What price good health? When it comes to visiting your general practitioner (GP), prices can vary considerably.

Surgery visits for private patients can cost from £5 to £20, with charges for home visits ranging between £20 and £40.

Because GPs' fees are not fixed, the cost for the likes of a urine or pregnancy test might be included in the surgery consultation fee of one doctor, while another might issue a detailed bill itemising every dressing, needle or test kit used, which is charged on top of the flat fee.

With the doctors' trade union, the Irish Medical Organisation (IMO), moving towards encouraging all GPs to introduce itemised billing, the age-old tradition of rule-of-thumb charges by your benevolent family doctor is a dying practice.

General practices run single-handedly by a doctor from a front room with no overheads are increasingly being replaced by purpose-built health clinics which house a variety of professionals such as physiotherapists, chiropodists and counsellors as well as GPs.

The bills for patients attending such one-stop shops obviously reflect the practice's higher overheads, the costs for ancillary nursing and administrative staff and the wider choice of services available under one roof.

It would be illegal for the IMO or the Government to fix the fees of the State's 2,400 GPs. And in the free market that now exists, some doctors in Dublin are reported to charge as little as £5 for a surgery consultation, while at the other end of the scale the charge can be around £25.

Setting the level of fees is a matter of considerable debate within medical practices as doctors balance the need to compete with their colleagues against the financial imperative of making profits.

A survey in Medicine Weekly magazine found that the average charge for a surgery visit in Dublin was £17.34. In the mid-west it was around £15, and £15.49 in the south-east.

The average charge for a home visit in cities or large towns was more than £22, compared to around £19 in small towns and rural areas, according to the survey of 300 GP practices by MRC Telephone Research Centre.

People with health insurance can claim for visits to their GPs, but a family will

have to pay around £400 before any claims for a refund can be made.

So what do you get for your money? The style of each GP's consultation is as varied as their fee scales, making direct comparisons between practices and regions difficult.

One GP may have invested in the latest equipment, offering sophisticated services such as minor surgery which remove the need for routine hospital visits; while another operates with little more than a biro and notepad. Of course, some patients may prefer the intimacy of an ongoing relationship with a lowtech doctor in a small single practice, while others opt for the skills of a group practice.

Dr Michael Coughlan, chairman of the Irish College of General Practitioners (ICGPs), says GPs' charges have traditionally "been ruled more by the heart than by economic sense or the head in that it wasn't traditionally part of your training to run the business side of the practice.

"There is now training at a post-graduate level and GPs are increasingly aware that they are self-employed business people and they have to cover their costs and provide for their futures."

"There tends to be a bit of a Robin Hood mentality about how to charge fees," agrees Dr Cormac MacNamara, a member of the IMO's GP Committee.

"With 99 per cent of doctors, the whole fee structure is negotiation between them and their patients."

The IMO is encouraging GPs to examine their fee structures to ensure that they are pitched at a level which is viable for their business, reflects the service offered and is practicable for patients, according to Dr MacNamara, who is also president of the European Union of GPs.

He says the IMO has estimated that a fully equipped and computerised GP practice with a multi-disciplinary team would not be viable without charging a £25 fee for a surgery visit.

His own practice in Waterford the Keogh Practice is the largest in the State, with 35 staff including 10 GPs with a gender balance and mixture of skills. His practice charges £25 for a surgery consultation and £30 to £35 for a home visit.

While a patient who has had to call out her GP three times in one fortnight to treat a sick child or elderly relative may baulk at the mounting charges, GPs argue that £35 is poor financial compensation for night-after-night of disrupted sleep. Many GPs say they make a profit of around 50 per cent, after all their costs are taken out of their fees.

Compiled by Siobhan Creaton

Dr MacNamara uses the comparison with other specialists who work on a 24-hour call out basis.

A locksmith in Dublin charges around £60 for an out-of-hours trip to change a lock. "If you're locked outside your door in Dublin, it's possible to get two doctors out [for the same price]. Generally calls for a locksmith are not life or death situations," he says.

According to Dr MacNamara, the IMO is "hoping to move from a standard fee to a sliding scale of fees which bear a direct relationship to the nature of the service provided and the length of the consultation".

Itemised billing, which is common among GPs in the US, Germany and France, is already in place in many practices in Ireland.

Dr Tony Hynes, the IMO's vice-president, says this would help GPs provide a better range of services for their patients and allow patients to see what exactly they were paying for.

The two-GP Seabury Medical Centre in Malahide, Co Dublin, already provides itemised billing and has lists of fees posted on the walls throughout the building.

In addition to two doctors, two part-time nurses and three receptionists, the centre has a chiropodist, a physiotherapist, a dietician, a well-woman nurse, a counsellor and a travel centre. Dr Jim Keely said 40 per cent of the practice's turnover is consumed by running costs.

"We provide a good service, so we charge for it," says Dr Keely. "We regard each service as an item to be charged separately and we need to charge a £20 consultation fee in this practice to keep it viable. Our patients are happy with our billing system."