Gatekeeping and referral of patients holding private health insurance: a survey among general practitioners in Norway.

HEALTH services accessibility; CROSS-sectional method; RESEARCH funding; GENERAL practitioners; HEALTH insurance; MULTIPLE regression analysis; PHYSICIANS' attitudes; PRIVATE sector; DECISION making in clinical medicine; REFUSAL to treat; DESCRIPTIVE statistics; OVERTREATMENT; ODDS ratio; HEALTH equity; CONFIDENCE intervals; PSYCHOSOCIAL factors; MEDICAL referrals

Objective: Private health insurance is becoming more common in Norway. The aim of this study was to investigate GPs' opinions on private health insurance, and their experiences from consultations where health insurance can affect decisions about referring. Design: A web based cross-sectional survey. Setting: Norwegian general practice. Subjects: All GPs in Norway were in 2019 invited to participate in an online survey. Main outcome measures: The GPs' opinions and experiences regarding health insurance were reported as proportions. Multiple logistic regression was used to test associations between how frequently GPs refer patients without further considerations and variables concerning their characteristics, opinions, and experiences. Results: Of 1,309 GPs (response rate 27%), 93% stated that private health insurance raises the risk of overtreatment and 90% considered such insurance to contribute to inequality in health. Frequently being pressured to refer in the absence of a medical indication was reported by 42%. Moreover, 28% often or always chose to refer patients without further consideration, and this was associated with perceptions of pressure with an adjusted odds ratio (AOR) of 3.80, 95% confidence interval (CI) 2.73–5.29, and unpleasant reactions from patients following refusals (AOR 1.63, 95% CI 1.14–2.33). Conclusion: Although most participating GPs associated private health insurance with overtreatment and inequality in health, more than one in four choose to refer without further consideration. GPs' experience of pressure to refer and negative reactions from patients when they consider referrals not to be medically indicated, raises the risk of medical overuse for patients holding private health insurance. KEY POINTS: Although most GPs had negative opinions regarding private health insurance, more than one quarter frequently referred insurance holders without further considerations. Perceived pressure and negative reactions from patients were associated with accommodating requests rather than acting as a gatekeeper. Private health insurance challenges the gatekeeping role of GPs in Norway and raises the risk of medical overuse. [ABSTRACT FROM AUTHOR]

Copyright of Scandinavian Journal of Primary Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)