Skip to main content
Top
Published in: Applied Health Economics and Health Policy 5/2017

01-10-2017 | Original Research Article

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

Authors: Christian Kronborg, Line Bjørnskov Pedersen, Anders Fournaise, Christel Nøhr Kronborg

Published in: Applied Health Economics and Health Policy | Issue 5/2017

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Pauly MV. Economics of moral hazard: reply. Am Econ Rev. 1968;58(3):531–7. Pauly MV. Economics of moral hazard: reply. Am Econ Rev. 1968;58(3):531–7.
2.
go back to reference 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. 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.
3.
go back to reference Mooney G. Key issues in health economics. New York: Harvester Wheatsheaf; 1994. Mooney G. Key issues in health economics. New York: Harvester Wheatsheaf; 1994.
4.
go back to reference Pedersen KM, Christiansen T, Bech M. The Danish health care system: evolution, not revolution, in a decentralized system. Health Econ. 2005;14:S41–57.CrossRefPubMed Pedersen KM, Christiansen T, Bech M. The Danish health care system: evolution, not revolution, in a decentralized system. Health Econ. 2005;14:S41–57.CrossRefPubMed
5.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
6.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
7.
go back to reference 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. 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.
8.
go back to reference Det Økonomiske Råd. Dansk økonomi, forår 2000. Copenhagen: Det Økonomiske Råd; 2000. Det Økonomiske Råd. Dansk økonomi, forår 2000. Copenhagen: Det Økonomiske Råd; 2000.
11.
go back to reference 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.PubMed 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.PubMed
12.
go back to reference Poulsen CA. Introducing out-of-pocket payment for general practice in Denmark: feasibility and support. Health Policy. 2014;117(1):64–71.CrossRefPubMed Poulsen CA. Introducing out-of-pocket payment for general practice in Denmark: feasibility and support. Health Policy. 2014;117(1):64–71.CrossRefPubMed
13.
go back to reference Schokkaert E, Van de Voorde C. User charges. In: Glied S, Smith PC, editors. Oxford handbook of health economics. Oxford: Oxford University Press; 2011. Schokkaert E, Van de Voorde C. User charges. In: Glied S, Smith PC, editors. Oxford handbook of health economics. Oxford: Oxford University Press; 2011.
15.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
16.
go back to reference 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. 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.
go back to reference Sygesikringens Forhandlingsudvalg. Økonomisk og statistisk redegørelse for konflikten på landsoverenskomsten om almen lægegerning 1. oktober 1984 til 5. januar 1985. Amtsrådsforeningen; 1985. Sygesikringens Forhandlingsudvalg. Økonomisk og statistisk redegørelse for konflikten på landsoverenskomsten om almen lægegerning 1. oktober 1984 til 5. januar 1985. Amtsrådsforeningen; 1985.
18.
go back to reference Pedersen KM. Viden om effekten af brugerbetaling i almen praksis og lægevagten. Centre of Health Economics Research. Odense: Syddansk Universitet; 2013. Pedersen KM. Viden om effekten af brugerbetaling i almen praksis og lægevagten. Centre of Health Economics Research. Odense: Syddansk Universitet; 2013.
19.
go back to reference 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.PubMed 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.PubMed
20.
go back to reference 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. 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.
21.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
22.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
23.
go back to reference Bateman I. Economic valuation with stated preference techniques: a manual. Cheltenham: Edward Elgar; 2004. Bateman I. Economic valuation with stated preference techniques: a manual. Cheltenham: Edward Elgar; 2004.
24.
go back to reference 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.CrossRefPubMedPubMedCentral 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.CrossRefPubMedPubMedCentral
25.
go back to reference 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.CrossRef 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.CrossRef
26.
go back to reference Wooldridge JM. Introductory econometrics: a modern approach. UK: South-Western College Publishing; 2000. Wooldridge JM. Introductory econometrics: a modern approach. UK: South-Western College Publishing; 2000.
27.
go back to reference 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: http://statistikbanken.dk. Accessed 4 Nov 2016. 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: http://​statistikbanken.​dk. Accessed 4 Nov 2016.
28.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
29.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
30.
go back to reference Statistics Denmark. SYGK: contacts covered by the public health insurance by region, type of benefits, age, sex and socioeconomic status. 2016. Available from: http://statistikbanken.dk. Accessed 4 Nov 2016. Statistics Denmark. SYGK: contacts covered by the public health insurance by region, type of benefits, age, sex and socioeconomic status. 2016. Available from: http://​statistikbanken.​dk. Accessed 4 Nov 2016.
31.
go back to reference 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: http://statistikbanken.dk. Accessed 4 Nov 2016. 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: http://​statistikbanken.​dk. Accessed 4 Nov 2016.
32.
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
User Fees in General Practice: Willingness to Pay and Potential Substitution Patterns—Results from a Danish GP Patient Survey
Authors
Christian Kronborg
Line Bjørnskov Pedersen
Anders Fournaise
Christel Nøhr Kronborg
Publication date
01-10-2017
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 5/2017
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-017-0325-y

Other articles of this Issue 5/2017

Applied Health Economics and Health Policy 5/2017 Go to the issue