Correlation between the ratio of physician consultation fees to hourly minimum wage and consultation length: a cross-sectional study of nine countries

OBJECTIVES: Current healthcare reimbursement system is criticised for not adequately compensating physicians’ cognitive services. This study was performed to examine primary care physicians’ consultation fees in nine countries, relative to the national hourly minimum wage and to examine the correlations of the physician consultation fee with consultation length and other healthcare indices. DESIGN AND OUTCOME MEASURES: Nine reference countries for which healthcare statistics are publicly available and outpatient consultation is compensated by fee-for-service payment were selected. A representative consultation fee was chosen to calculate the ratio of the consultation fee to the hourly minimum wage. The primary outcome was the correlation between the consultation fee/hourly minimum wage ratio and consultation length. In addition, the consultation fees were compared with fees for haemoglobin A1c tests and brain imaging. Pearson’s method was primarily used for correlation analysis. RESULTS: The mean representative consultation fee/hourly minimum wage ratio was 4.02 (median, 2.7; range, 0.80–10.36). The mean consultation length was 12.9 min (median, 14.7 min; range, 5–21.1 min). A significant correlation (r=0.79) was found between consultation length and the consultation fee/hourly minimum wage ratio. The ratio of consultation fee to hourly minimum wage was moderately negatively correlated with the annual number of physician visits, number of consultations per doctor and length of hospital stay. The brain CT fee/consultation fee ratio was moderately positively correlated with the number of CT units per 1 million population. In Japan and Korea, where the brain CT/consultation fee ratio was highest, the number of CT examinations per population was also highest. CONCLUSIONS: The relationship of consultation fees to each country’s hourly minimum wage varied in nine reference countries; however, it was strongly correlated with consultation length. The imbalance in compensation for cognitive services might drive increased use of imaging tests in some countries.