Does socioeconomic status of list populations affect GP practice? A register-based study of 2201 Norwegian GPs

Abstract

Background: Mortality and morbidity rates differ markedly across social strata, resulting in different needs for health services. The utilization of GP services may be higher in groups with lower socioeconomic status (SES), although findings differ when taking health needs into account.Objectives: The aim of this study was to assess the association between the SES of list populations and the characteristics of GP practices, consultation rates, and income per patient in a fee-for-service financing model.Method: A cross-sectional register-based study, including all Norwegian specialist GPs practising in 2008. After grouping GP lists into five levels based on a constructed index of SES, associations between SES and GP practice characteristics were analysed by analysis of variance and linear regression.Results: GP lists with the lowest SES had higher consultation rates (regression coefficient, 0.31; P < 0.001) and a higher total fee-for-service (regression coefficient, 104; P < 0.001) than lists with the highest SES. Laboratory use in consultations was less frequent in the lowest SES group (regression coefficient, –3.1; P < 0.001). No differences were found in the frequency of long consultations or fee-for-service per consultation. The frequency of multidisciplinary meetings was 2.5 times higher in the lowest SES group compared to the highest SES group.Conclusion: The findings indicate a markedly higher utilization of GP services in list populations with a lower SES, compensated by a higher annual GP income per patient. However, consultation characteristics, such as time spent with patients and use of laboratory tests, did not increase with lower SES lists.