Patients' attitudes to co-payments for general practitioner services: do they reflect the prevailing system?

Objectives: Most Organisation for Economic Co-operation and Development (OECD) countries have introduced cost-sharing. This study compares the views of patients who are used to a service that is free at the point of delivery with those who are used to a system where 70% of patients pay for consultations. Methods: Secondary analysis of survey data from a random sample of 11,870 patients in Northern Ireland and the Republic of Ireland. Results: A 52% response rate was achieved, though respondents were representative of the two populations. Attitudes generally reflected the national status quo with little support for co-payments where there was currently no charging, but broad support where charging was established. Charging for missed appointments would be supported where there were delays in getting an appointment. Conclusions: More research is needed to understand what underlies support for, or opposition to, charges. However, it is apparent that patients' opinions need to be considered when formulating health care policy.

[1]  A. Murphy,et al.  Perceived and reported access to the general practitioner: an international comparison of universal access and mixed private/public systems. , 2007, Irish medical journal.

[2]  P. Crampton,et al.  Utilization of general practitioner services in New Zealand and its relationship with income, ethnicity and government subsidy , 2003, Health services management research.

[3]  L. Tollen,et al.  How low can you go? The impact of reduced benefits and increased cost sharing. , 2002, Health affairs.

[4]  Cathy Schoen,et al.  Inequities in health care: a five-country survey. , 2002, Health affairs.

[5]  A. Murphy,et al.  A national general practice census: characteristics of rural general practices. , 2001, Family practice.

[6]  P. Groenewegen,et al.  All rights reserved, or can we just copy? Cost sharing arrangements and characteristics of health care systems. , 2000, Health policy.

[7]  P. Groenewegen,et al.  Does General Practitioner Gatekeeping Curb Health Care Expenditure? , 2000, Journal of health services research & policy.

[8]  Jonathan Reggler User fees would both yield money and encourage more responsible use of NHS , 1998, BMJ.

[9]  W. Browner,et al.  Case-finding instruments for depression , 1997, Journal of General Internal Medicine.

[10]  S. Soumerai,et al.  Effects of Limiting Medicaid Drug-Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia , 1994 .

[11]  C. Elliott,et al.  Free for All: Lessons from the RAND Health Insurance Experiment , 1994 .

[12]  W. Manning,et al.  Utilization Review Savings at the Micro Level , 1992, Medical care.

[13]  B. Abel-Smith Cost containment and new priorities in the European community. , 1992, The Milbank quarterly.

[14]  S B Soumerai,et al.  Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. , 1991, The New England journal of medicine.

[15]  P. Marquez Containing health costs in the Americas. , 1990, Health policy and planning.

[16]  Stephen B. Soumerai,et al.  Payment Restrictions for Prescription Drugs under Medicaid , 1987 .

[17]  W. Manning,et al.  Inappropriate use of hospitals in a randomized trial of health insurance plans. , 1986, The New England journal of medicine.

[18]  M. Pauly Readings in the economics of contract law: The economics of moral hazard: comment , 1982 .

[19]  E. Abbo,et al.  Controlling health care costs. , 2004, Journal of the American Veterinary Medical Association.

[20]  W. Cullen,et al.  The financial cost to patients of visiting a GP in Ireland: a cross-sectional survey , 2001, Irish journal of medical science.

[21]  W. Browner,et al.  Case-finding instruments for depression. Two questions are as good as many. , 1997, Journal of general internal medicine.

[22]  Hugh Davies,et al.  Is it Cash that the Deprived are Short of? , 1997 .

[23]  J. Newhouse Free for All?: Lessons from the RAND Health Insurance Experiment , 1993 .

[24]  A. Mcguire,et al.  Providing health care : the economics of alternative systems of finance and delivery , 1991 .

[25]  E. Wagner,et al.  The effect of office visit copayments on preventive care services in an HMO. , 1990, Inquiry : a journal of medical care organization, provision and financing.

[26]  S B Soumerai,et al.  Payment restrictions for prescription drugs under Medicaid. Effects on therapy, cost, and equity. , 1987, The New England journal of medicine.

[27]  J. Butler,et al.  THE FUTURE OF THE NATIONAL HEALTH SERVICE , 1969 .