General practitioners not very sensitive to financial incentives

The way general practitioners (GPs) are paid has only limited effects on the affordability, accessibility and quality of care. Medical ethics and guidelines in Dutch general practice seem to have counteracted large differences in the provision of health care, says Christel van Dijk in NIVEL-research on which she attained the doctoral degree at Tilburg University.

Christel van Dijk investigated the effects of changes in the remuneration system of GPs.  In January 2006, the GP remuneration system changed simultaneously with the introduction of a new health insurance act. The combined system of public and private health insurance was replaced by a single universal basic health insurance. The capitation system for publicly insured patients and the fee-for-service system for privately insured patients was replaced by a combined system of capitation and fee-for-service for all insured patients. Van Dijk: “Trends in the use of services are similar for former publicly insured patients and privately insured patients. Changes in the remuneration system of GPs did not result in large differences in consultations, accessibility, consultation length and adherence to guidelines.”

Medical ethics and guidelines
Based on the literature, GPs were expected to have opportunities to influence the use of health care. Christel van Dijk: “Whether this opportunity is actually used, is dependent on the utility function of GPs, which we assumed consists of medical ethics and guidelines, income and leisure. Since the remuneration system affects income, we expected the remuneration system of GPs to be an important element for controlling the health care provided. The fact that changes in provision of health care after changes in remuneration were limited could be explained by the more important role of medical ethics and guidelines in the utility function of GPs. However, literature shows indications that a strong focus on financial incentives, as fee-for service or pay-for-performance,  may crowd out the intrinsic motivation (medical ethics) of GPs. It is important to take into account these unintentional consequences in designing a new remuneration system.”

LINH
For this study, longitudinal data were used from EMRs from general practices participating in Netherlands Information Network of General Practice (LINH) from 2002 to 2008. The LINH database holds longitudinal data on contacts, morbidity, prescriptions and referrals of around 90 general practices and 350,000 patients derived from EMRs.

Cooperating partners
- LHV
- NHG
- IQ healthcare