Self-referral and self-payment in Danish primary care.

This study aims at characterizing the group of people who want to have the right to consult any general practitioner or practising specialist without referral on condition of part self-payment, as opposed to the group of people who choose to be registered with a general practice that offers free services but controls further access to the health care system. All adults or a 10% sample of those listed in nationwide Danish registers were examined cross-sectionally for social and demographic factors and utilization of primary and secondary health care. A minority, which totals 3% of the population, chose free choice of doctor and part self-payment. On average, this group is older and has a higher income. Its mortality and its utilization of general practice and hospital services are lower, and its use of practising specialists is higher, than the majority. Among the persons who chose free choice and self-payment, the pattern of utilization is more likely to be due to a wish for free choice and for specialized medical care than to high morbidity. Dissatisfaction caused by restrictions on self-referral to specialists can be met by offering an option of a parallel system of free choice of doctor on condition of part self-payment.

[Epidemiologic study of persons having group 2 insurance in Denmark. 1. Historical development, social and demographic differences between health insurance groups 1 and 2]. / En epidemiologisk undersøgelse af de gruppe 2 sikrede i Danmark. 1. Den historiske udvikling. Sociale og demografiske forskelle imellem sygesikringsgruppe 1 og 2.

The majority of adults in Denmark can choose between the forms of health insurance 1 and 2. Persons insured in Group 2, on payment of a premium, obtain certain perquisites as compared with Group 1, primarily they may consult general practitioners and specialists of their own choice. Since the introduction of the Health Insurance Law in 1976, the number of persons insured in Group 2 has decreased to 3.8% of those insured in 1988. More than 3/4 of these have been insured in Group 2 since 1976. The number of new group 2 insured persons has remained relatively stable at about 3,000 persons per annum. The average age in Group 2 is 58.3 years as compared with 45.0 years in Group 1. 60% live in the region of the capital. The number of economically and socially well established persons in Group 2 is markedly higher than in Group 1, particularly in the higher age groups where the mortality in Group 2 insured persons is considerably lower than in Group 1 insured persons.

[Epidemiologic study of persons having group 2 insurance in Denmark. 2. Utilization of the health services among persons insured in groups 1 and 2]. / En epidemiologisk undersøgelse af de gruppe 2 sikrede i Danmark. 2. Brug af sundhedsvaesenet blandt personer i sygesikringens gruppe 1 og 2.

Persons insured in Group 2 constitute only approximately 4% of the total number of persons insured. In contrast to the approximately 96% of the population insured in Group 1, persons insured in Group 2 are ensured free choice of general practitioner and practising specialists from time to time on payment of partial payment of the doctor's bill. Group 2 insured persons make less use of assistance from the general practitioner than persons in Group 1. On the other hand, persons in Group 2 make much more use of assistance from practising specialists. Persons in Group 2 thus substitute specialist help for help from the general practitioner. This holds particularly true for the specialties gynaecology and medicine. An age-subdivided analysis of the differences between the utilization of hospital services by the two insurance groups shows that persons insured in Group 2 have lower rates of hospitalization and briefer periods of hospitalization than persons insured in Group 1. A review of the utilization of health services by the two health insurance groups supports the theory that persons in insurance Group 2 are, on the whole, relatively healthy persons with a relatively high demand for the level of service of health treatment.

[Epidemiologic study of persons having group 2 insurance in Denmark. 3. A questionnaire study. Attitudes and knowledge of persons insured in group 2 concerning their insurance]. / En epidemiologisk undersøgelse af de gruppe 2 sikrede i Danmark. 3. En spørgeskemaundersøgelse. De gruppe 2 sikredes viden om og syn på sikringsgruppe 2.

A questionnaire investigation among established persons insured in Group 2 and persons who have recently been transferred from Group 1 to Group 2 or vice versa shows that all three groups find that there are considerable advantages in insurance in Group 2. In particular, the right to free choice of general practitioner is emphasized. Under the present arrangement this is associated with geographic and temporal restrictions. In addition, it is regarded as an advantage to be able to change one's doctor (including specialist) from time to time. Approximately 1/3 emphasize that their way through the health system is easier in Group 2 and that they are treated more kindly. The reason for changing from Group 2 to Group 1 was mainly of economical nature. Where a number of persons were concerned, this was associated with retiral. Information about the health of this group also suggest that deterioration in health may also play a part in their choice. Nevertheless, the advantages of Group 2 insurance were not contested. The results of a series of investigations suggest that new Group 2 insured persons are considerably different from the established members of this group. This group consists mainly of young women. The transfer to insurance Group 2 was motivated mainly by definite dissatisfaction and where a number of these were concerned the change was merely temporary. It is concluded that the Group 2 form of health insurance has assumed new perspectives and forms of employment.