Effect of the remuneration system on the general practitioner's choice between surgery consultations and home visits.
OBJECTIVE
To assess the influence of the remuneration system, municipality, doctor, and patient characteristics on general practitioners' choices between surgery and home visits.


METHODS
Prospective registration of patient contacts during one week for 116 general practitioners (GPs).


METHODS
General practice in rural areas of northern Norway.


METHODS
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.


CONCLUSIONS
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.
Kristiansen
I S
IS
Centre for Health Economics, University of York.
Holtedahl
K
K
D000208:Acute Disease; D000367:Age Factors; D002755:Choice Behavior; D005194:Family Practice / Q000191:economics*; D005260:Female; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009664:Norway; D009819:Office Visits / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012424:Rural Population; D012456:Salaries and Fringe Benefits; D012737:Sex Factors