GP-income development in relation to recent health care reforms: an international comparison.

Kroneman, M., Zee, J. van der. GP-income development in relation to recent health care reforms: an international comparison. European Journal of Public Health: 2011, 21(suppl. 1), p. 53. Abstract. 4th European Public Health Conference: 'Public Health and Welfare - Welfare Development and Public Health' 9-12 november 2011, Copenhagen.
Background: Health care reforms have been introduced in several European countries in the past decade. In most countries, these reforms had (intended and unintended) consequences for the remuneration and incomes of GPs. The reforms can be grouped into two types: incremental reforms and reforms that intend to change the GP remuneration system fundamentally. The research question addressed in this paper is the question whether fundamental changes have different effects on GP income development compared to incremental changes. Methods: We collected for each country in our study (Belgium, France, Germany, The Netherlands, Sweden and the UK) data on GP-incomes in the period 2000–2009. The income of a GP is considered being the income for a full-time GP after deduction of practice expenses and before taxes and, if possible, excluding income from out-of-hours care and special activities. The data came from national institutes, most of them collecting data on GPs routinely. National data were converted into Purchasing Power Parities US$ (pppUS$) and corrected for inflation. Fundamental changes alter the way GPs are remunerated totally, incremental changes keep the existing method in place, changing or adding only minor items.
Results In two of countries in our study (UK,NL), fundamental reforms took place. From the year of introduction of these changes, the income of GPs increased substantially. In the other countries, where incremental changes took place in the 10-year period, in most years the income corrected for inflation increased slightly, with a few exceptions where income slightly reduced or did not change. Conclusions: Whereas in countries where incremental changes were introduced, the income of GPs increased gradually, the income of GPs in countries with fundamental changes (UK NL) increased substantially. We think this is the result of 1) incentives provided by the new system and 2) more precise billing by GPs at insurers or national health funds because of uncertainties regarding their future income. Since fundamental remuneration changes often require new administrative systems, GPs cannot estimate their new income based on their former administration and therefore charge all possible events that the new remuneration rules allow to be charged. (aut. ref.)