Primary Care

Overview

Overview

We apply microeconomics and econometrics to analyse policy issues in primary care. We use both traditional health economics tools and to draw on concepts from other areas of economics, such as industrial economics, labour economics, spatial economics, economics of regulation, micro-econometrics and the economics of uncertainty and insurance.

GP’s

GP’s

Research in the area of general practice (GP) medicine has been a prominent research topic within the health policy team for some time.  Topics which have been examined in the area include:

  • Economies of scale in general practice
  • General practitioner job satisfaction and the relationship between income and hours worked
  • GP responses to financial incentives
  • The relationship between general practice and health outcomes
  • Geographical distributions of general practitioners

Publications

  • Dixon J, Smith PC, Gravelle H, Martin S, Bardsley M, Rice N, Georghiou T, Dusheiko M, Billings J, De Lorenzo M, Sanderson C. A person based formula for allocating commissioning funds to general practices in England: development of a statistical model. British Medical Journal 2011;DOI:10.1136/bmj.d6608.
  • Gravelle H, Dusheiko M, Martin S, Smith P, Rice N, Dixon J. Modelling individual patient hospital expenditure for general practice budgets. Centre for Health Economics, University of York; CHE Research Paper 73 (PDF , 358kb)‎ 2011.
  • Gravelle H, Hole AR, Santos R. Measuring and testing for gender discrimination in physician pay: English family doctors. Journal of Health Economics 2011;30(4):660-74.
  • Morris S, Goudie R, Sutton M, Gravelle H, Elliott R, Hole A, Ma A, Sibbald B, Skatun D. Determinants of general practitioners’ wages in England. Health Economics 2011;20:147-60.
  • Olsen KR, Gyrd-Hansen D, Højmark TB, Kristensen T, Vedsted P, Street A. Organisational determinants of production and efficiency in General Practice. A population based study. European Journal of Health Economics 2011;DOI:10.1007/s10198-011-0368-1.
  • Goddard M, Gravelle H, Hole A, Marini G. Where did all the GPs go? Increasing supply and geographical equity in England and Scotland. Journal of Health Services Research and Policy 2010;15(1):28-35.
  • Dixon J, Asaria P, Georghiou T, Billings J, Gravelle H, Martin S, Rice N, Smith P, Wennberg D, DeLorenzo M, Siegal M, Russell R, Filipova N. Developing a person based resource allocation formula for general practices in England. Report to the Department of Health; October 2009.
  • Hann M, Goudie R, Sutton M, Gravelle H, Sibbald B. The Fifth National GP Worklife Survey. Final Report to Department of Health; June 2009.
  • Goddard M, Gravelle H, Hole A, Marini G. Fairness in Primary Care Procurement.  Trends in Inequality of GP Distribution and Determinants of PCT GP Supply. Second Report to Department of Health; November 2008.
  • Gravelle H, Hole A. Measuring and testing for gender discrimination in professions: the case of English GPs.  Department of Economics and Related Studies (DERS), University of York Discussion Paper 08/28 2008.
  • Gravelle H, Hole A, Hussein I. Response bias in job satisfaction surveys: the case of English GP. Department of Economics and Related Studies (DERS), University of York Discussion Paper 08/24 July 2008.
  • Gravelle H, Morris S, Sutton M. Are family physicians good for your health? Endogenous supply and health. Health Services Research. 2008;published on line 31 January 2008 doi: 10.1111/j.1475-6773.2007.00823.x.
  • Hole A, Marini G, Goddard M, Gravelle H. Fairness in primary care procurement measures of under-doctoredness: sensitivity analysis and trends. Centre for Health Economics, University of York; CHE Research Paper 35 (PDF , 2,021kb), 2008.
  • Mason A. New medicines in primary care: a review of influences on general practitioner prescribing. Journal of Clinical Pharmacy and Therapeutics. 2008;33(1):1-10.
  • Morris S, Gravelle H. GP supply and obesity. Journal of Health Economics 2008;27(5):1357-67.
  • Morris S, Sutton A, Gravelle H, Elliott B, Hole A, Ma A, et al. Determinants of general practitioners' wages in England. Centre for Health Economics, University of York; CHE Research Paper 36 (PDF , 252kb)‎ 2008.
  • Whalley D, Gravelle H, Sibbald B. Impact of the new general medical services contract on general practitioners' job satisfaction and perceptions of quality of care in the UK. British Journal of General Practice. 2008;58:8-14.
  • Dixon J, Asaria P, Georghiou T, Billings J, Gravelle H, Martin S, Rice N, Smith P, Wennberg D, DeLorenzo M, Siegal M, Russell R, Filipova N. Person Based Resource Allocation: Developing a resource allocation formula at a general practice level based on individual patient characteristics. Report to the department of Health. November 2007.
  • Gravelle H, Hole A. The work hours of general practitioners' workload: survey of English GPs. British Journal of General Practice. 2007;57:96-100.
  • Street A. Should GPs hold budgets to purchase hospital services? Revista Espanola de Economia de la Salud. 2007;6(2):88-92. Download from Economia de la Salud
  • Gravelle H, Morris S, Sutton, M. Are General Practitioners good for you? Endogenous supply and health. Centre for Health Economics, University of York; CHE Research Paper 20 (PDF , 605kb)‎ , 2006.
  • Morris S, Gravelle H. GP supply and obesity. Centre for Health Economics, University of York; CHE Research Paper 13 (PDF , 451kb)‎, 2006.
  • Scott A, Gravelle H, Simeon S, Sibbald B, Bojke C. Job satisfaction and quitting intentions: a structural model of British general practitioners British Journal of Industrial Relations 2006;44:519-40.
  • Whalley D, Bojke C, Gravelle H, Sibbald B. Morale of the GP workforce in the light of reform: a national survey of job satisfaction. British Journal of General Practice 2006;56:87-92.
  • Hann M, Gravelle H. The maldistribution of general practitioners in England and Wales: 1974-2003. British Journal of General Practice 2004;54:894-898.
  • Mannion R, Goddard M. General practitioners' assessments of hospital quality and performance. Clinical Governance: An International Journal 2004;9:42-7.
  • Sibbald B, Bojke C, Gravelle H. National survey of job satisfaction and retirement intentions among general practitioners in England. BMJ 2003;326:22-4.
  • Ferguson B, Gravelle H, Dusheiko M, Sutton M, Johns R. Variations in practice admission rates the policy relevance of regression standardisation Journal of Health Services Research and Policy 2002;7(3):170-6.

Disease management

Disease management

Work in this area has concentrated on examining the relationship between admission rates and quality of care in general practices using routine administrative datasets.  Some specific work includes an investigation into whether practices with better clinical quality have lower avoidable admission rates.  Other research has attempted to examine variations in practice admission rates in order to identify possible inefficiencies or inequalities within the health care system – across the entire practice as well as for specific conditions.

Publications

  • Brilleman SL, Gravelle H, Hollinghurst S, Purdy S, Salisbury C, Windmeijer F. Keep it simple? predicting primary health care costs with measures of morbidity and multimorbidity: Centre for Health Economics, University of York, CHE Research Paper 72 (PDF , 227kb)‎ 2011.
  • Dusheiko M, Doran T, Gravelle H, Fullwood C, Roland M. Does higher quality of diabetes management in family practice reduce unplanned hospital admissions? Health Services Research2011;46(1):27-46.
  • Dusheiko M, Gravelle H, Martin S, Rice N, Smith PC. Does better disease management in primary care reduce hospital costs? Centre for Health Economics, University of York; CHE Research Paper 65 (PDF , 315kb)‎ 2011.
  • Dusheiko M, Gravelle H, Martin S, Rice N, Smith PC. Does disease management in primary care reduce hospital costs? Evidence from English primary care. Journal of Health Economics 2011;30(5):919-32.
  • Morris S, Gravelle H. GP supply and obesity. Journal of Health Economics 2008;27(5):1357-67.
  • Gravelle H, Dusheiko M, Sheaff R, Sargent P, Boaden R, Pickard S, et al. Impact of case managment (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. British Medical Journal. 2007;334(31).
  • Morris S, Gravelle H. GP supply and obesity. Centre for Health Economics, University of York; CHE Research Paper 13 (PDF , 451kb)‎ , 2006.
  • Roland M, Dusheiko M, Gravelle H, Parker S. Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data. BMJ 2005;330(7486):289-92.
  • Bojke C, Gravelle H, Hassell K, Whittington Z. Increasing patient choice in primary care: the management of minor ailments. Health Economics 2004;13:73-86.
  • Richardson G, Godfrey L, Gravelle H, Watt I. Cost-effectiveness of implementing new guidelines for treatment of hypertension in general practice. British Journal of General Practice 2004;54(507):765-771.