analysis in the preceding sub-sections.
9.91 The medical profession is comprised of three distinct segments, namely the general practitioner (GP), the non-consultant hospital doctor (NCHD) or junior doctor and the hospital consultant. With the exception of emergency admissions to acute hospitals, the GP is normally the first point of contact between the general public and the medical profession. Under the referral system, patients may be referred to a specialist consultant by his/her GP. Junior doctors normally assist consultants within a hospital setting.
9.92 Medical practitioners’ services comprise a range of distinct areas (e.g. GP consultations and prescribing of medicines, and specialist consultations), differentiated on the basis of objective characteristics and price, for which the geographical scope is likely to be local. However, it is appropriate in a sectoral policy study to adopt a more general definition of the relevant market, incorporating the range of services provided by practitioners, the geographic scope of which is the State. In this market environment, the predominant type of supplier is the GP practice, and it is estimated that there are around 2,700 GPs currently practising in Ireland. In addition to GPs, there are estimated to be 2,067 consultants and 3,542 NCHDs practising in Ireland. The majority (51%) of GP practices are single practitioner businesses, while 35% of GPs are partners in a GP practice.
9.93 As at September 2002, there were 15,034 persons on the General Register of Medical Practitioners. However, the number of doctors per inhabitant in Ireland is the second lowest (after the UK) out of fourteen European countries. The average annual rate of increase in the General Register of Medical Practitioners increased from 2.5% per annum between 1991-1996 to 5% per annum between 1997 and 2002. However, that the number of doctors may not have kept pace with the demand for medical services is indicated by the faster growth in the economy over this period (7% on average between 1992 and 2001). 9.94 That the number of doctors may not have kept pace with demand is
also reflected in fee income growth. According to our survey of the profession, the vast majority of GPs experienced a significant increase in fee income during the period 1999-2001. Accepting that this was a period of exceptional growth in the Irish economy, the average annual growth in fee income in the case of nearly all respondents to our survey exceeded any measure of the growth in national product. In particular, among the 97.5% of responding practices that indicated an increase in fee income on an annual average basis between 1999 and 2001, 27.9% indicated an increase of between 5-9% per annum and 46.4% stated an increase of between 10-24% per annum.
Section 9 Competition and the Medical Practitioners’ Profession in Ireland
9.95 Our analysis of the frequency of usage of medical practitioners and the ability of patients to assess the quality of medical services provided would suggest that the extent of information asymmetries in relation to quality is unlikely to be significant among the patients of GP practices in Ireland. In relation to price, while a majority of patients would appear to know in advance what they would be charged for medical services provided by their GP, 45% of respondents stated that more information should be provided on the scale of doctors’ fees.
9.96 Regarding the nature of competition on the market, our analysis of professional fees charged by doctors for typical services such as a standard attendance at a doctor’s clinic and a home visit point to the presence of some price dispersion in each case. Our analysis of CSO data on doctors’ fees has also indicated that the rate of inflation in medical fees has been substantially higher in urban areas than in rural areas over the period 1995-2000.
9.97 In relation to consumers’ views on the extent of price competition in the medical profession, it is notable that the vast majority of respondents to our survey were of the view that virtually no or very little price competition exists among medical practitioners in Ireland. This perception may reflect a lack of transparency regarding the level of fees charged to patients in addition to the increase in medical cost inflation in recent years.
9.98 Another vehicle of competition available to medical practitioners is advertising. However, our analysis of Golden Pages entries and of practitioners’ responses to our survey of practitioners indicates that the medical profession is one in which advertising is limited as a potential means of competing in the relevant market. Reflecting the advertising restrictions imposed by the Medical Council, adverts are aimed principally as a means of providing minimal information rather than as a tool of competition.
9.99 Finally, in terms of market dynamics, it is relevant to note that medical practitioners have reported difficulties in recruiting doctors over the past three years. Significantly, 72.4% of GP practices found it either ‘extremely difficult’ or ‘very difficult’ to recruit doctors during this period. The difficulties prevailing in relation to recruitment may reflect restrictions on the supply of doctors in Ireland, including in relation to the number of medical graduates from the schools of medicine.
Indecon- London Economics
Section 9 Competition and the Medical Practitioners’ Profession in Ireland