“And by the way, I have private health insurance…” The sentence usually comes towards the end of the doctor’s appointment, from patients who expect to receive treatment or be examined, says GP Bjørg Marie Vabø Sætermo in Sandnes. GPs are often called the “gatekeepers of the healthcare system”, and have a great influence on who gets healthcare from specialists – and who doesn’t. But Sætermo believes that GPs’ function as gatekeepers is under pressure. One reason is that more and more people have private health insurance through work. – We must be careful where we are going, says Sætermo, who fears a class-divided health care system where the economically strong patients get better and faster help than others. As a GP, Bjørg Marie Vabø Sætermo is sometimes refused by hospital doctors when she refers patients to hospital. But she has never been turned down by an insurance company. Photo: Tom Edvindsen Believes health insurance increases the risk of overtreatment Insurance companies with guarantees for examination or treatment create a certain expectation among patients. And that creates problems for GPs. – In general, people come to a greater extent because they “just have to” when they come to the doctor. And those with health insurance are some of the most demanding, says Stefan Hjørleifsson, GP for 20 years. Hjørleifsson is among the researchers behind a recent research article from the University of Bergen (UiB). In a study, around 1,300 GPs in Norway were asked how private health insurance affects their work: Nine out of ten GPs in the study believe that private health insurance contributes to an increased risk of overtreatment in the Norwegian healthcare system. “The insurance companies in Norway have in practice made GPs responsible for guarding their services, without negotiating an agreement with the General Practitioners’ Association on this”, write the researchers at UiB. Photo: Ksenia Novikova The same proportion believes that the insurance contributes to increased inequality in health. – Patients with health insurance are reported to be more insistent than other types of patients, says Jørgen Breivold, GP for 13 years and lead author of the study. Breivold links the findings to several European studies, which show that patients with a high social and economic status are more likely than others with the same need to be examined by a medical specialist. Private health insurance Typically covers consultation, examination and treatment in the specialist health service – with a referral from a GP or company doctor. The vast majority have such insurance through their employer. The most common type of health insurance is treatment insurance. 816,000 Norwegians were covered by this as of 2023. That is over 260,000 more than five years ago. In 2023, Klassekampen revealed that 32 out of 70 state-owned companies buy private health insurance for their employees. Source: Finans Norge, Klassekampen. Almost 1 in 3 pass on without assessment GPs such as Bjørg Marie Vabø Sætermo have a duty not to waste public resources. If patients who come to her do not need treatment, examination or sick leave, they must be turned away. But in practice it is not always that easy. 28 per cent of GPs reply that they often or always only refer patients with health insurance without carrying out a medical assessment. – We are not dispatchers. We do not work in a service profession. We will make professional assessments, says researcher Hjørleifsson, who says that he understands that it is difficult for GPs to resist in a hectic everyday life. Some health insurances promise X-rays and diagnostic imaging within ten working days after receiving a referral from a GP. Photo: Rolf Jakobsen/news General practitioner Sætermo says that she sometimes does not have time to face demanding patients. She always sets aside 20 minutes for each patient. Then she feels that she gets time to explain, and that patients who do not receive an examination or treatment understand the decision. – But sometimes I end up behind, and there isn’t enough time. If the patient has made up his mind, it can be difficult to change them, says Sætermo. 42 percent of the GPs in the study answered that they regularly feel pressured to refer people with health insurance. – If GPs give in to the pressure, it will overall increase the risk of medical overactivity and reinforce the perception that health is a commodity that can easily be ordered at will, says researcher Breivold. This is what the insurance companies say about the study: Tryg Tryg Forsikring – We of course accept the GP’s experience, but disagree with their conclusion, says Christer Kjørsvik at Tryg. – We understand that doctors in a busy everyday life can experience pressure from patients who on their own initiative want a referral or diagnostics. It is not in the insurance company’s interest that the services are overused. If this is a real problem, it is something we need to look into more closely. If – We only treat those who have been referred to a medical specialist, and it is not our aim to refer as many as possible. We put our trust in GPs, and do not want to contribute to a dichotomy around the GP scheme, says Urd Pedersen, head of health insurance at If. She is clear that If does not approve referrals from GPs without a medical indication. Fremtind Fremtind Forsikring – No one benefits from overtreatment. In addition to putting pressure on the doctors, in the long run it could also lead to increased insurance prices. It is important to us that the treatment we offer must be necessary and have an effect, says Bim Cornelia Kase, communications advisor at Fremtind Forsikring. She is clear that health insurance should not cover more treatment than through the public sector. Storebrand StorebrandWe believe it is important to see what kind of treatments the insurance is used for. By far the largest share of the use of insurance is musculoskeletal disorders, as well as psychology, which are the two biggest causes of sickness absence in Norway. If we get people back to work faster, it is very good for society, says communications director Stig-Øyvind Blystad, who welcomes research in the field. Own doctors for patients with insurance? Recently, the Norwegian Association of General Medicine also announced (external link) that they fear health insurance will increase social differences in Norway. In the UiB study, a majority of GPs answered that the insurance companies should hire their own doctors. It meets with mixed reactions from those news talks to. – In isolation, own insurance doctors could have been a good measure. But at the same time, this would increase the speed towards a bifurcation of the healthcare system and further weaken the public healthcare service, says GP Sætermo. – Own doctors for the insurance companies would be a step forward. But again, that will eat into the limited resources we have. I think everyone agrees that we want a strong public health service. Yet this is happening in front of our eyes, says researcher and GP Hjørleifsson. Stefan Hjørleifsson is a specialist in general medicine and a researcher at the University of Bergen (UiB). Photo: UiB The insurance companies do not want their own doctors: Fremtind is currently associated with consulting doctors, but does not want its own doctors to replace the role of GPs. If emphasizes that the insurance company must be an independent party, and they will not be that with their own doctors. Tryg does not want the insurance companies to contribute to increasing the current shortage of GPs in Norway, and still believes that the primary healthcare service should be the gateway to all further treatment. Storebrand believes that the doctor who knows the patient best should assess the patient’s needs, and wants an interaction with the public. The company offers access to a general practitioner as part of the product. See the Debate on private health insurance in the video window below: In the “Debate” in April, Health and Care Minister Jan Christian Vestre had to answer about health insurance and queues in the public sector. Published 05/08/2024, at 20.53
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GPs feel pressured by patients with health insurance – news Rogaland – Local news, TV and radio
