RT Journal Article
SR Electronic
T1 Paying general practitioners: shedding light on the review of health services.
JF The Journal of the Royal College of General Practitioners
JO J R Coll Gen Pract
FD British Journal of General Practice
SP 114
OP 117
VO 39
IS 320
A1 C Donaldson
A1 K Gerard
YR 1989
UL http://bjgp.org/content/39/320/114.abstract
AB This paper reviews evidence from recent research on the effects of different methods of remunerating general practitioners. Each method is examined in terms of patient use of health services in general, use of services by different groups in society and health outcome. Little is known about the effects of capitation as it currently exists in the UK, salaries or special payments for 'good practice', although evidence from British research is likely to be forthcoming on the last of these. Both health maintenance organizations and charges deter utilization, although little is known about the effect of this reduced demand. Furthermore, these two methods of financing health care appear to discriminate between members of society on lower and higher incomes in terms of both service use and health outcome. Fees for items of service provided tend to lead to unnecessary demands for fee yielding services by patients on the recommendation of their doctors. Although more evidence on different methods of remuneration is required, the importance of what is already known depends on the objectives of health care provision.