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Changes in the remuneration system for general practitioners: effects on contact type and consultation length
Christel E van Dijk1, Robert A Verheij, Hans te Brake
1NIVEL, Netherlands Institute for Health Services Research, P.O.Box 1568, 3500 BN, Utrecht, The Netherlands, c.vandijk@nivel.nl.
Summary
The 2006 Dutch GP remuneration reform minimally impacted consultation types and lengths. However, practices began consistently declaring telephone consultations post-reform.
Area of Science:
- Health Economics
- General Practice
- Healthcare Policy
Background:
- The Netherlands reformed its General Practitioner (GP) remuneration system in 2006.
- Previously, GPs used capitation fees for publicly insured patients and fee-for-service (FFS) for privately insured patients.
- The new system integrated capitation and FFS elements for all patients.
Purpose of the Study:
- To investigate the impact of the 2006 remuneration system change on GP contact types and consultation lengths.
- To compare the effects on patients previously under public insurance versus private insurance.
Main Methods:
- Analysis of electronic medical records from 36-58 Dutch GP practices (532,800-743,961 patient contacts, 2002-2008) for contact type.
- Analysis of 1,994 (2002) and 499 (2008) videotaped consultations for consultation length.
- Utilized multilevel multinomial, logistic, and linear regression analyses.
Main Results:
- The remuneration system change had minimal effect on overall contact type and consultation length.
- A slight decrease in home visits was observed for privately insured patients compared to publicly insured patients.
- Declaration practices for telephone consultations became more consistent after 2006.
Conclusions:
- The shift in GP remuneration in the Netherlands had a limited impact on consultation patterns and duration.
- Changes in declaration behavior for telephone consultations suggest a potential administrative or reporting shift.
- Further research may explore the nuances of declaration behavior and its implications.
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