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[What does the higher concentration of general practitioners mean for fee-for-service reimbursement]
1Institutt for sosialforskning, Oslo.
Insights
General practitioner density in Norway increased, with higher fee-for-service reimbursements observed in areas with fewer doctors. These variations had minimal impact on overall gross revenues.
Area of Science:
- Health Economics
- Primary Care Medicine
Context:
- General practitioner (GP) density has steadily increased in Norway.
- By 1989, Norway had 1,339 inhabitants per GP.
- GP remuneration includes fee-for-service reimbursement and patient co-payment.
Purpose:
- To analyze the relationship between general practitioner density and fee-for-service reimbursement levels.
- To investigate regional variations in GP reimbursement in Norway between 1985 and 1989.
Summary:
- Average fee-for-service reimbursement for GPs increased by approximately 60% from 1985 to 1989, exceeding nominal tariff changes.
- Reimbursement increases were slightly higher in areas with lower GP density.
- Slightly higher average fee-for-service reimbursements were noted in areas with lower GP density throughout the study period.
Impact:
- Fee-for-service reimbursement variations had a minor impact on the gross revenues of general practitioners.
- Findings can inform models of general medical service utilization, considering health changes, behavior, and supplier-induced demand.
- Limitations due to aggregate data restrict deeper exploration of explanatory factors.
Abstract:
The density of general practitioners has increased steadily in Norway. By the end of 1989, there were 1,339 inhabitants per general practitioner. General practitioners are partly remunerated per item of service, i.e., by reimbursement from the National Insurance Fund and partly by patient co-payment. The article analyses the connection between density of general practitioner and level of fee-for-service reimbursement. The average general practitioner received about 60% higher fee-for-service reimbursement in 1989 than in 1985. This increase is markedly higher than the nominal changes in the tariff. The increase was somewhat higher in areas with a relatively low density of general practitioners. Also, in each of the years 1985-1989, the average fee-for-service reimbursement was slightly higher in areas with a low density of general practitioners. The variations have only a slight impact on the gross revenues of general practitioners. Three models explaining the use of general medical services are outlined. The results can be interpreted in the light of changes in health, changes in health-related behaviour, and supplier-induced demand. Since only aggregate data are available, it is difficult to further explore possible explanations.