Journal of Medical Systems

, Volume 32, Issue 1, pp 37–41

A Co-payment for Consultant Services: Primary Care Physicians’ Referral Actualization

  • Daniel A. Vardy
  • Tami Freud
  • Michael Sherf
  • Ofer Spilberg
  • Dan Goldfarb
  • Arnon D. Cohen
  • Shlomo Mor-Yosef
  • Pesach Shvartzman
Original Paper


Prospective evaluation of the effect of a new co-payment for specialists consultations on actualization of referrals (2,432 patient), was examined. Actualization of the appointment, reasons for not actualizing, and sociodemographic characteristics were recorded. Actualization was 85.1% in community consultation clinics and 91.7% in hospital outpatient clinics. The main reasons for non actualization were: inability to reach the clinic (53.4%), the problem had resolved (15%), and co-payment (2%). In addition, 19.1% stated that they did not actualize a past consultant visit due to co-payment. Referring physicians noted that co-payment had some effect on their decision, especially with the elderly or lower income patients. A relatively small compulsory co-payment was not found to have a long term effect on utilization of specialists’ services.


Co-payment Exemption Consultation Health services use 


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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Daniel A. Vardy
    • 1
    • 2
  • Tami Freud
    • 2
  • Michael Sherf
    • 1
  • Ofer Spilberg
    • 3
  • Dan Goldfarb
    • 1
  • Arnon D. Cohen
    • 1
    • 2
  • Shlomo Mor-Yosef
    • 4
  • Pesach Shvartzman
    • 1
    • 2
  1. 1.Clalit Health Services, Southern districtBeer-ShevaIsrael
  2. 2.Department of Family Medicine, Siaal Research Center for Family Medicine and Primary CareBen-Gurion University of the NegevBeer-ShevaIsrael
  3. 3.Rabin Medical CenterPetach TikvaIsrael
  4. 4.Hadassah Medical OrganizationJerusalemIsrael

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