Applied Health Economics and Health Policy

, Volume 15, Issue 5, pp 615–624 | Cite as

User Fees in General Practice: Willingness to Pay and Potential Substitution Patterns—Results from a Danish GP Patient Survey

  • Christian KronborgEmail author
  • Line Bjørnskov Pedersen
  • Anders Fournaise
  • Christel Nøhr Kronborg
Original Research Article



Increases in public expenditures to general practitioner (GP) services and specialist care have spurred debate over whether to implement user fees for healthcare services such as GP consultations in Denmark.


The objective of this study was to examine Danish patients’ attitudes towards user fees and their willingness to pay (WTP) for a consultation, and to investigate how user charges may impact patients’ behaviour.


A questionnaire survey was conducted in a GP clinic.


A total of 343 individual persons answered the questionnaire. One hundred and seventy (50%) persons were not willing to pay for a consultation. Among patients reporting positive WTP values, the mean WTP was 137 (standard deviation 140) Danish kroner (DKK). Patients who were 65 years old or older were more likely to be willing to pay for a GP consultation than patients under the age of 65 years. Furthermore, patients with a personal annual income of more than 200,000 DKK were more likely to be willing to pay for a consultation than other income groups. With respect to patients with a positive WTP value, their own assessment of the seriousness of the consultation and their self-assessed health influenced the amount they would be willing to pay. Finally, we observed a stated willingness to substitute GP consultations with alternatives that are free of charge.


About half of the patients with an appointment for a GP consultation are willing to pay for the consultation. User charges may potentially influence the patients’ behaviour. NCT01784731.


Moral Hazard User Charge Payment Card Hypothetical Bias General Practitioner Visit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author contributions

All authors contributed to the study conception and design, development of the questionnaire, data analysis, drafting and revision of the article, and have approved the final version of the article.

Compliance with Ethical Standards


The study was financed by the University of Southern Denmark.

Conflict of interest

Three of the authors (Christian Kronborg, Line Bjørnskov Pedersen and Anders Fournaise) are employees at the University of Southern Denmark. Christel Nøhr Kronborg is the co-owner of the clinic in which the data for the study were collected.

Ethics approval

The Regional Committees on Health Research Ethics for Southern Denmark did not find that the project needed permission from their committee, cf. section 14, subsection 1 in the Act on Research Ethics Review of Health Research Projects (in Danish: Lov om videnskabsetisk behandling af sundhedsvidenskabelige forskningsprojekter, Lov nr. 593 af 14/06/2011, The study was approved by the Danish Data Agency (2013-41-1429). The study was registered at (NCT01784731).

Consent to participate

All participants were informed about the objective of the study, that it was voluntary to participate and that they could withdraw their consent to participate at any time. All participants provided written informed consent.

Supplementary material

40258_2017_325_MOESM1_ESM.docx (97 kb)
Supplementary material 1 (DOCX 96 kb)
40258_2017_325_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 14 kb)
40258_2017_325_MOESM3_ESM.docx (22 kb)
Supplementary material 3 (DOCX 21 kb)


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Business and EconomicsUniversity of Southern Denmark, Centre of Health Economics Research (COHERE)Odense MDenmark
  2. 2.Research Unit for General PracticeUniversity of Southern DenmarkOdense CDenmark
  3. 3.Department of Cross-sectorial CollaborationRegion of Southern DenmarkVejleDenmark
  4. 4.Department of Geriatric MedicineOdense University HospitalOdense CDenmark
  5. 5.Lægerne NyenstadNyborgDenmark

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