List size and quality of care among GPs within the The Regular General Practitioner Scheme( 24.04.2012 )
1-page key messages
The Regular General Practitioner (RGP) Scheme was introduced in Norway in June 2001. In a revision of the RGP Scheme, it has been proposed to regulate the number of people assigned (list size) to one general practitioner (GP) to a maximum of 2,500 persons. A further suggestion is to let the municipalities decide whether to increase the list up to 1,500 persons in cases where the GP’s list is shorter.
Currently, the relationship between list size and quality of health care services is uncertain.
This overview is intended to be used as part of the documentation concerning decisions about GPs' list size.
The Norwegian Knowledge Centre for the Health Services was asked by The Norwegian Directorate of Health to review available research which addressed the question: What are the effects of the number of people assigned to GPs on the quality of health care services?
We searched systematically for:
• Systematic reviews, randomized controlled trials, controlled studies and interrupted time series that examine the effect of GPs' list size on quality parameters (primary objective)
• Studies that have assessed GPs' list size in relation to various quality dimensions of services provided by GPs (cross-sectional studies)
There is an evidence gap regarding the effects of GPs' list size on health care quality parameters. We can not conclude whether short or long lists result in differences in the quality of services provided by primary care physicians.
We have found 91 studies that, although they did not evaluate effect, examined the association between GPs' list size and the quality of the services provided. Among these are sixteen Norwegian registry- and cross-sectional studies. We have presented the studies, including their results, and elucidated that the studies are varied as regards aims, methods used and study settings. It is difficult to use registry- and cross-sectional studies as basis for answering questions on associations. The results of the included studies showed a large variation, thus we are uncertain about a possible association between list size and the quality of primary care physician services. None of the studies examined what the optimal list size would be in relation to quality of primary care physician services.
>1-page key messages
3-page executive summary