Consultations with doctors

Consultations with doctors are, for most people, the most frequent contacts with health services. These consultations can take place either in doctors’ offices or clinics, in hospital outpatient departments or, in some cases, in patients’ own homes.

In 2016, the number of doctor consultations per person per year was highest in the Slovak Republic, the Czech Republic, Hungary and Germany, with 10 consultations or more per year. It is lowest in Sweden, Finland and Denmark with less than 5 consultations per person per year (Figure 7.15). The EU average is 7.5 consultations per person per year, with most countries reporting 5 to 8 visits. Some differences in health service delivery and payment methods can explain some of the variations across countries. In Sweden and Finland, the low number of doctor consultations can be explained partly by the fact that nurses and other health professionals play an important role in primary care centres, lessening the need for consultations with doctors (Maier et al., 2017). Some countries which pay their doctors mainly by fee-for-service (e.g. the Slovak Republic and the Czech Republic) tend to have higher consultation rates than other countries where doctors are mainly paid by salaries or capitation.

The estimated number of consultations per doctor is highest in Hungary, the Slovak Republic, Poland and the Czech Republic, with more than 3 000 consultations per doctor per year. It is lowest in Sweden, Denmark, Austria and Finland, with less than 1 500 consultations per doctor per year (Figure 7.16). This indicator should not be taken as a measure of doctors’ productivity, since consultations can vary in length and effectiveness, and also because it excludes the services doctors deliver for hospital inpatients and other tasks. The duration of consultations with a primary care doctor in Sweden, as reported by doctors themselves, tends to be longer than in other countries such as the Netherlands and Germany (Commonwealth Fund, 2015). However, from a patient’s perspective, a lower proportion of patients in Sweden report that their primary care doctors spent enough time with them in consultation (see indicator on Patient experience in Chapter 6).

Looking at trends over time in the estimated number of consultations per doctor per year, the number has decreased at least slightly since 2000 in Sweden, Denmark, Austria and France, as the number of doctors has increased more rapidly than the number of consultations, whereas it has remained relatively stable in Germany and has increased in Poland but mainly between 2000 and 2008 (Figure 7.17).

Definition and comparability

Consultations with doctors refer to the number of contacts with physicians, including both generalists and specialists. There are variations across countries in the coverage of different types of consultations, notably in outpatient departments of hospitals. The data come mainly from administrative sources, although in some countries (Ireland, Italy, the Netherlands, Spain and Switzerland) the data come from health interview surveys. Data from administrative sources tend to be higher than those from surveys because of problems with recall and non-response rates and also because the surveys used only cover the adult population, leading to an under-estimation.

In Hungary, the data include consultations for diagnostic exams, such as CT and MRI scans (resulting in an over-estimation). The data for the Netherlands exclude contacts for maternal and child care. In Germany, the data include only the number of cases of physicians’ treatment according to reimbursement regulations under the Social Health Insurance Scheme (a case only counts the first contact over a three-month period, even if the patient consults a doctor more often, leading to an under-estimation). Telephone contacts are included in a few countries (e.g. Spain).

References

Commonwealth Fund (2015), International Health Policy Survey of Primary Care Doctors, New York.

Maier, C. et al. (2017), “Nurses in Advanced Roles in Primary Care: Policy Levers for Implementation”, OECD Health Working Papers, No. 98, OECD Publishing, Paris, https://doi.org/10.1787/a8756593-en.

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