The Income Sensitivity of GP Utilization: A Conceptual and Empirical Exploration Using the Northern Ireland Household Panel

There is a temptation for the debate on reducing GP utilization to employ terms such as ‘appropriate’ or ‘unnecessary’, terms that are in fact value-laden. The meaning of such terms is rarely defined explicitly, perhaps reflecting the lack of consensus on the nature of services that should be provided. For example, the social interaction afforded by a consultation may be construed as a legitimate and effective form of treatment in itself. By developing the standard utility maximizing framework this paper has sought to eschew such subjectivity. It has highlighted the role of the user as a rational and active decision maker rather than a feckless or passive recipient of a service conditionally supplied by a paternalistic authority. We have demonstrated the insights generated by using standard economic concepts such as income and opportunity cost. The conclusion that 16% of GP consultations are income sensitive is thus based upon aggregate consumer behaviour. This is distinct from the ex post assessments of practitioners employing a particular professional definition of “appropriate” that may legitimately vary perhaps reflecting pressures on the individual GP. We discuss a number of policy instruments that may be used to reduce utilisation tackle unnecessary visits. We maintain that a policy based on consumer behaviour is more likely to be successful than one based on professional prescription.