title: User Fees in General Practice: Willingness to Pay and Potential Substitution Patterns-Results from a Danish GP Patient Survey.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Business and Economics, University of Southern Denmark, Centre of Health Economics Research (COHERE), Campusvej 55, 5230, Odense M, Denmark. cka@sam.sdu.dk.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0001-9627-1419
authors.initials: C
authors.lastname: Kronborg
authors.affiliation: Department of Business and Economics, University of Southern Denmark, Centre of Health Economics Research (COHERE), Campusvej 55, 5230, Odense M, Denmark.|Research Unit for General Practice, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark.
authors.forename: Line Bjørnskov
authors.initials: LB
authors.lastname: Pedersen
authors.affiliation: Department of Cross-sectorial Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark.|Department of Geriatric Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Fournaise
authors.affiliation: Lægerne Nyenstad, Nyenstad 31, 5800, Nyborg, Denmark.
authors.forename: Christel Nøhr
authors.initials: CN
authors.lastname: Kronborg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003718:Denmark; D005249:Fees and Charges / Q000706:statistics & numerical data*; D005260:Female; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data*; D058006:General Practice / Q000191:economics* / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: General Practitioner Visit; Hypothetical Bias; Moral Hazard; Payment Card; User Charge