Munro J, Skinner J
Medical Care Research Unit, University of Sheffield.
Br J Gen Pract. 1998 Dec;48(437):1837-9.
The 1990 contract and the 1991 fundholding scheme encouraged speculation that general practitioners (GPs) may remove patients from their lists for financial reasons. Despite assertions that patient removals are increasing, little evidence exists on the number or trends in removals.
To describe the epidemiology of removals by time, place, and person, and to determine whether removals have increased in recent years.
Descriptive analysis of routine data relating to all removals of Sheffield residents from GP lists during 1991-1996.
Removal from a doctor's list was a rare event (2.4 per 1000 patients per year) that did not become more common over the period examined. Removal rates varied by age, sex, and practice, with relatively high rates among children, young women, and the over-75s. There was a significant tendency for higher removal rates in more deprived parts of the city.
Removal rates have not increased in Sheffield. The reasons for the variation in rates by age, sex, and practice are unknown. The higher rates noted in the under-fives and young women are consistent with the possibility that the 1990 target payment scheme may have increased removal rates in these age groups.
1990年的合同和1991年的基金持有计划引发了人们的猜测，即全科医生（GPs）可能出于经济原因将患者从其名单中移除。尽管有人声称患者被移除的情况在增加，但关于移除的数量或趋势的证据很少。
按时间、地点和人员描述移除的流行病学特征，并确定近年来移除情况是否有所增加。
对1991 - 1996年期间谢菲尔德居民从全科医生名单中所有移除情况的常规数据进行描述性分析。
从医生名单中移除是一个罕见事件（每年每1000名患者中有2.4例），在所研究的时间段内并未变得更加普遍。移除率因年龄、性别和诊所而异，儿童、年轻女性和75岁以上人群的移除率相对较高。该市较贫困地区的移除率有显著升高的趋势。
谢菲尔德市的移除率没有增加。年龄、性别和诊所导致移除率差异的原因尚不清楚。五岁以下儿童和年轻女性中较高的移除率与1990年的目标支付计划可能增加了这些年龄组的移除率这一可能性相符。
