Patient complexity and GPs' income under mixed remuneration

Area of Science:

• Health economics
• Primary care policy

Background:

• Recruitment of general practitioners (GPs) to underserved areas in Denmark is challenging.
• The current mixed remuneration scheme (combining per capita and fee-for-service payments) is under scrutiny for its adequacy in compensating GPs for treating high-need patients.

Purpose of the Study:

• To assess the impact of patient heterogeneity on GP list size, income, and total utility within a mixed remuneration system.
• To evaluate the effectiveness of the current payment model in addressing the needs of complex patient populations.

Main Methods:

• Adaptation of the Iversen (2004) model as a theoretical framework.
• Empirical analysis using data from 1039 Danish solo general practice solo practitioners.
• Statistical analysis of the relationship between patient complexity, list size, and income.

Main Results:

• Theoretical model indicates higher patient complexity leads to lower list size, with ambiguous effects on income but a negative impact on total utility (income and leisure).
• Empirical data confirms that patient complexity significantly reduces both list size and income for GPs.
• The mixed remuneration system does not fully compensate practices for the increased demands of more complex patient panels.

Conclusions:

• The current mixed remuneration system is insufficient to ensure equitable compensation for GPs serving complex patient populations.
• Differentiated per capita payments could be a viable strategy to promote fair and consistent income distribution among GPs.
• Policy interventions may be needed to adequately support GPs working with high-need patients.