Changing the Payment System of General Practitioners

Résumé du livre

The study was designed as a natural experiment. The experimental group was made up by a sample of GPs in Copenhagen City, who recorded the contents of their consultations for three periods of one week. The contents of the consultations recorded relate to complaints presented and diagnoses made, services performed, and referrals made. The one-week recording periods were six months after and one year after the payment change in Copenhagen City. The payment change consisted in a shift from almost full capitation to a roughly equal mix of capitation fees and fees for services. The control group in the natural experiment was made up by the population of GPs in the (sub)urban area of Copenhagen County. The GPs payment system introduced in Copenhagen City was operative in Copenhagen County all the time. Effects of the payment change in Copenhagen City are assessed by comparing changes in Copenhagen City with those in Copenhagen County. Effects are generalized by relating the data collected before change in Copenhagen City to data collected in the Netherlands, where an almost full capitation system is still operative for publicly insured patients.