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E-mail: ihs@cso.ie Sinead Bracken (+353) 21 453 5935
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CSO statistical release, , 11am

HSE Funded GP Claims

2013-2017

GMS Patients and corresponding GP claim costs, 2013-2017
 20132014201520162017
GP costs€293.8m€281.2m€302.6m€345.1m€311.5m
Number of patients (‘000)2,1162,1092,3162,3432,329
Number of GPs2,4132,5422,6952,8583,005
Average number of patients per GP877830859820775
Average annual refund per GP€121,700€110,600€112,300€120,700€103,700

State GP costs increase by 6%, while patients availing of the GMS scheme increase by 10%.

Figure 1 Number of GMS Patients 2013-2017
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  • The overall cost of GP claims increased by 6% while the number of GMS patients treated increased by 10% between 2013-2017. These increases were likely driven by the introduction of the "Under 6s GP Visit Cards" which came into effect July 1st 2015. GMS patients were treated by 2,413 GPs in 2013. The number of GPs treating under the GMS scheme increased to 3,005 in 2017 (see headline table and Figure 1).

These payments were paid by the Primary Care Reimbursement service (PCRS). Please see background notes for a further description of the PCRS and GMS. The figures on this release are based off fully complete and processed claims. For this reason, figures may vary from those published by the HSE as HSE figures are inclusive of allowances. For more information on allowances, please see background notes. 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.  

  • The average number of GMS patients per GP decreased by 11.6% in the reference period. In 2013 the average number of GMS patients per GP was 877 GMS patients, while in 2014 the average number of GMS patients per GP was 830 patients. By 2017, the average number of GMS patients per GP decreased to 775 GMS patients (see headline table).
  • The average annual refund for GPs decreased by 14.8% between the years 2013 and 2017. In 2013, the average annual refund per GP was  €121,700, while in 2017 the annual average refund was €103,700 (see headline table).
  • More female GMS patients than male GMS patients were treated by GPs under the GMS scheme between 2013-2017. Most GMS patients were in the 0-24 years age group while the least GMS patients were in the 55-64 years age group. The number of GMS patients was consistently highest in the Southern Local Health Office Region (see Table 1). These socio-demographic patterns are broadly reflected in the GP costs (see Table 2). 
Table 1 Total number of patients, by gender, age group and Local Health Office Region, 2013-2017 (‘000)
 20132014201520162017
 State
Total2,1162,1092,3162,3432,329
      
 Gender of patient
 Male 1,0039981,1051,1191,110
 Female 1,1121,1111,2111,2241,220
Age Group
 0 - 24 years 731727915937927
 25 - 34 years 261253232251196
 35 - 44 years 262263254251245
 45 - 54 years 210214212215218
 55 - 64 years 188188186187189
 65 - 74 years 227227260273282
 75 years and over 238238257267272
 Local Health Office Region
 Dublin Mid-Leinster 530534603617615
 Dublin North East 447450497503500
 West 566557596599593
 South 573568620625621
Table 2 Total costs1 of patients, by gender, age group and Local Health Office Region, 2013-2017 ('000,000)
 20132014201520162017
State
Total293.80281.20302.60345.10311.50
Gender of Patient
Male124.00118.60129.80151.70137.40
Female169.70162.60172.80193.30174.20
Age Group
0 - 24 years60.5056.6072.5095.7078.30
25 - 34 years25.3022.9021.2020.6015.50
35 - 44 years25.4023.7023.4024.1020.10
45 - 54 years28.4027.4027.6029.2026.80
55 - 64 years26.2025.0025.2026.4024.70
65 - 74 years52.8051.7055.2065.1065.50
75 years and over75.1073.8077.4084.0080.50
Local Health Office Region
Dublin Mid-Leinster72.3069.4076.3089.5082.80
Dublin North East57.5055.7060.2069.0064.40
West79.0075.2079.8088.6080.30
South84.9080.8086.5097.9084.10
1 Costs includes GP claims for capitation fees, correction fees, fee-per-item fees, special service fees and special type of consultation fees.

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; 

Local Health Offices

Dublin Mid-Leinster

Dublin South

Dublin North East

Dublin North West

 

Dublin South East

 

Dublin North Central

 

Dublin South City

 

Dublin North City

 

Dublin South West

 

Cavan / Monaghan

 

Dublin West

 

Louth

 

Kildare / West Wicklow

 

Meath

 

Wicklow

 

 

 

Laois / Offaly 

 

 

 

Longford / Westmeath

 

 

 

 

 

 

West

Galway

South

South Lee Cork

 

Mayo

 

North Lee Cork

 

Roscommon

 

West Cork

 

Donegal

 

Kerry

 

Sligo / Leitrim

 

North Cork

 

Clare

 

Carlow / Kilkenny

 

North Tipperary / East Limerick

 

Waterford

 

Limerick

 

South Tipperary

 

 

 

Wexford

 

 

 

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