Oh, does it now?

Charging for GP services leads to sub-optimal prescribing that’s bad for health

Interesting assertion.

It is widely known that excessive antibiotic prescribing is bad for patients, for populations and long term drug resistance that undermines public health. And yet it is prevalent in Jersey where the only really likely factor to explain the difference in prescribing is charging (and I have noted the other arguments in the article and think they are extraordinarily unlikely to be relevant across the population as a whole, to which this data relates).

Giving people a prescription to justify their fee is bad medicine, but all too easy to succumb to. Charging leads to bad medicine. It’s an easy, and in this case, very obviously correct conclusion.

But it keeps drug companies happy.


Once you’ve signed up with your insurance company Holland does not charge for a GP visit, Sweden does. Finland charges, the UK does not.

So, the contention that there’s a direct link seems refuted, no? But then, as we know, there’s no limit to what the Snippa doesn’t know about but will pronounce upon.

14 thoughts on “Oh, does it now?”

  1. It’s a suspicion of mine that all the overprescribing of antibiotics of which medics are accused may be part of what has led to the great decline of heart attacks among middle aged men. Certainly the decline set in far too early to be attributed to cessation of smoking, or alterations in diet, or browsing statins.

    Heart attacks now are mainly cullers of codgers. The epidemic among the middle-aged is over.

  2. @dearieme
    Fascinating. There is surely some research about this.
    Come to think of it, if prescribing practice is a long term thing (and traditions tend to last) then we could see some difference in heart attack rates between Netherlands and Denmark today. Do we?

  3. @philip: dunno. The heart-attack-as infectious-disease notion I got from medics who dissent from the cholesterol dogma. The antibiotic conjecture is my own. It may simply be redundant – the end of epidemics of infectious diseases is usually attributed to immune systems becoming better at their jobs.

    For what it’s worth this week I came across a discussion of the recent discovery that alcoholic liver disease is to do with a bacterial infection:

    Everything, perhaps, comes down to genes or germs.

  4. Two thoughts on this. (1) cholesterol dogma is never shown with a fantastic chart of blood cholesterol and heart attacks as the axes and a nice line with dots around it. Why not? The epidemiologists can’t possibly know everyone’s blood cholesterol level throughout their lives so linkages are guesses in statistics. (2) the UK has lots of people from places that given out pills like a drug dealer at a rave. Those pills are antibiotics. FFS in Romania you can walk into a pharmacy and buy antibiotics without a prescription

  5. That is really very interesting isn`t it . My general rule is that when you are forced back on International comparisons your argument s inherently weak because the difficulty of interpreting numbers sets generally in multiplied when the context is different .
    My guess would be that the use of anti biotics was a culturally determined phenomenon but climate might be a factor ?
    One good reason to have charges for GP time would be to get GPs to sort out their bloody awful service . Much of what they do face to face could be done by email . AI will very soon be able to take a lot of the load and many old people just go along to ask what their name is so they can vote for Brexit
    This “care ” service could be sub contracted to a simple machine that said “there there” and made tea..s teas made basically …

  6. Your arrogance needs beating out Facepainter. But if Jizz wins he will arrange matters for the destruction of middle class shite like you very effectively. For everybody else also but the destruction of well off remainiac trash like you would be one of very few points of enjoyment.

  7. Bloke in Germany in Hong Kong

    I don’t usually rise to the ragging posts but as its a medical topic i can’t resist correcting another bit of ritchiebollocks here. There is no money in antibiotics so prescribing them doesn’t make drug companies especially happy.

  8. Personally, I’d rather pay for a GP visit if it meant I could get to see said GP on the day I’m ill rather than having to phone bob on 8.30 am with the vain hope of getting an appointment on that day.

    Now I’m living in NL, I can get to see a GP on the day and time of my choosing.

  9. There are of course private doctor’s who will see you when you like. You don’t get it on the NHS though which means paying twice.

    If only there were some way that you could take your contributions back from the useless public NHS and use them to rewards the private practices that will give you good service.

    A kind of market for services if you will where the good one’s prosper… God forbid.

  10. It would help if the diagnoses were known leading to the prescriptions of antibiotics.

    It was once ‘97% of all doctors consensus’ that stomach ulcers were the result of stress, causing over-production of HCl in the stomach leading to mucosal erosion.

    As a result the pharmas developed a nice range of expensive H+ inhibitors which, since they did not cure just alleviated the symptoms, were a nice little earner.

    Along came two Australian vets… let’s call them ‘deniers’ the name for those who challenge ‘the science’ as preached by the Consensus… who noticed stomach ulcers in animals, clearly not stress.

    Well… long story short… it turns out stomach ulcers are caused by H Pylori bacterium and therefore cross infection can take place between people, particularly families.

    The treatment and cure was a cocktail of two genetic (cheap) antibiotics and an antacid.

    Cue: howls of protest from the Consensus supported by the pharmas.

    But the fact is a cheap curative antibiotic treatment, which could also be used prophylactically, in families or institutionalised groups, replaced an expensive, non-curative treatment and refuted the long held opinion of what caused ulcers.

  11. There are times antibiotics are needed long term. My wife has been on them daily for several years – does not solve the problem, does vastly reduce her hospital visits to A&E and her stays in hospital. Her GP is very glad she’s on daily antibiotics.
    Previously she almost died. Not dying anytime soon is preferred by her husband. anyway.

    I use GP services regularly, I have no problem paying per visit if it was required. Would not change my visits.
    I would question, besides raising money for the GP surgery (and maybe a cut in payment to the company from the NHS) as to the benefit of charging.
    I know a few people who use the same surgery – cannot think they would reduce the number of visits.

  12. @Mr Yan November 20, 2019 at 1:13 pm

    If only there were some way that you could take your contributions back from the useless public NHS and use them to rewards the private practices that will give you good service

    Private Med was taax deductible until the Blair/Brown Left Mob abolished it in 1997 – notable “The Conservatives” still haven’t reinstated it.

    @John B November 20, 2019 at 2:18 pm


    H Pylori* – being recent – is an example I use against “the science is settled” supporters

    Similar and more recent is Human Papillomavirus [cervical cancer] Vaccine (HPV)

    * brave Aussie guy proving by self-infecting

  13. Pingback: Oh, does it now? | Tim Worstall – Politics Article – Politics Blog

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