Changing perceptions of general practitioner care

Calnan, M.W.; Coyle, Julia; Williams, Simon

doi:10.1093/eurpub/4.2.108

Cited by 13 publications

(5 citation statements)

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“…It is assumed that patients' perceptions of quality of care (q) are primarily concerned with aspects of the doctor-patient relationship in the consultation (see previous section), rather than with practice or GP characteristics. 2 This is consistent with much of the evidence from the patient satisfaction literature (Rees- Lewis, 1994;Calnan et al, 1994;Smith and Armstrong, 1989). GP characteristics such as age, gender, and qualifications and experience may also be important to patients when choosing a GP, although these variables are often used as proxies for various attributes of the doctor patient relationship.…”

Section: The Choice Contextsupporting

confidence: 59%

Patients, Doctors and Contracts: An Application of Principal‐Agent Theory to the Doctor‐Patient Relationship

Scott

Vick

1999

Scottish J Political Eco

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The doctor-patient relationship has been the main focus of principal-agent theory in health care. This paper focuses on communication between doctors and patients within the doctor-patient relationship as a method by which the utility of the principal (patient) can be maximised. Patients' preferences for various attributes of the doctor-patient relationship are examined using a discrete choice experiment. Individuals were presented with pairs of hypothetical scenarios describing GP visits that differed depending on the attributes of the doctor-patient relationship. In the time-constrained GP consultation, the results show that being able to talk to the doctor is the most important attribute, followed by patients' understanding of the doctor's explanations, waiting time for an appointment, and the amount of information transferred to the patient. Quality of information is more important than its quantity. The extent to which patients were involved in decision making had no influence on the choice of visit, although it was important to patients who were relatively young and female. Policies aimed at involving patients in decision making should be targeted at specific groups of patients only. The results have implications for the training of doctors in communication skills as a response to market failure caused by asymmetry of information.Ã University of Aberdeen ÃÃ Queen Margaret College, Edinburgh and health, the absence of an explicit contract between doctor and patient, combined with the absence of extensive competition between GPs for patients, leaves patients in a potentially weak position. Only recently, however, have attempts been made to examine the nature of this agency relationship in any detail (Mooney, 1992;Mooney and Ryan, 1993;Ryan, 1994).The main policy responses to this type of market failure have concentrated on the licensure of doctors to`protect' vulnerable consumers and on designing financial incentives for doctors to reduce the possibility of supplier-induced demand (Arrow, 1963;Evans, 1984;Labelle et al., 1994). It is suggested, however, that although these policies are important, they deal with the symptoms of this type of market failure (i.e. consumer vulnerability and supplier-induced demand) rather than its source: that is, an imbalance of information in the doctor-patient relationship.The role of information transmission in market transactions has generally been ignored in the principal-agent literature. In many applications, and not just health care, relationships between buyers and sellers are characterised by trust, communication and are of a long term nature (Casson and Wadeson, 1997). The emphasis is on co-operation rather than the self-interested bargaining that is apparent in principal-agent theory and Coasian models of the firm. Because of this, explicit information transmission (rather than neoclassical competition) plays a central role in meeting the objectives of the principal at minimum cost. For example, in health care there is evidence suggesting that the nature of the docto...

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Section: The Choice Contextsupporting

confidence: 59%

Patients, Doctors and Contracts: An Application of Principal‐Agent Theory to the Doctor‐Patient Relationship

Scott

Vick

1999

Scottish J Political Eco

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“…Satisfaction varies not only with the type of service provided but also with the characteristics of the patient population being served. For example, among those who have had recent treatment, satisfaction levels tend to be higher than with those who have not recently used the specific service (5). Also, of the socio-demographic characteristics of the population, age is the most important influence, and satisfaction seems to increase with age (5).…”

Section: Quality Of Care: Empirical Evidencementioning

confidence: 99%

“…The nature and quality of the doctor-patient relationship is of particular importance in general practice, and there was some concern that the changes in the new general practitioner (GP) contract in the United Kingdom in 1990 would have a detrimental effect on this interaction in that the changes might have accorded a more formal and bureaucratic role to the GP with less time for consultation. The results of a recent study in Canterbury comparing consumer perceptions before (in 1988) and after (1991), the new GP contract was implemented (5) showed that these fears were unfounded. Overall satisfaction with general practitioners was broadly similar in 1988 and 1991, and there was little change in concerns about time restriction.…”

Section: Quality Of Care: Empirical Evidencementioning

confidence: 99%

“…For example, among those who have had recent treatment, satisfaction levels tend to be higher than with those who have not recently used the specific service (5). Also, of the socio-demographic characteristics of the population, age is the most important influence, and satisfaction seems to increase with age (5). This finding may reflect real differences in the actual experience of health care, or it may reflect lower expectations of the older generation, or more realistic expectations in that they experienced the health service before NHS existed or do not expect too much of modern medicine and accept its limitations.…”

Section: Quality Of Care: Empirical Evidencementioning

confidence: 99%

“…One possible source of strain is that medicine cannot successfully solve all the problems with which it is presented. Yet, where criticisms are found, they usually focus on the personal qualities of the doctor or on her or his performance in the consultation, such as the ability to listen to patients' stories, to reassure, or to clearly communicate information about the patients' conditions (5).…”

Section: Perceptions Of Modern Medicinementioning

confidence: 99%

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