[Change in service provision and availability under the list patient system reform].

BACKGROUND: In this article, we analyse the relationship between length of patient lists and general practitioners' (GPs') service provision in order to investigate whether the list patient system reform has led to reduced accessibility and/or supplier inducement.

MATERIAL AND METHODS: The data were collected from a comprehensive questionnaire survey among GPs in the list patient system in 2002 (2306 GPs) and from the National Insurance Administration in 2001 (1637 GPs). The relationship between length of patient lists and service provision was analysed using regression analysis.

RESULTS: The relationship between length of patient lists and number of consultations per GP was almost proportional, as was the relationship between length of patient list and number of consultations initiated by GPs. GPs who wanted more patients on their list had fewer consultations than those who were satisfied with the length of their lists and they did not compensate by taking more laboratory tests per consultation. Analysis of the two independent sets of data gave almost identical results.

INTERPRETATION: Patients' access to their GPs is independent of the length of his or her patient list. Even GPs with long lists do not ration consultations. This probably reflects efficient organisation of the practice. Our results do not support the theory that GPs induce demand for their services; one explanation is that GPs with short lists have chosen to have precisely that and have no need to induce demand.