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Do list size and remuneration affect GPs' decisions about how they provide consultations?

van den Berg MJ, de Bakker DH, Westert GP, van der Zee J, Groenewegen PP - BMC Health Serv Res (2009)

Bottom Line: 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.This role is, however, small compared to other factors such as patient characteristics.

View Article: PubMed Central - HTML - PubMed

Affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.vandenberg@nivel.nl.

ABSTRACT

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.

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Related in: MedlinePlus

The relationship between list size and likelihood of a home visit for small practices with 55% publicly insured patients, small practices with 75% publicly insured patients and small practices with 65% publicly insured patients (average) (male GP in urban group practice, female, publicly insured patient with good self-rated health, other variables are average).
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Figure 2: The relationship between list size and likelihood of a home visit for small practices with 55% publicly insured patients, small practices with 75% publicly insured patients and small practices with 65% publicly insured patients (average) (male GP in urban group practice, female, publicly insured patient with good self-rated health, other variables are average).

Mentions: In the models for home visits (3), we also found a significant interaction between list size and the proportion of publicly insured patients in the small practices (3b). This relationship is displayed in figure 2. It shows that the likelihood of a home visit rises with increasing list size when the proportion of publicly insured patients is relatively small. When this proportion is relatively high, this likelihood decreases with an increasing list size. Yet, it must be noted that the overall chance of a home visit is small in the Netherlands.


Do list size and remuneration affect GPs' decisions about how they provide consultations?

van den Berg MJ, de Bakker DH, Westert GP, van der Zee J, Groenewegen PP - BMC Health Serv Res (2009)

The relationship between list size and likelihood of a home visit for small practices with 55% publicly insured patients, small practices with 75% publicly insured patients and small practices with 65% publicly insured patients (average) (male GP in urban group practice, female, publicly insured patient with good self-rated health, other variables are average).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654894&req=5

Figure 2: The relationship between list size and likelihood of a home visit for small practices with 55% publicly insured patients, small practices with 75% publicly insured patients and small practices with 65% publicly insured patients (average) (male GP in urban group practice, female, publicly insured patient with good self-rated health, other variables are average).
Mentions: In the models for home visits (3), we also found a significant interaction between list size and the proportion of publicly insured patients in the small practices (3b). This relationship is displayed in figure 2. It shows that the likelihood of a home visit rises with increasing list size when the proportion of publicly insured patients is relatively small. When this proportion is relatively high, this likelihood decreases with an increasing list size. Yet, it must be noted that the overall chance of a home visit is small in the Netherlands.

Bottom Line: 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.This role is, however, small compared to other factors such as patient characteristics.

View Article: PubMed Central - HTML - PubMed

Affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.vandenberg@nivel.nl.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus