2 research outputs found
Do list size and remuneration affect GPs' decisions about how they provide consultations?
Background: Doctors' professional behaviour is influenced by the way they are paid. When GPs are paid per
item, i.e., on a fee-for-service basis (FFS), there is a clear relationship between workload and income: more work
means more money. In the case of capitation based payment, workload is not directly linked to income since the
fees per patient are fixed. In this study list size was considered as an indicator for workload and we investigated
how list size and remuneration affect GP decisions about how they provide consultations. The main objectives of
this study were to investigate a) how list size is related to consultation length, waiting time to get an appointment,
and the likelihood that GPs conduct home visits and b) to what extent the relationships between list size and
these three variables are affected by remuneration.
Methods: List size was used because this is an important determinant of objective workload. List size was
corrected for number of older patients and patients who lived in deprived areas. We focussed on three
dependent variables that we expected to be related to remuneration and list size: consultation length; waiting
time to get an appointment; and home visits. Data were derived from the second Dutch National Survey of
General Practice (DNSGP-2), carried out between 2000 and 2002. The data were collected using electronic
medical records, videotaped consultations and postal surveys. Multilevel regression analyses were performed to
assess the hypothesized relationships.
Results: Our results indicate that list size is negatively related to consultation length, especially among GPs with
relatively large lists. A correlation between list size and waiting time to get an appointment, and a correlation
between list size and the likelihood of a home visit were only found for GPs with small practices. These
correlations are modified by the proportion of patients for whom GPs receive capitation fees. Waiting times to
get an appointment tend to become shorter with increasing patient lists when there is a larger capitation
percentage. The likelihood that GPs will conduct home visit rises with increasing patient lists when the capitation
percentage is small.
Conclusion: Remuneration appears to affect GPs' decisions about how they provide consultations, especially
among GPs with relatively small patient lists. This role is, however, small compared to other factors such as
patient characteristics.