EFFECT OF THE REMUNERATION SYSTEM ON THE GENERAL-PRACTITIONERS CHOICEBETWEEN SURGERY CONSULTATIONS AND HOME VISITS

Objective-To assess the influence of the remuneration system, municipa lity, doctor, and patient characteristics on general practitioners' ch oices between surgery and home visits. Design-Prospective registration of patient contacts during one week for 116 general practitioners (GP s). Setting-General practice in rural areas of northern Norway. Main o utcome measure-Type of GP visit (surgery v home visit). Results-The es timated home visit rate was 0-14 per person per year. About 7% (range 0-39%) of consultations were home visits. Using multilevel analysis it was found that doctors paid on a ''fee for service'' basis tended to choose home visits more often than salaried doctors (adjusted odds rat io 1.90, 99% confidence interval 0.98, 3.69), but this was statistical ly significant for ''scheduled'' visits only (adjusted OR 4.50, 99% CI 1-67, 12.08). Patients who were older, male, and who were living in a reas well served by doctors were more likely to receive home visits. C onclusion-In the choice between home visits and surgery consultations, doctors seem to be influenced by the nature of the remuneration when the patient's problem is not acute. Although home visiting is a functi on of tradition, culture, and organisational characteristics, the stud y indicates that financial incentives may be used to change behaviour and encourage home visiting.