Background Notes

General Medical Services Scheme (GMS):

The data in this release is provided to the Central Statistics Office by the Primary Care Reimbursement Service (PCRS). The PCRS is the part of the Health Service Executive (HSE) that processes payments to all GPs, pharmacists, dentists and other health professionals who provide free or reduced cost services to the public.

The HSE Primary Care Reimbursement Service (PCRS) is part of the HSE. It processes payments to all the GPs, Dentists, Pharmacist and other professionals who provide free or reduced cost services to the public. The GP claims for the service and the PCRS pays for this service on behalf of the HSE.

Under the GMS, people who are unable without undue hardship to arrange general practitioner medical and surgical services for themselves and their dependants may be granted a medical card and receive free general medical services. All GMS claims are processed and paid by the PCRS.

The figures derived in this release refer to claims that were carried out in the corresponding year.

Please note the figures in the headline table for annual average refund per GP are based off of rounded figures.

Explanation for differences between published PCRS figures and CSO figures:

Please note, there are some differences between figures presented in this release, and releases composed by the HSE. These figures are not comparable. CSO figures are calculated from a claim records data set, while HSE figures are calculated from a claim record and expenditure data set. 

CSO expenditure figures are based solely off complete and fully processed GP claims for the calendary year, while PCRS expenditure figures include other expenses. The PCRS total expenditure encompass expenses such as – Secretarial/Nursing, Annual Leave, Rostering/Out–of–Hours, Medical Indemnity Insurance, Rural Practice, Study Leave, Sick Leave, Maternity Leave/Paternity Leave, Locum and Practice Expenses (2017). The figures in this release do not take these expenses into account as they are not featured in the data set the CSO received from the HSE. 

Please also note, this release includes the following fee types: Capitation, Fee-per-item, Special Service, and Special type of Consultation. This release does not include “out of hours” fee type as featured in the PCRS figures as they are not included in the data set the CSO received from the HSE.

This data set on which this release is based includes only claims and costs for claims which were filled out in full, processed and paid. Claims made to PCRS, were deemed incomplete if they lacked patient information (e.g. gender, DOB) and are not reported in this release. The use of only fully complete claims enables the breakdown of the figures by age group, gender and Local Health Office Region which is a valuable dimension of the data set. 

All claims in this release were processed using valid and up to date medical and GP visit cards. Claims, processed or unprocessed, for cards that are invalid or expired do not appear in this data set.

Treatments carried out in one calendar year, but not claimed until the following calendar year do not always appear in this claims data set. Furthermore, claims which are rejected and not processed until the following calendar year do not always appear in this claims data set.

• Medical card: With a medical card issued by the HSE, one can receive certain health services free of charge. To qualify for medical card, an individual’s weekly income must be below a certain figure. If an individual does not qualify for a medical card, they may qualify for a GP visit card. This card covers all GMS Services (medical card). A laminated plastic card containing information on the card relating to the individual and a ‘valid to’ date.
• GP visit card: A GP visit card allows an individual to visit a participating GP for free. Unlike the Medical card, the GP visit card does not cover prescribed charges or hospital charges. This card covers limited GMS Services. The GP Visit Card Holder is entitled to receive free Doctor treatment. They are not entitled to Dentist or Optometrist treatment or prescribed medicines and appliances. A laminated plastic card containing information on the card relating to the individual and a ‘valid to’ date.

Regions

The regions consist of the local health offices and are constructed as follows; 

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