Cf7.1 The Effects Of Capitation And Fee For Service On The Consultation Process: A Cross Sectional Study

Author(s): 
K. Thompson1, A.W. Murphy2, D. O’Reilly1, T. O’Dowd4, E. Shryane2
1 Queen’s University, Belfast, Ireland
2 National University of Ireland, Galway, Ireland
3 Trinity College, Dublin, Ireland
Text: 
Objective.
To determine the effects of fee for service (FFS) and capitation payments on the process of the consultation.
Design.
Cross sectional questionnaire and record review. Setting. Twenty representative general practices in Ireland. Participants: 1668 patients, selected from a random selection of 3351 patients who consulted during the previous twelve month period. Study hypotheses. That, allowing for age, sex, health status and all other variables, GP initiated visits, prescription, investigation and referral rates and satisfaction with communication will be higher in the FFS group in comparison to the capitation group.
Results. Mean age of patients was 44.0 years (SD 13.6); 39% were male and 41% female. 28.4% were patients capitation and 70.4% FFS. Adjusted logistic regression models suggested that FFS patients were half as likely to experience a GP initiated visit (OR: 0.56, p = 0.005, CI: 0.37-0.84). and were a quarter less likely to receive a prescription when compared to capitation patients (OR: 0.75, p Conclusions.
Prescription and investigation patterns indicate that the method of GP remuneration impacts upon the process of the consultation. The theory of supplier induced demand does not appear to explain the differences between payment status, rather GPs may be more concerned with their patients’ ability to pay, than with opportunities for income generation.
Literature: 
CF7.1 THE EFFECTS OF CAPITATION AND FEE FOR SERVICE ON THE CONSULTATION PROCESS: A CROSS SECTIONAL STUDY