Montalto M, Dunt D, Richardson J
Department of Public Health and Community Medicine, University of Melbourne.
Aust Health Rev. 1996;19(3):56-65. doi: 10.1071/ah960056a.
This study sought to compare the rate of patient throughput by community health centre general practitioners (GPs) and their private practice fee-for-service counterparts. The study group comprised 44 community health centre GPs (out of an identified 51) in 16 community health centres; the control group comprised 268 GPs. Community health centre GPs were found to have significantly fewer consultants and significantly smaller rebates than their private practice counterparts. The difference of means for consultation numbers and rebates was 30.3 per cent. The pattern was reversed in the case of rural community health centre GPs (who retain fee-for-service arrangements). Figures are uncorrected for patient status, and data relate to Medicare billing practices rather than observed activity or outcome. However, at face value they would indicate that if Australian general practice moved to a community health centre model, with predominantly salaried GPs, then patient throughput in general practice could be expected to drop. Whether these reflect the impact of incentives on throughput and, if so, whether this indicates a difference in the quality or accessibility of the service provided to patients is not certain.
本研究旨在比较社区卫生中心全科医生（GP）与私人执业按服务收费的全科医生的患者诊疗率。研究组包括16个社区卫生中心的44名社区卫生中心全科医生（在确定的51名中）；对照组包括268名全科医生。结果发现，社区卫生中心全科医生的会诊医生明显较少，回扣也明显低于私人执业的同行。会诊次数和回扣的均值差异为30.3%。农村社区卫生中心全科医生（保留按服务收费安排）的情况则相反。这些数字未根据患者状况进行校正，数据与医疗保险计费做法有关，而非观察到的活动或结果。然而，从表面看，它们表明如果澳大利亚的全科医疗转向以社区卫生中心模式为主，全科医生主要为受薪制，那么全科医疗中的患者诊疗率可能会下降。这些是否反映了激励措施对诊疗率的影响，如果是，这是否表明向患者提供的服务质量或可及性存在差异，尚不确定。
