Consultations with doctors

Consultations with primary care doctors are, for many people, the most frequent contact with health services, and often provide an entry point for subsequent medical treatment. Consultations can take place in doctors’ clinics, hospital outpatient departments or, in some cases, patients’ own homes. Increasingly, consultations can also take place online and through video calls, through the development of teleconsultations (Oliveira Hashiguchi, 2020[10]). The use of teleconsultations increased greatly during the COVID-19 pandemic as a way to protect both patients and doctors, and to avoid spreading the virus (see indicator “Digital health”).

In 2019, the number of in-person doctor consultations per person ranged from fewer than 3 in Mexico, Costa Rica, Sweden, Colombia and Chile, to over 17 in Korea (Figure 5.11). The OECD average was 6.8 consultations per person per year, with most countries reporting between four and ten. The average number of doctor consultations per person across OECD countries has remained relatively stable since 2009. However, some countries have seen large increases over time (such as Turkey, Lithuania and Colombia).

Differences in service delivery modalities explain some of the cross-country variation. In Canada, Finland, Ireland, New Zealand, Sweden, the United Kingdom and the United States, the relatively low number of doctor consultations can be explained in part by the fact that nurses and other health professionals play an important role in primary care – notably in the management of patients with chronic diseases and in dealing with patients with minor health issues. This lessens the need for doctor consultations (Maier, Aiken and Busse, 2017[11]).

Provider payment methods and levels of co-payments also have an impact on the number of doctor consultations. In some countries, doctors are paid predominantly by fee-for-service (as in Germany, Japan, Korea and the Slovak Republic). Such countries tend to have higher consultation rates than those countries where doctors are mainly paid by salaries or capitation (such as Denmark, Finland, Mexico and Sweden). However, in Switzerland and the United States, doctors are paid mainly by fee-for-service, but consultation rates are below average. In these countries, patient co-payments are high for a large proportion of the population, which may result in patients not consulting a doctor because of the cost of care.

COVID-19 has also had a substantial impact on doctor consultations. Stay-at-home orders and suspension of non-urgent care – particularly early on in the pandemic – contributed to fewer doctor consultations, as did many people’s reluctance to visit health care facilities due to concerns about catching the virus (OECD, 2020[5]). Based on preliminary data for 2020, consultations per capita dropped in seven out of eight OECD countries, compared to 2019. In-person consultations fell by around 30% in Chile and Spain, by 16-17% in Costa Rica, Israel and Norway, and by just under 10% in Australia and Mexico, with no change observed in Denmark. However, declines in in-person consultations were offset to some extent by increasing numbers of teleconsultations (see indicator “Digital health” and Chapter 2 for an in-depth analysis of the health impact of COVID-19).

Information on the number of doctor consultations per person can be used to estimate the annual numbers of consultations per doctor. This indicator should not be taken as a measure of doctors’ productivity, since consultations vary in length and effectiveness, and because it excludes services doctors deliver for hospital inpatients, as well as time spent on research and administration. Keeping these comparability issues in mind, the estimated number of consultations per doctor is highest in Korea, Turkey and Japan (Figure 5.12). Numbers were lowest in Greece, Sweden and Costa Rica. In Sweden, consultations with doctors in both primary care and hospital settings tend to be focused on patients with more severe and complex cases.

The number and type of doctor consultations can vary among different socio-economic groups. Wealthier individuals are more likely to see a doctor than individuals in the lowest income quintile, for a comparable level of need. Income inequalities in accessing doctors are much more marked for specialists than for general practitioner consultations (OECD, 2019[4]).

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