title: Consultation charges in Ireland deter a large proportion of patients from seeing the GP: results of a cross-sectional survey.
abstract: OBJECTIVE
  To estimate the effect of a consultation charge on the health-seeking behaviour of patients.
  
  
  METHODS
  Cross-sectional survey of patients carried out in Northern Ireland, where services are free at the point of delivery, and the Republic of Ireland, where 70% of the population are charged a consultation fee to see the general practitioner (GP).
  
  
  RESULTS
  There were 11 870 respondents to the survey (response rate 52%). In the Republic of Ireland, 18.9% of patients (4.4% of non-paying patients and 26.3% of paying patients) had a medical problem in the previous year but had not consulted the doctor because of cost; this compares with only 1.8% of patients in Northern Ireland. Because those in the Republic of Ireland on low income are entitled to free care, the effects of the consultation charge were most marked in the middle of the income distribution, with such patients being over four times as likely to have been deterred as those in the most affluent group. However, amongst paying patients, it was the poorest and those with the worst health who were most affected. Compared to the most affluent patients and those without depression, the likelihood of not having seen the GP due to cost was 6.75 (95% confidence interval [CI] 3.79, 11.09) for the poorest patients and 2.01 (95% CI 1.53, 2.52) for those with depression.
  
  
  CONCLUSIONS
  Even in countries with exemptions for the poor and more vulnerable, a consultation charge can deter a large proportion of poorer and less healthy patients from seeing their GP.
authors.affiliation: Epidemiology & Public Health, Queen's University Belfast, Royal Group of Hospitals, Belfast. d.oreilly@qub.ac.uk
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Reilly
authors.forename: Tom
authors.initials: T
authors.lastname: O'Dowd
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Galway
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.forename: Ethna
authors.initials: E
authors.lastname: Shryane
authors.forename: Keith
authors.initials: K
authors.lastname: Steele
authors.forename: Gerry
authors.initials: G
authors.lastname: Bury
authors.forename: Andrew
authors.initials: A
authors.lastname: Gilliland
authors.forename: Alan
authors.initials: A
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000191:economics*; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000191:economics; D012017:Referral and Consultation / Q000191:economics*