Time is money: general practitioners' reflections on the fee-for-service system.

Area of Science:

• Health Economics
• Primary Health Care
• General Practice

Background:

• Fee-for-service (FFS) is a prevalent payment model for general practitioners (GPs) in OECD countries, including Norway where it constitutes two-thirds of GP income.
• FFS systems typically incentivize high service volume and short consultation times, influencing physician behavior and patient access to care.
• GPs serve as gatekeepers for various services, including medications, referrals, and sick leave certifications, making their decision-making processes critical for healthcare system efficiency.

Purpose of the Study:

• To explore general practitioners' (GPs) perspectives on the fee-for-service (FFS) system in Norway.
• To investigate the potential impact of FFS on GPs' gatekeeping decisions and clinical practice.
• To understand GPs' awareness of financial incentives and their influence on patient management.

Main Methods:

• Six focus group interviews were conducted with 33 general practitioners (GPs) in Norway during 2022.
• Thematic analysis was employed to analyze the qualitative data gathered from the focus groups.
• The study focused on GPs' reflections and perceptions regarding the fee-for-service payment model.

Main Results:

• GPs recognized the financial incentives within the FFS system and discussed strategies to maximize income, such as shorter consultations.
• Participants acknowledged that FFS fees could influence their behavior, though not always directly dictating gatekeeping decisions.
• Time constraints associated with rejecting patient requests were identified as a factor contributing to granting them, even when potentially unreasonable, due to the efficiency incentives of FFS.

Conclusions:

• GPs are cognizant of the financial drivers within the FFS system and perceive its potential influence on their decision-making processes.
• Challenges in accurately remembering and interpreting complex FFS codes can affect accurate billing and potentially clinical judgment.
• The FFS model may inadvertently encourage shorter consultations, potentially limiting the time available for GPs to thoroughly assess and reject unnecessary treatments, thus impacting gatekeeping effectiveness.