European Commission - Public Health: healthindicators.org

General practitioner (GP) utilisation

Definition of indicator

Mean number of visits to general practitioner per capita per year.

Calculation (numerator, denominator)

1) Average number of contacts with a general practitioner (self-reports) per capita per year, derived from EHIS-questions on General practioner visits HC.11:

HC.11: During the past four weeks ending yesterday, that is since (date), how many times did you consult a GP (general practitioner) or family doctor on your own behalf? (0, 1, 2 etc)

2) Eurostat: the average number of patient contacts to General Practitioners (GP) (self reports from survey the Eurostat European Community Household Panel, ECHP) within a calendar year.

Additional underlying concepts

EHIS recall period of 4 weeks is not optimal for calculating number of visits per year. The introduction to EHIS questions (HC.10 and) HC.11 is: “The next set of questions is about consultations with your general practitioner or family doctor. Please include visits to your doctor’s practice as well as home visits and consultations by telephone.”

Relevant dimensions (subgroups)

Country (also region), calendar year, gender, age group, SES.

Preferred data sources

Now: Eurostat European Community Household Panel (ECHP), National HIS

In future: EHIS

Eurostat , WHO or OECD

Rationale

A basic indicator for the use of medical services. Indicator used in assessment of costs of health care and (equity of) access to health services.

Data availability, quality and periodicity

- Eurostat: The data are collected from the Eurostat European Community Household Panel (ECHP) carried out during the period 1994-2001. From 2004 onwards in EU15 Member States and 2005 onwards in the new Member States, the new EU Statistics on Income and Living Condition survey (SILC) will be used. Data available at least for 11 countries.

- OECD indicator “Doctor’s consultations” is defined as “the number of contacts with an ambulatory care physician divided by the population. Contacts in out-patient wards should be included”. But in fact, several countries record only general practitioners, others include specialists. Thus, although data are available for most countries, the figures are not comparable.

OECD Note: The number of physician contacts according to the above definition is only a crude measure of the volume of services provided, as services are added regardless of their complexities. Because in some countries the GP has much more of a gatekeeping function than in others, cross-country comparisons of GP utilisation have some limitations.

- EHIS implemented 2007-2009. Data will thus be available in the coming years (and will be pooled by Eurostat).

- WHO-HfA has an indicator “Outpatient contacts per person per year” defined as “the total number of primary health care or ambulatory care contacts divided by the population”. It does not separate GP and other outpatient visits.

References

- EHIS standard questionnaire (version of 11/2006)

- Eurostat European Community Household Panel (ECHP)

- The EUPHIX (European Union Public Health Information & Knowledge System, www.euphix.org); the Determinants of health chapter dedicates a topic on GP utilisation among Health interventions & systems / Health care utilisation

Work to do

• Decide which calculation method (and data source) to follow: Eurostat? YES
• Does Eurobarometer have a question?
• EHIS: question on when last time visited a GP (HC.10) and how many times during past 4 weeks consulted a GP (HC.11). Is 4 weeks appropriate reference period?
• HIS preferred over administrative data, as admistrative data not really comparable across countries? Yes.