Economics of general practice

General (or family) practice and its role within primary care is increasingly regarded as the key to achieving efficiency and equity in many health care systems. This is particularly relevant where general practitioners (GPs) act as gatekeepers to specialist care. This chapter outlines the main economic issues in general practice. Within the context of gatekeeping, the first half of the chapter examines literature on agency, patient choice and preferences for GP services, and the utilisation of GP services. Given that much demand is determined by supply, this is followed by an examination of the determinants of referral behaviour, the effects of payment systems, and GPs as firms (partnerships and vertical integration). Overall, there has been little research by economists in these areas. This needs to be rectified giving the growing importance of primary care in many health care systems.