To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the NHS reforms in April 1991.
Design-Prospective collection of data on general practitioners'referrals to specialist outpatient clinics between June 1990 and January 1994 and detailed comparisons of three phases-October 1990 to March 1991 (phase 1), October 1991 to March 1992 (phase 2), and October 1993 to January 1994 (phase 3).
Setting-10 first wave fundholding practices and six non-fundholding practices in the Oxford region.
Subjects-Patients referred to consultant outpatient clinics.
NHS referral rates increased in fundholding practices in phase 2 and phase 3 of the study by 8.1/1000 patients a year (95% confidence interval 5.7 to 10.5), an increase of 7.5% from phase 1 (107.3/1000) to phase 3 (115.4/1000).
Non-fundholders'rates increased significantly, by 25.3/1000 patients (22.5-28.1), an increase of 26.6% from phase 1 (95.0/1000) to phase 3 (120.3/1000).
Conclusions-No evidence existed that budgetary pressures caused first wave fundholders to reduce referral rates, although the method of budget allocation may have encouraged general practitioners to inflate their referral rates in the preparatory year.
Despite investment in new practice based facilities, no evidence yet exists that fundholding encourages a shift away from specialist care.
Mots-clés Pascal : Homme, Etude comparative, Médecin généraliste, Spécialité médicale, Ambulatoire, Economie santé, Royaume Uni, Rentier, Europe
Mots-clés Pascal anglais : Human, Comparative study, General practitioner, Medical specialty, Ambulatory, Health economy, United Kingdom, Europe
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0000512
Code Inist : 002B30A01C. Création : 01/03/1996.