The impact of budgets for gatekeeping physicians on patient satisfaction: Evidence from fundholding

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jhealeco.2006.12.003 Byline: Mark Dusheiko (a), Hugh Gravelle (a), Ning Yu (b), Stephen Campbell (c) Keywords: Budgets; Gatekeepers; Fundholding; Patient satisfaction; Health care Abstract: Between 1991 and 1998 English general practices had the option of holding budgets for prescribing and elective secondary care. Fundholding was reintroduced in 2005. We examine the effect of fundholding on patients' satisfaction with their practice, using a cross section of 4441 patients from 60 practices in the last year of fundholding (1998). We employ instrumental variables to allow for the endogeneity of fundholding. Patients of fundholders were less satisfied with the opening hours of their practice, their GP's knowledge of their medical history, with their GP's ability to arrange tests and willingness to refer to a specialist, and were more likely to agree that their doctor was more concerned about keeping costs down. Fundholder practices performed better on a number of process measures of care, and fundholding patients were more satisfied with additional non-medical services provided by the practice. The probability that patients were overall at least very satisfied with their GP practice was 0.073 (95% CI, 0.009-0.138) smaller in fundholding practices. Author Affiliation: (a) National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York YO10 5DD, England (b) Tayside Centre for General practice, MacKenzie Building, University of Dundee, Dundee DD2 4BF, Scotland (c) National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, England Article History: Received 17 December 2004; Revised 13 March 2006; Accepted 18 December 2006