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

Abstract

Background

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.

Objective

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.

Methods

A questionnaire survey was conducted in a GP clinic.

Results

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.

Conclusion

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.

ClinicalTrials.gov NCT01784731.

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Author information

Affiliations

Authors

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.

Corresponding author

Correspondence to Christian Kronborg.

Ethics declarations

Funding

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, http://www.retsinformation.dk). The study was approved by the Danish Data Agency (2013-41-1429). The study was registered at ClinicalTrials.gov (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.

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Kronborg, C., Pedersen, L.B., Fournaise, A. et al. User Fees in General Practice: Willingness to Pay and Potential Substitution Patterns—Results from a Danish GP Patient Survey. Appl Health Econ Health Policy 15, 615–624 (2017). https://doi.org/10.1007/s40258-017-0325-y

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Keywords

  • Moral Hazard
  • User Charge
  • Payment Card
  • Hypothetical Bias
  • General Practitioner Visit