Copies of the general medical services (GMS) claims and actual consultation charges to patients were examined to determine whether patients had been charged the doctors' regular fee or an amount greater or less than this, in 1993. These data were compared with results from a previous study describing charging data in 1989.
Results:
Information on 59,215 consultations was collected in 1993 and compared with information on 97,869 consultations collected in 1989. The proportion of consultations which resulted in a regular fee being charge had reduced from 47.0% in 1989 to 34.1% in 1993 (p < 0.001). The proportion of cases in which a less than normal fee was charged had risen 7.9 times from 3.5% in 1989 to 27.5% in 1993 (p < 0.001). The contribution of Accident Compensation (ACC) funding for general practitioner consultations had reduced from 17.5% of consultations in 1989 to 10.1% of 1993 consultations (p < 0.001). Excluding consultations in which a maternity or immunisation claim was made, 19.4% of consultations in 1993 generated no fee to the patient.
Conclusion:
In the 4 years between these two data collections, changes in the contribution of different agencies funding general practice care is marked. Public agencies have diminished input and both patients and practitioners are carrying more of the financial burden for access to primary care.
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