Abstract
In The Netherlands, the remuneration system for GPs changed in 2006. Before the change, GPs received a capitation fee for publicly insured patients and fee for service (FFS) for privately insured patients. In 2006, a combined system was introduced for all patients, with elements of capitation as well as FFS. This created a unique opportunity to investigate the effects of the change in the remuneration system on contact type and consultation length. Our hypothesis was that for former publicly insured patients the change would lead to an increase in the proportion of home visits, a decrease in the proportion of telephone consultations and an increase in consultation length relative to formerly privately insured patients. Data were used from electronic medical records from 36 to 58 Dutch GP practices and from 532,800 to 743,961 patient contacts between 2002 and 2008 for contact type data. For consultation length, 1,994 videotaped consultations were used from 85 GP practices in 2002 and 499 consultations from 16 GP practices in 2008. Multilevel multinomial regression analysis was used to analyse consultation type. Multilevel logistic and linear regression analyses were used to examine consultation length. Our study shows that contact type and consultation length were hardly affected by the change in remuneration system, though the proportion of home visits slightly decreased for privately insured patients compared with publicly insured patients. Declaration behaviour regarding telephone consultations did change; GP practices more consistently declared telephone consultations after 2006.
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Notes
We assumed the time investment to be dependent of the type of consultation and equal between publicly and privately insured patients. Hypotheses are based on the relative difference between contact types at a certain moment, which are not influenced by increasing the time costs for privately insured patients.
Our hypotheses are stable for varying time investments with the time investment for home visits > consultations > telephone consultations.
References
Thomson, S., Foubister, T., Mossialos, E.: Financing Health Care in the European Union: Challenges and Policy Responses. European Observatory on Health Systems and Policies, Copenhagen (2009)
Chaix-Couturier, C., Durand-Zaleski, I., Jolly, D., Durieux, P.: Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues. Int. J. Qual. Health Care 12, 133–142 (2000)
Donaldson, C., Gerard, K.: Paying general practitioners: shedding light on the review of health services. J. R. Coll. Gen. Pract. 39, 114–117 (1989)
Hickson, G.B., Altemeier, W.A., Perrin, J.M.: Physician reimbursement by salary or fee-for-service: effect on physician practice behavior in a randomized prospective study. Pediatrics 80, 344–350 (1987)
Iversen, T., Luras, H.: The effect of capitation on GPs’ referral decisions. Health Econ. 9, 199–210 (2000)
Krasnik, A., Groenewegen, P.P., Pedersen, P.A., Von Scholten, P., Mooney, G., Gottschau, A., Flierman, H.A., Damsgaard, M.T.: Changing remuneration systems: effects on activity in general practice. BMJ 300, 1698–1701 (1990)
Kristiansen, I.S., Holtedahl, K.: Effect of the remuneration system on the general practitioner’s choice between surgery consultations and home visits. J. Epidemiol. Community Health 47, 481–484 (1993)
Kristiansen, I.S., Mooney, G.: The general practitioner’s use of time: is it influenced by the remuneration system? Soc. Sci. Med. 37, 393–399 (1993)
van den Berg, M.J., de Bakker, D.H., Westert, G.P., Van der Zee, J., Groenewegen, P.P.: Do list size and remuneration affect GPs’ decisions about how they provide consultations. BMC Health Serv. Res. 9, 39 (2009)
Greß, S., Delnoij, D.M.J., Groenewegen, P.P.: Managing primary care behaviour through payment systems and financial incentives. In: Saltman, R.B., Rico, A., Boerma, W. (eds.) Primary Care in the Driver’s Seat? Organizational Reform in European Primary Care, pp. 184–200. Open University Press/Maidenhead, New York (2006)
Labelle, R., Stoddart, G., Rice, T.: A re-examination of the meaning and importance of supplier-induced demand. J. Health Econ. 13, 347–368 (1994)
De Jaegher, K., Jegers, M.: A model of physician behaviour with demand inducement. J. Health Econ. 19, 231–258 (2000)
Arrow, K.J.: Uncertainty and the welfare economics of medical care. Am. Econ. Rev. 53, 941–973 (1963)
Flierman, H.A.: Changing the Payment System of General Practitioners. NIVEL, Utrecht (1991)
Gosden, T., Forland, F., Kristiansen, I.S., Sutton, M., Leese, B., Giuffrida, A., Serginson, M., Pedersen, L.: Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst. Rev. 3, CD000531 (2000)
Boerma, W.G.W.: Profiles of General Practice in Europe. NIVEL, Utrecht (2003)
Boerma, W.G.W., Groenewegen, P.P.: GP home visiting in 18 European countries: adding the role of health system features. Eur. J. Gen. Pract. 7, 132–137 (2001)
Madden, D., Nolan, A., Nolan, B.: GP reimbursement and visiting behaviour in Ireland. Health Econ. 14, 1047–1060 (2005)
Dijk, C.E. van, van den Berg, B., Verheij, R.A., Spreeuwenberg, P., Groenewegen, P.P, de Bakker, D.H.: Moral hazard and supplier-induced demand: empirical evidence in general practice. Health Econ. 22, 340–352 (2013). doi:10.1002/hec.2801
Enthoven, A.C., Van de Ven, W.P.M.M.: Going Dutch—managed-competition health insurance in The Netherlands. N. Engl. J. Med. 357, 2421–2423 (2007)
Bartholomée, Y., Maarse, H.: Health insurance reform in The Netherlands. Eurohealth 12, 7–9 (2006)
Biesheuvel B.W., Commissie modernisering curatieve zorg.: Gedeelde zorg: betere zorg: rapport van de Commissie modernisering curatieve zorg [Shared care: better care: report of the Commitee for the Modernisation of Curative Health Care]. Rijswijk: Ministerie van Welzijn, Volksgezondheid en Cultuur, Rijswijk (1994)
Tabaksblad, M., Commisie toekomstige financieringsstructuur huisartsenzorg.: Een gezonde spil in de zorg: rapport commissie toekomstige financieringsstructuur huisartsenzorg [A healthy linchpin in health care: report of Commitee for the Future GP Remuneration System]. Ministerie van Volksgezondheid, Welzijn en Sport, The Hague (2001)
Verheij, R.A., van Dijk, C.E., Stirbu-Wagner I, Dorsman SA, Visscher S, Abrahamse, H., Davids, R., Braspenning, J., van Althuis, T., Korevaar J.C.: Landelijk Informatienetwerk Huisartsenzorg. Feiten en cijfers over huisartsenzorg in Nederland [Netherlands Information Network of General Practice: facts and figures of general practice in The Netherlands]. http://www.linh.nl (2010). Accessed 26 September 2010
Wolff, J.L., Starfield, B., Anderson, G.: Prevalence, expenditures and complications of multiple chronic conditions in the elderly. Arch. Intern. Med. 162, 2269–2276 (2002)
Schellevis, F.G., Van der Velden, J., Van de Lisdonk, E., Van Eijk, J.T.M., Van Weel, C.: Comorbidity of chronic diseases in general practice. J. Clin. Epidemiol. 46, 469–473 (1993)
Westert, G.P., Schellevis, F.G., de Bakker, D.H., Groenewegen, P.P., Bensing, J.M., Van der Zee, J.: Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice. Eur. J. Public Health. 15, 59–65 (2005)
Brink-Muinen, A. van den, Van Dulmen, A.M., Schellevis, F.G., Bensing, J.M.: Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk. Oog voor communicatie: huisarts-patiënt communicatie in Nederland [The Second Dutch National Survey of General Practice. Eye for communication: GP-patient communication in The Netherlands]. NIVEL, Utrecht (2004)
Deveugele, M., Derese, A., van den Brink-Muinen, A., Bensing, J., De Maeseneer, J.: Consultation length in general practice: cross-sectional study in six European countries. BMJ 325, 472–475 (2002)
Snijders, T.A.B., Bosker, R.J.: Multilevel Analysis; An Introduction to Basic and Advanced Multilevel Modelling. Sage Publications, London (1999)
Karssen, B., Schipper, M., Jurling, B.R.A.: Praktijkkosten en opbrengsten van huisartsenpraktijken: Eindrapportage van een onderzoek naar de praktijkkosten en opbrengsten van huisartsenpraktijken in Nederland in 2006 [Practice costs and revenue of GP practices: Final report on practice costs and revenue of GP practices in The Netherlands in 2006]. Significant, Barneveld (2009)
van den Berg, M.J., Cardol, M., Bongers, F.J.M., de Bakker, D.H.: Changing patterns of home visiting in general practice: an analysis of electronic medical records. BMC Fam. Pract. 7, 58 (2006)
Zantinge, E.M., Verhaak, P.F.M., Kerssens, J.J., Bensing, J.M.: The workload of GPs: consultations of patients with psychological and somatic problems compared. Br. J. Gen. Pract. 55, 609–614 (2005)
Verhaak, P.F.M.: Detection of psychologic complaints by general practitioners. Med. Care 26, 1009–1020 (1988)
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van Dijk, C.E., Verheij, R.A., te Brake, H. et al. Changes in the remuneration system for general practitioners: effects on contact type and consultation length. Eur J Health Econ 15, 83–91 (2014). https://doi.org/10.1007/s10198-013-0458-3
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DOI: https://doi.org/10.1007/s10198-013-0458-3