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.
Similar content being viewed by others
Notes
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
Department of Health (2012) Future health a strategic framework for reform of the health service 2012–2015. Department of Health, Dublin
Kroneman M. Paying General Practitioners in Europe. NIVEL, 2011
Duran A, Lara JL, van Waveren M (2006) Health Systems in Transition, Spain: Health System Review: European Observatory on Health Care Systems
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
Rhys G, Beerstecher HJ, Morgan CL (2010) Primary care capitation payments in the UK. An observational study. BMC Health Services Res 10(1):1
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
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
Lamers LM, Vliet R (2003) Health-based risk adjustment Improving the pharmacy-based cost group. Eur J Health Econ 4(2):107–114
McElroy B (2006) Risk-adjustment of prescription drug expenditure in Ireland. Department of Economics, University College Cork, Cork
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
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
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
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
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
MRBI/Department of Health (2015) Healthy Ireland survey 2015: summary of findings. Department of Health, Dublin
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
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
Irish Social Science Data Archive. Available from: https://www.ucd.ie/issda/ Accessed from 30/11/2016
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
CSO. http://www.cso.ie/en/releasesandpublications/ep/p-ihs/irishhealthsurvey2015/ov/ Cork: CSO; 2016 [30/11/2016]
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
CSO (2012) Household Budget Survey. Cork: Central Statistics Office
Gorecki P (2016) The impact of free GP care on the utilisation of GP Services in Ireland: An evaluation of different approaches. ESRI, WP534
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
Evans C, Crawford B (1999) Patient self-reports in pharmacoeconomic studies. Pharmacoeconomics. 15(3):241–256
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
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
CSO (2002) Quarterly National Household Survey: Health Third Quarter 2001. Cork: Central Statistics Office
Eurostat (2015) http://ec.europa.eu/eurostat/web/gdp-and-beyond/quality-of-life/median-income Acessed from 11/11/2015
O’Shea E (1997) Male mortality differentials by socio-economic group in Ireland. Soc Sci Med 45(6):803–809
Layte R, Nolan A (2013) Socioeconomic differentials in male mortality in Ireland: 1984-2008. Working Paper, The Economic and Social Research Institute (ESRI), Dublin
Department of Health (2013) Healthy Ireland: a framework for improved health and wellbeing 2013-2025. Department of Health, Dublin
General Medical Services (Payments) Board (2002) General Medical Services (Payments) Board Annual Report. GMS (Payments) Board, Dublin
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-016-1548-x