FAMILY PRACTITIONERS REMUNERATION AND PATTERNS OF CARE - DOES SOCIAL-CLASS MATTER

The objective of the study is to examine whether medical care patterns and/or outcomes for patients under a prepaid system differ fron? thos e under fee-for-service according to social class. An effect of this k ind war suggested by the investigators reporting on the RAND Health In surance Experiment (RAND HIE). We performed a cross-sectional study ir , family practice in Germany (fee-for-service) and the UK (predominant ly capitation ie. prospective payment). 778 attending patients aged 18 and above were included Indicators of care, relating mainly to cardio vascular prevention, were collected by patient interview and questionn aire, doctor's questionnaire, analysis of records, and blood pressure (BP) measurement. Multiple linear and logistic regression models with these indicators as dependent Variables were calculated to examine pos sible interactions between social class and system of payment. Social class asa main effect was related to diastolic BP, BP measurement freq uency and the number of non-pharmacological interventions to lower BP. The data on the process and the outcome of primary care from British and German family practice do not show any significant interaction bet ween system of family practitioners' remuneration and patients' social class. We were unable to reproduce the effect postulated by the RAND HIE investigators.