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



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.

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  1. 1.

    Pauly MV. Economics of moral hazard: reply. Am Econ Rev. 1968;58(3):531–7.

    Google Scholar 

  2. 2.

    Zweifel P, Manning WG. Moral hazard and consumer incentives in health care. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics. Amsterdam: Elsevier; 2000. p. 410–59.

    Google Scholar 

  3. 3.

    Mooney G. Key issues in health economics. New York: Harvester Wheatsheaf; 1994.

    Google Scholar 

  4. 4.

    Pedersen KM, Christiansen T, Bech M. The Danish health care system: evolution, not revolution, in a decentralized system. Health Econ. 2005;14:S41–57.

    Article  PubMed  Google Scholar 

  5. 5.

    van Dijk CE, van den Berg B, Verheij RA, et al. Moral hazard and supplier-induced demand: empirical evidence in general practice. Health Econ. 2013;22(3):340–52.

    Article  PubMed  Google Scholar 

  6. 6.

    Schreyögg J, Grabka MM. Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Eur J Health Econ. 2010;11(3):331–41.

    Article  PubMed  Google Scholar 

  7. 7.

    Robinson R. User charges for health care. In: Mossialos E, Dixon A, Figueras J, Kutzin J, editors. Funding health care: options for Europe. Buckingham: Open University Press; 2002.

    Google Scholar 

  8. 8.

    Det Økonomiske Råd. Dansk økonomi, forår 2000. Copenhagen: Det Økonomiske Råd; 2000.

  9. 9.

    Velfærdskommissionen. Fremtidens velfærd: vores valg. Ministry of Finance; 2005. Available from: A Accessed 7 Dec 2016.

  10. 10.

    Det Etiske Råd. Etik og prioritering i sundhedsvæsenet: hvorfor er det så svært? Det Etiske Råd; 2013. Available from: Accessed 7 Dec 2016.

  11. 11.

    Manning WG, Newhouse JP, Duan N, et al. Health-insurance and the demand for medical-care: evidence from a randomized experiment. Am Econ Rev. 1987;77(3):251–77.

    CAS  PubMed  Google Scholar 

  12. 12.

    Poulsen CA. Introducing out-of-pocket payment for general practice in Denmark: feasibility and support. Health Policy. 2014;117(1):64–71.

    Article  PubMed  Google Scholar 

  13. 13.

    Schokkaert E, Van de Voorde C. User charges. In: Glied S, Smith PC, editors. Oxford handbook of health economics. Oxford: Oxford University Press; 2011.

    Google Scholar 

  14. 14.

    Aron-Dine A, Einav L, Finkelstein A. The RAND health insurance experiment, three decades later. J Econ Perspect. 2013;27(1):197–222.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Layte R, Nolan A, McGee H, O’Hanlon A. Do consultation charges deter general practitioner use among older people? A natural experiment. Soc Sci Med. 2009;68(8):1432–8.

    Article  PubMed  Google Scholar 

  16. 16.

    Pedersen S, Pedersen C, Damgaard Pedersen NE, Pedersen PA. Den overenskomstløse periode 1.10.1984-6.1.1985 i en almen praksis. [In Danish: The contract-free period at a Danish general practice from 1 October 1984 to 6 January 1985]. Ugeskrift for Laeger. 1988;150(51):3190–5.

  17. 17.

    Sygesikringens Forhandlingsudvalg. Økonomisk og statistisk redegørelse for konflikten på landsoverenskomsten om almen lægegerning 1. oktober 1984 til 5. januar 1985. Amtsrådsforeningen; 1985.

  18. 18.

    Pedersen KM. Viden om effekten af brugerbetaling i almen praksis og lægevagten. Centre of Health Economics Research. Odense: Syddansk Universitet; 2013.

  19. 19.

    Wolthers OD, Stellfeld M. Skadestuehenvendelser i en periode med patientbetaling for lægeydelser i almen praksis. [In Danish: Consultations in a casualty department during a period when direct payment was required for consultation in general practice]. Ugeskr Laeger. 1986;148(16):975–8.

    CAS  PubMed  Google Scholar 

  20. 20.

    Pedersen LB, Jarbøl DE. Præferencer for brugerbetaling i almen praksis og nedsættelse i yderkantsområder [In Danish: Preferences for user fees in general practice and the establishment of general practitioners in rural areas]. Ugeskr Laeger. 2012;174(3):2940–3.

    Google Scholar 

  21. 21.

    Pedersen KM, Andersen JS, Søndergaard J. General practice and primary health care in Denmark. J Am Board Fam Med. 2012;25(Suppl. 1):S34–8.

    Article  PubMed  Google Scholar 

  22. 22.

    Christensen A, Søgaard R. Determinants for employer-paid health insurance coverage: a population-based study of the Danish labour force. Scand J Public Health. 2013;41:597–603.

    Article  PubMed  Google Scholar 

  23. 23.

    Bateman I. Economic valuation with stated preference techniques: a manual. Cheltenham: Edward Elgar; 2004.

    Google Scholar 

  24. 24.

    Jonas DE, Russell LB, Chou J, Pignone M. Willingness-to-pay to avoid the time spent and discomfort associated with screening colonoscopy. Health Econ. 2010;19(10):1193–211.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Donaldson C, Jones AM, Mapp TJ, Olson JA. Limited dependent variables in willingness to pay studies: applications in health care. Appl Econ. 1998;30(5):667–77.

    Article  Google Scholar 

  26. 26.

    Wooldridge JM. Introductory econometrics: a modern approach. UK: South-Western College Publishing; 2000.

    Google Scholar 

  27. 27.

    Statistics Denmark. SYGP: number of persons with contacts covered by public health insurance by region, type of benefits, age, sex and socioeconomic status. 2016. Available from: Accessed 4 Nov 2016.

  28. 28.

    Donfouet HPP, Mahieu PA, Malin E. Using respondents’ uncertainty scores to mitigate hypothetical bias in community-based health insurance studies. Eur J Health Econ. 2013;14(2):277–85.

    Article  PubMed  Google Scholar 

  29. 29.

    Ozdemir S, Johnson FR, Hauber AB. Hypothetical bias, cheap talk, and stated willingness to pay for health care. J Health Econ. 2009;28(4):894–901.

    Article  PubMed  Google Scholar 

  30. 30.

    Statistics Denmark. SYGK: contacts covered by the public health insurance by region, type of benefits, age, sex and socioeconomic status. 2016. Available from: Accessed 4 Nov 2016.

  31. 31.

    Statistics Denmark. FOLK1: population at the first day of the quarter by municipality, sex, age, marital status, ancestry, country of origin and citizenship. 2014. Available from: Accessed 4 Nov 2016.

  32. 32.

    Holmes TP, Kramer RA. An independent sample test of yea-saying and starting point bias in dichotomous-choice contingent valuation. J Environ Econ Manag. 1995;29(1):121–32.

    Article  Google Scholar 

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Author information




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


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.

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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).

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