Weingarten M A, Monnickendam M S
Fam Pract. 1985 Mar;2(1):35-41. doi: 10.1093/fampra/2.1.35.
Experience accumulated during the doctors' strike of 1983 in Israel was analysed to compare the effect on the work of the family doctor of direct-charge as against pre-paid insurance arrangements, in three different settings--suburban, rural and working-class small town. The imposition of direct charges greatly reduced the consultation rate; more of the patients consulting received prescriptions, especially for antibiotics; laboratory investigation, referral and admission to hospital were unchanged, but referral for specialist consultation was reduced; the most frequently seen diagnostic categories remained respiratory diseases and undefined signs or symptoms, but pneumonia was seen much more frequently; there was no change in the proportion of follow-up visits, but house calls were more frequent. These trends were stable over the four-month period of the strike, and partial reimbursement of the fee did not change the picture significantly. The evidence did not conclusively support the hypothesis that direct charges selectively deter trivial complainers.
对1983年以色列医生罢工期间积累的经验进行了分析，以比较在三种不同环境（郊区、农村和工人阶级小镇）中，直接收费与预付保险安排对家庭医生工作的影响。直接收费的实施大大降低了会诊率；更多前来会诊的患者拿到了处方，尤其是抗生素处方；实验室检查、转诊和住院情况未变，但专科会诊转诊减少；最常见的诊断类别仍是呼吸道疾病以及不明体征或症状，但肺炎的就诊率大幅上升；随访就诊比例没有变化，但出诊更频繁。这些趋势在罢工的四个月期间保持稳定，部分费用报销并未显著改变这种情况。证据并未确凿支持直接收费会选择性地阻止轻症患者就诊这一假设。
