Senior researcher International Comparative Research (WHO)
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Allocation of time under different payment systems by GPs in Europe.
Boerma, W., Groenewegen, P., Spreeuwenberg, P. Allocation of time under different payment systems by GPs in Europe. European Journal of Public Health: 2003, 13(4 sup) 89. Abstract. 11th Annual Eupha Meeting 'Globalisation and Health in Europe: Harmonising Public Health Practices'. Rome, Italy, 20-22 November 2003.
Background: Payment of GPs is relevant from two points of view: fair payment and effects on the quality of care. Fair pay is especially important in capitation systems (does the amount correctly reflect the invested work). Secondly, payment affects the allocation of time, and thus indirect the quality of care to individual patients, the management of the practice and the involvement in continuing medical education. Aim: To answer the question whether different payment systems are related to different ways of spending time by GPs if their workload conditions (e.g. the size of the practice) vary. Methods: The study was a cross-sectional survey including a one-week workload diary implemented in 32 countries, using a multi-level design with data collected at the level of individual GPs and practices and at the level of health care systems. Results: Measures of GP workload varied strongly between countries. Time that GPs reserve for appointments ranged from 7 to 24 minutes per patient. A working week for GPs showed national averages between 40 and 60 hours. Among smaller practices we found influences of payment systems on the number of GPs’ working hours, the time devoted to patient care and the number of patient contacts. Conclusions: The dominant curve expressing the relationship between practice size and measures of workload and allocation of time is rising for smaller practices and flat when the focus is on the larger practices. The absence of relationships among the larger practices was not expected. This may be due to methodological limitations. (aut. ref.)
Background: Payment of GPs is relevant from two points of view: fair payment and effects on the quality of care. Fair pay is especially important in capitation systems (does the amount correctly reflect the invested work). Secondly, payment affects the allocation of time, and thus indirect the quality of care to individual patients, the management of the practice and the involvement in continuing medical education. Aim: To answer the question whether different payment systems are related to different ways of spending time by GPs if their workload conditions (e.g. the size of the practice) vary. Methods: The study was a cross-sectional survey including a one-week workload diary implemented in 32 countries, using a multi-level design with data collected at the level of individual GPs and practices and at the level of health care systems. Results: Measures of GP workload varied strongly between countries. Time that GPs reserve for appointments ranged from 7 to 24 minutes per patient. A working week for GPs showed national averages between 40 and 60 hours. Among smaller practices we found influences of payment systems on the number of GPs’ working hours, the time devoted to patient care and the number of patient contacts. Conclusions: The dominant curve expressing the relationship between practice size and measures of workload and allocation of time is rising for smaller practices and flat when the focus is on the larger practices. The absence of relationships among the larger practices was not expected. This may be due to methodological limitations. (aut. ref.)
