Effect of the remuneration system on the general practitioner's choice between surgery consultations and home visits

Abstract

Objective - To assess the influence of the remuneration system, municipality, doctor, and patient characteristics on general practitioners' choices between surgery and home visits. Design - Prospective registration of patient contacts during one week for 116 general practitioners (GPs). Setting - General practice in rural areas of northern Norway. Main outcome measure - Type of GP visit (surgery v home visit). Results - The estimated home visit rate was 0.14 per person per year. About 7% (range 0.39%) of consultations were home visits. Using multilevel analysis it was found that doctors paid on a 'fee for service' basis tended to choose home visits more often than salaried doctors (adjusted odds ratio 1.90, 99% confidence interval 0.98, 3.69), but this was statistically significant for 'scheduled' visits only (adjusted OR 4.50, 99% CI 1.67, 12.08). Patients who were older, male, and who were living in areas well served by doctors were more likely to receive home visits. Conclusion - In the choice between home visits and surgery consultations, doctors seem to be influenced by the nature of the remuneration when the patient's problem is not acute. Although home visiting is a function of tradition, culture, and organisational characteristics, the study indicates that financial incentives may be used to change behaviour and encourage home visiting.