HSE Funded Primary Care Treatments and Claims, 2017-2021

Introduction

The Primary Care Reimbursement Service (PCRS) is responsible for reimbursing GPs under the General Medical Scheme (GMS). The payments in this report were paid under the GMS for persons eligible for a medical card or GP visit card and include a proportion of the fees to GPS only for these persons. Fees for COVID-19 vaccinations, among others, are not included. See Background Notes for a full list of the GP payments included in this publication.

Only claims that are fully complete and processed under the GMS scheme in the reference year are included in this publication. Figures may vary from those published by the HSE. Please note, care should be taken when examining trends over time in the form of expenditure and average amounts as eligibility criteria can change over time. Please see background notes for a further description of the PCRS, GMS and GP payments.

HSE funded claims for GPs increased by over a third between 2017 and 2021

Between 2017 and 2021, the overall cost of GMS claims increased by over a third (36%) with the highest costs of €495.2 million seen in 2020. This excludes the GP costs of COVID-19 vaccinations. The average annual refund per GP saw a similar increase, with a 30% increase in average annual refund per GP between 2017 and 2021. See Figure 2.1.

The number of patients under the GMS scheme decreased in this period, from 2.4 million patients in 2017 to 2.3 million patients in 2021, a 4% decrease. The average number of patients per GP decreased by 8% between 2017 and 2021, with the average number of patients per GP at its lowest in 2021, at 815 patients. The number of GPs availing of the GMS scheme increased from 2,571 in 2017 to 2,700 in 2021. See Table 2.1.

Around 4 in 10 patients are aged 24 years and under

There were more female than male patients treated by GPs under the GMS schemes across all years, with 47% of patients being male and 53% of patients being female from 2018 to 2021. In 2021, there were 1.1 million male patients and 1.2 million female patients. In 2021, around 4 in 10 or approximately 852,700 patients were aged 24 years and under. In 2021, 16% or approximately 358,200, were patients aged over 75. Patients aged 24 years and under or 75 years and over accounted for 53% of all patients in 2021. The smallest cohort of patients were those aged 25-34 in 2021 at approximately 139,800, accounting for 6% of all patients.

Regionally, the smallest number of patients were in the Dublin North East LHO region at approximately 486,100 in 2021. In 2021, the largest number of patients were in the South LHO region at 608,500. See Figures 2.2 and 2.3 and Table 2.2.

GMS claims for patients aged 75 and over increased by almost 70% between 2017 and 2021

The cost of claims for patients aged 75 and over increased by almost 70% between 2017 and 2021. For those aged 34 and under, the cost of claims increased by less than 2% over the same period. In 2021, the cost of GP claims for patients who were 75 years and over accounted for 34% of the costs of claims, with the cost of GP claims for patients between 65-74 years of age at €99.7 million and the cost of GP claims for patients between 75 years and over at €161.3 million. Between 2017 and 2021, the cost of GP claims for patients decreased for only one age cohort, those aged 25-34 years at 1% from €17.4 million to €17.3 million.  

Reflecting the larger cohort of patients in the South LHO region, the cost of GP claims was highest in this area at €132.2 million in 2021. In 2021, the cost of GP claims was lowest in the Dublin North East LHO region at €95.5 million. See Table 2.3.