Counting the cost of social disadvantage in primary care

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7089.1275a (Published 26 April 1997) Cite this as: BMJ 1997;314:1275

Conclusions arising from economic evaluations in primary care should be treated with caution

  1. D P Kernick, General practitionera
  1. a St Thomas Health Centre, Exeter EX4 1HJ
  2. b Medical Centre, Church Stretton, Shropshire SY6 6BL
  3. c Kentish Town Health Centre, London NW5 2AJ
  4. d Department of Social Medicine, Bristol University, Bristol BS8 2PR

    Editor—Adrian Worrall and colleagues' paper costing the increased workload caused by social disadvantage has important resource implications but exposes the danger of a superficial approach to health economics.1 The cost of a consultation in general practice is a key input for primary care studies, and by taking at face value Netten and Dennett's frequently quoted figure of £162 Worrall and colleagues fall into the common trap of failing to appreciate context, definition, and interpretation when analysing costs.

    Netten and Dennett's analysis is based on the work of Hughes, who assumed that half of a general practitioner's working time was spent in the consultation.3 In fact, however, if the workload survey for 1992-3 is used,4 and if an hour a day is allocated for case work arising from the consultation, this figure will be above 70%. Information on lengths of consultation and home visits are taken from data that are over 10 years old. Furthermore, Netten and Dennett's analysis is based on a general practitioner's gross direct and indirect remuneration. This will include reimbursement for dispensing doctors, who do not exist in …

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