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Logo of jroyalcgpracBJGP at RCGPBJGP at PubMed CentralJ R Coll Gen Pract at PubMed CentralRCGP homepage
J R Coll Gen Pract. 1989 March; 39(320): 114–117.
PMCID: PMC1711771

Paying general practitioners: shedding light on the review of health services.


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.

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Selected References

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  • Maynard A, Marinker M, Gray DP. The doctor, the patient, and their contract. III. Alternative contracts: are they viable? Br Med J (Clin Res Ed) 1986 May 31;292(6533):1438–1440. [PMC free article] [PubMed]
  • Klein R. Financing health care: the three options. Br Med J (Clin Res Ed) 1988 Mar 12;296(6624):734–736. [PMC free article] [PubMed]
  • Vayda E. A comparison of surgical rates in Canada and in England and Wales. N Engl J Med. 1973 Dec 6;289(23):1224–1229. [PubMed]
  • Vayda E, Barnsley JM, Mindell WR, Cardillo B. Five-year study of surgical rates in Ontario's counties. Can Med Assoc J. 1984 Jul 15;131(2):111–115. [PMC free article] [PubMed]
  • Vayda E, Mindell WR, Rutkow IM. A decade of surgery in Canada, England and Wales, and the United States. Arch Surg. 1982 Jun;117(6):846–853. [PubMed]
  • Fuchs VR. The supply of surgeons and the demand for operations. J Hum Resour. 1978;13 (Suppl):35–56. [PubMed]
  • Cromwell J, Mitchell JB. Physician-induced demand for surgery. J Health Econ. 1986 Dec;5(4):293–313. [PubMed]
  • Phelps CE. Induced demand--can we ever know its extent? J Health Econ. 1986 Dec;5(4):355–365. [PubMed]
  • Rice TH. The impact of changing medicare reimbursement rates on physician-induced demand. Med Care. 1983 Aug;21(8):803–815. [PubMed]
  • Grivell AR, Forgie HJ, Fraser CG, Berry MN. Effect of feedback to clinical staff of information on clinical biochemistry requesting patterns. Clin Chem. 1981 Oct;27(10):1717–1720. [PubMed]
  • Cohen DI, Jones P, Littenberg B, Neuhauser D. Does cost information availability reduce physician test usage? A randomized clinical trial with unexpected findings. Med Care. 1982 Mar;20(3):286–292. [PubMed]
  • Myers LP, Schroeder SA. Physician use of services for the hospitalized patient: a review, with implications for cost containment. Milbank Mem Fund Q Health Soc. 1981 Fall;59(4):481–507. [PubMed]
  • Needham A, Brown M, Freeborn S. Introduction and audit of a general practice antibiotic formulary. J R Coll Gen Pract. 1988 Apr;38(309):166–167. [PMC free article] [PubMed]
  • Grol R, Mokkink H, Schellevis F. The effects of peer review in general practice. J R Coll Gen Pract. 1988 Jan;38(306):10–13. [PMC free article] [PubMed]
  • Newhouse JP. A design for a health insurance experiment. Inquiry. 1974 Mar;11(1):5–27. [PubMed]
  • Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. [PubMed]
  • Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, Marquis MS. Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev. 1987 Jun;77(3):251–277. [PubMed]
  • Dowd BE, Johnson AN, Madson RA. Inpatient length of stay in Twin Cities health plans. Med Care. 1986 Aug;24(8):694–710. [PubMed]
  • Yelin EH, Shearn MA, Epstein WV. Health outcomes for a chronic disease in prepaid group practice and fee for service settings. The case of rheumatoid arthritis. Med Care. 1986 Mar;24(3):236–247. [PubMed]
  • Buchanan JL, Cretin S. Risk selection of families electing HMO membership. Med Care. 1986 Jan;24(1):39–51. [PubMed]
  • Berki SE, Ashcraft M, Penchansky R, Fortus R. Enrollment choice in a mutli-HMO setting:the roles of health risk, financial vulnerability, and access to care. Med Care. 1977 Feb;15(2):95–114. [PubMed]
  • Berki SE, Penchansky R, Fortus RS, Ashcraft ML. Enrollment choices in different types of HMOs: a multivariate analysis. Med Care. 1978 Aug;16(8):682–697. [PubMed]
  • Roghmann KJ, Gavett JW, Sorensen AA, Wells S, Wersinger R. Who chooses prepaid medical care: Survey results from two marketings of three new prepayment plans. Public Health Rep. 1975 Nov-Dec;90(6):516–527. [PMC free article] [PubMed]
  • Juba DA, Lave JR, Shaddy J. An analysis of the choice of health benefits plans. Inquiry. 1980 Spring;17(1):62–71. [PubMed]
  • Ware JE, Jr, Brook RH, Rogers WH, Keeler EB, Davies AR, Sherbourne CD, Goldberg GA, Camp P, Newhouse JP. Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care. Lancet. 1986 May 3;1(8488):1017–1022. [PubMed]
  • Newhouse JP, Manning WG, Morris CN, Orr LL, Duan N, Keeler EB, Leibowitz A, Marquis KH, Marquis MS, Phelps CE, et al. Some interim results from a controlled trial of cost sharing in health insurance. N Engl J Med. 1981 Dec 17;305(25):1501–1507. [PubMed]
  • Brook RH, Ware JE, Jr, Rogers WH, Keeler EB, Davies AR, Donald CA, Goldberg GA, Lohr KN, Masthay PC, Newhouse JP. Does free care improve adults' health? Results from a randomized controlled trial. N Engl J Med. 1983 Dec 8;309(23):1426–1434. [PubMed]
  • Bailit H, Newhouse J, Brook R, Duan N, Goldberg G, Hanley J, Kamberg C, Spolsky V, Black A, Lohr K. Does more generous dental insurance coverage improve oral health? J Am Dent Assoc. 1985 May;110(5):701–707. [PubMed]
  • Relman AS. The Rand health insurance study: is cost sharing dangerous to your health? N Engl J Med. 1983 Dec 8;309(23):1453–1453. [PubMed]

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