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Remuneration, workload, and allocation of time in general practice.

Berg, M.J. van den, Westert, G.P., Groenewegen, P.P., Bakker, D.H. de, Zee, J. van der. Remuneration, workload, and allocation of time in general practice. European Journal of Public Health: 2006, 16(Suppl. 1) 38. Abstract. 14 th Eupha conference "Politics, Policies and /or the Public's Health", Montreux, 16-18 November 2006.
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Background: General Practitioners (GPs) can cope with workload by, among others, spending more hours in patient care or by spending less time per patient. The way GPs are paid might affect the way they cope with workload. From an economical point of view, capitation payment is an incentive to minimize the amount of work, contrary to a fee-for-service system, which makes more work remunerative. The main question of this study was ‘to what extent are the allocation of time and strategies to cope with workload affected by remuneration?’ The Dutch mixed system (until 2006) provides the opportunity to investigate the effects of both payment systems. Methods: 1) We carried out multilevel analyses (practice-level and GP-level) on four variables considering allocation of time: 2) Hours spent in patient care. 3) Booking-interval (scheduled time per patient on consultation hour). 4) Number of home visits. 5) Waiting time. Workload is measured as the number of contacts per week. Data origin from the second Dutch National Survey of General Practice. This study was carried out between 2000 and 2002 among 104 practices, comprising 195 GPs. These GPs were representative for the Dutch population of GPs. Data were collected using questionnaires, diaries, and electronic medical files. The models were corrected for relevant case mix, GP, and practice characteristics. The percentage of patients for which GPs received a capitation payment varied from 42 to 91%. Results: Booking-intervals turned out to be shorter when the workload was higher. Contrary to our expectations, this negative effect of workload became weaker when the proportion of patients for which GPs received a capitation payment was higher. Furthermore, significant effects were found for the number of elderly, ethnic minorities, urbanization, and practice type. Conclusions The way GPs cope with workload and allocate time seems to be more determined by the composition of their practice population and their organizational setting than the remuneration system.(aut. ref)