Empirically derived weights for GMS capitation payments to General Practitioners

Abstract

Aim

Unlike other weighted capitation schemes used in Irish health service financing and in health systems internationally, the GMS capitation payments scheme for General Practitioners lacks transparency in both the data used and the model employed. In this study, evidence-based weights were generated and compared to current payment weights.

Methods

Four datasets on GP utilisation were interrogated.

Results

Evidence-based weights indicated that over 70s had higher payments per consultation than other groups. Considerable intra-age band differences in capitation payment were detected.

Discussion and conclusion

The results suggest that there is a need for a comprehensive review of the current payments system. Current age bands should be narrowed. The implications for the efficiency and equity of general practice in Ireland are discussed.

This is a preview of subscription content, log in to check access.

Notes

  1. 1.

    Although beyond the scope of this study due to data limitations, under 6 s, who are universally entitled to visit GPs for free (at point of contact) since 2015, received a capitation payment of €125 per annum. Before this change, the drop in capitation payment for those who remain on the GMS scheme at age 6 was €30.17, a 41% fall. Since 2015, the fall is at least €81.47, a 65% fall.

References

  1. 1.

    Department of Health (2012) Future health a strategic framework for reform of the health service 2012–2015. Department of Health, Dublin

    Google Scholar 

  2. 2.

    Kroneman M. Paying General Practitioners in Europe. NIVEL, 2011

  3. 3.

    Duran A, Lara JL, van Waveren M (2006) Health Systems in Transition, Spain: Health System Review: European Observatory on Health Care Systems

  4. 4.

    Schäfer W, Kroneman M, Boerma W, Berg M, Westert G, Devillé W et al (2010) The Netherlands: health system review. Health Syst Trans 12(1):xxvii, 1–228

  5. 5.

    Rhys G, Beerstecher HJ, Morgan CL (2010) Primary care capitation payments in the UK. An observational study. BMC Health Services Res 10(1):1

    Article  Google Scholar 

  6. 6.

    Sibley LM, Glazier RH (2012) Evaluation of the equity of age–sex adjusted primary care capitation payments in Ontario, Canada. Health Policy 104(2):186–192

    Article  PubMed  Google Scholar 

  7. 7.

    Van de ven WPMM, Ellis RP (2000) Risk adjustment in competitive health plan markets. In: Culyer AJNJP (ed) Handbook of health economics. 1: Elsevier, pp 755–845

  8. 8.

    Lamers LM, Vliet R (2003) Health-based risk adjustment Improving the pharmacy-based cost group. Eur J Health Econ 4(2):107–114

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    McElroy B (2006) Risk-adjustment of prescription drug expenditure in Ireland. Department of Economics, University College Cork, Cork

    Google Scholar 

  10. 10.

    Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P et al (2011) The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract 28(5):516–523

    Article  PubMed  Google Scholar 

  11. 11.

    Molony D, Beame C, Behan W, Crowley J, Dennehy T, Quinlan M et al (2016) 70,489 primary care encounters: retrospective analysis of morbidity at a primary care centre in Ireland. Ir J Med Sci 185(4):805–811

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Salisbury C, Procter S, Stewart K, Bowen L, Purdy S, Ridd M et al (2013) The content of general practice consultations: cross-sectional study based on video recordings. Br J Gen Pract 63(616):e751–e759

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Behan B, Molony DD, Beame C, Cullen W (2013) Are Irish adult general practice consultation rates as low as official records suggest? A cross sectional study at six general practices. Ir Med J 106:297–299

    CAS  PubMed  Google Scholar 

  14. 14.

    Quarterly National Household Survey: Health Status and Health Service Utilisation. Central Statistics Office. 2011. http://www.cso.ie/en/qnhs/releasesandpublications/qnhs-specialmodules/. Accessed from 11/11/15

  15. 15.

    MRBI/Department of Health (2015) Healthy Ireland survey 2015: summary of findings. Department of Health, Dublin

    Google Scholar 

  16. 16.

    Barrett A BH, Cronin H, Hickey A, Kamiya Y, Kenny RA, Layte R, Maty S, McGee H, Morgan K, Mosca I, Normand C, O’Regan C, O’ Sullivan V, Savva G, Sofroniou N, Timonen V, Whelan B (2011) Fifty plus in Ireland 2011: First results from The Irish Longitudinal Study on Ageing (TILDA). Trinity College Dublin, Dublin

  17. 17.

    Kenny RA, Whelan BJ, Cronin H, Kamiya Y, Kearney P, O’Regan C et al (2010) The design of the Irish longitudinal study on ageing. Trinity College Dublin, Dublin

    Google Scholar 

  18. 18.

    Irish Social Science Data Archive. Available from: https://www.ucd.ie/issda/ Accessed from 30/11/2016

  19. 19.

    Harcourt S, Edwards D, Fleming D, Smith R, Smith G (2004) How representative is the population covered by the RCGP spotter practice scheme? Using Geographical Information Systems to assess. J Publ Health 26(1):88–94

    CAS  Article  Google Scholar 

  20. 20.

    CSO. http://www.cso.ie/en/releasesandpublications/ep/p-ihs/irishhealthsurvey2015/ov/ Cork: CSO; 2016 [30/11/2016]

  21. 21.

    Quail A, Williams J, McCrory C, Murray A, Thornton M (2011) A Summary Guide to Wave 1 of the Infant Cohort (at 9 months) of Growing up in Ireland. Economic and Social Research Institute, Dublin

    Google Scholar 

  22. 22.

    CSO (2012) Household Budget Survey. Cork: Central Statistics Office

  23. 23.

    Gorecki P (2016) The impact of free GP care on the utilisation of GP Services in Ireland: An evaluation of different approaches. ESRI, WP534

  24. 24.

    Petrou S, Murray L, Cooper P, Davidson LL (2002) The accuracy of self-reported healthcare resource utilisation in health economic studiess. Int J Technol Assess Health Care 18(03):705–710

    Article  PubMed  Google Scholar 

  25. 25.

    Evans C, Crawford B (1999) Patient self-reports in pharmacoeconomic studies. Pharmacoeconomics. 15(3):241–256

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Kjellsson G, Clarke P, Gerdtham U-G (2014) Forgetting to remember or remembering to forget: a study of the recall period length in health care survey questions. J Health Econ 35:34–46

    Article  PubMed  Google Scholar 

  27. 27.

    Eurostat. Eurostat Statistics Explained. Available from: http://ec.europa.eu/eurostat/statistics-explained/index.php/European_health_interview_survey_-_methodology Accessed from 11/11/2015

  28. 28.

    CSO (2002) Quarterly National Household Survey: Health Third Quarter 2001. Cork: Central Statistics Office

  29. 29.

    Eurostat (2015) http://ec.europa.eu/eurostat/web/gdp-and-beyond/quality-of-life/median-income Acessed from 11/11/2015

  30. 30.

    O’Shea E (1997) Male mortality differentials by socio-economic group in Ireland. Soc Sci Med 45(6):803–809

    Article  PubMed  Google Scholar 

  31. 31.

    Layte R, Nolan A (2013) Socioeconomic differentials in male mortality in Ireland: 1984-2008. Working Paper, The Economic and Social Research Institute (ESRI), Dublin

  32. 32.

    Department of Health (2013) Healthy Ireland: a framework for improved health and wellbeing 2013-2025. Department of Health, Dublin

    Google Scholar 

  33. 33.

    General Medical Services (Payments) Board (2002) General Medical Services (Payments) Board Annual Report. GMS (Payments) Board, Dublin

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to B. McElroy.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

McElroy, B. Empirically derived weights for GMS capitation payments to General Practitioners. Ir J Med Sci 186, 471–476 (2017). https://doi.org/10.1007/s11845-016-1548-x

Download citation

Keywords

  • Weighted capitation
  • General Medical Services Scheme
  • General practice
  • Health care financing