title: A co-payment for consultant services: primary care physicians' referral actualization.
abstract: Prospective evaluation of the effect of a new copayment for specialists consultations on actualization of referrals (2,432 patient), was examined. Actualization of the appointment, reasons for not actualizing, and sociodemographic characteristics were recorded. Actualization was 85.1% in community consultation clinics and 91.7% in hospital outpatient clinics. The main reasons for non actualization were: inability to reach the clinic (53.4%), the problem had resolved (15%), and co-payment (2%). In addition, 19.1% stated that they did not actualize a past consultant visit due to co-payment. Referring physicians noted that co-payment had some effect on their decision, especially with the elderly or lower income patients. A relatively small compulsory co-payment was not found to have a long term effect on utilization of specialists' services.
authors.affiliation: Clalit Health Services, Southern district, POB 616, Beer-Sheva 84105, Israel. dvardy@bgu.ac.il
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Vardy
authors.forename: Tami
authors.initials: T
authors.lastname: Freud
authors.forename: Michael
authors.initials: M
authors.lastname: Sherf
authors.forename: Ofer
authors.initials: O
authors.lastname: Spilberg
authors.forename: Dan
authors.initials: D
authors.lastname: Goldfarb
authors.forename: Arnon D
authors.initials: AD
authors.lastname: Cohen
authors.forename: Shlomo
authors.initials: S
authors.lastname: Mor-Yosef
authors.forename: Pesach
authors.initials: P
authors.lastname: Shvartzman
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D017047:Cost Sharing; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010349:Patient Compliance; D010821:Physicians, Family; D012017:Referral and Consultation