Avoidable consultations in general medicine: identification method and avoidable cost assessment

Presenter: Christian de Peretti, Université Claude Bernard Lyon I

Abstract

Background:

The proportion of medical consultations per patient in France is higher than the proportion in other OCDE countries, without any impact on the population health. In France, the general practitioner constitutes the starting point of the health care system, whatever the pathology type and size. Then, using self-medication is a much less frequent practice: most of the self-medication drugs are also reimbursed when they are prescribed. While in France the drug expense is the highest in Europe, the average expense per person relative to self-medication drugs is about 27 euros against 60 euros in Germany and 40 euros in UK and Italy. According to the Association of the European Self-Medication Industry (AEGSP), the self-medication growth should permit to reduce the number of inappropriate medical consultations, and thus to save money. The assessment of the savings is 2.5 billion euros per year for the health insurance scheme in the case of 5% of the prescribed drugs become auto-medicated.

Objectives:

The purpose of this paper is to study a population of patients consulting general practitioners. This work assesses the hypothesis of a change of behaviour with respect to practitioner consulting as well as with respect to the various reimbursement ways. This analysis is made from the standard health cover and from the complementary health insurance schemes point of view. The aims of this research are to answer to two questions:
1. What is the proportion of the general medical consultations for Ear, Nose and Throat (ENT) and digestive motives that can be avoided, and switch to an individual self-medication?
2. What is the average cost of each strategy: general practitioner or self-medication?
This study is deliberately restricted to the ENT and the digestive symptomatologies because of the existence of a strong international consensus about what is relevant to self-medication, and because of the symptom frequency.

Methodology:

The consultations that can be considered as self-medicable are chosen with respect to the following criteria:
1. The consultation motives that correspond to mild ENT and digestive symptoms.
2. Among these consultations, the prescribed drugs are examined, and we exclude the consultations for which a least a drug does not correspond to a mild disease.
All these criteria are determined in accordance with practitioners.

Direct costs are computed on the basis of the standard prices. Since the diseases of interest are mild, the indirect costs are assumed to equal zero. A discussion is made about the price of self-medication.

Results:

The proportion of avoidable consultations among the ENT and digestive consultations is between 10 and 30%. The possible savings are between 236 and 833 million euros.