Download the report (150 p.) - KCE

KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 101
approach of psychology and communication, new lectures about forensic medicine,
patient’s rights, the structure of the health system, developing the clinical feeling as well
as the critical thinking. Suggestions regarding the duration of the lectures i.e., shorter
and more targeted, were also made.
The second theme in the open-ended comments is the multidisciplinary approach that
seems important for all stakeholders with various suggestions of studying together
during the first years of studies in order to develop a sense of health community.
Finally, the knowledge of the profession is the third theme mentioned: lectures about
administrative work, difficulties and how to react, participation to meetings of
professionals are proposed.
6.6.2.2 Financing policies
The literature review showed that financing policies have an important place in
attracting the young professionals in the practice. In this study, the competition was
very tied regarding financing policies. Most policies had a rank between 2.34 and 2.71
(table 17). However, one policy recorded a higher preference: the capitation in
addition to other fee-for-service got a mean rank of 1.90. This policy has, however, a
mean score of 4.97 and comes next to “incentives for the installation in an underserved
geographical area” which got a mean score of 5.14.
This difference can be explained by the fact that capitation is rather new in the Belgian
context despite having a smaller score than the Impulseo related policy (incentives for
the installation in an underserved geographical area).
Table 17: Preferred financing policies: mean ranks and scores (n=102)
Financing policies
Mean Mean
rank score
1. Capitation in addition to other fee-for-service 1.90 4.97
2. Increase the consultation fees 2.34 4.08
3. Incentives for the installation in an underserved geographical area 2.47 5.14
4. Target or quality of care payment in addition to other fee-for-service 2.66 4.73
5. Combining wage-earning and fee for service 2.71 4.33
The qualitative comments show that capitation seems interesting to get the patient’s
loyalty and to improve the GP’s central role in the health care system. However; the
fixed price should not be paid by the patient but directly by the Sickness funds directly.
This measure should be enlarged to the on-call duties too. In addition, fear of control
is mentioned. Other measures are suggested: a fixed price for the duty and a decrease
of the price of the drugs.
The policy that got the highest mean rank (2.71) and was thus the most discarded was
the combination of wage earning and fee for service (mean score of 4.33).
The term “wage-earning” was shocking for most interviewees: this idea is against their
conception of an independent profession paid through fee-for-service. Moreover, they
did not understand how this could be implemented in practice. Finally, for a few of
them it is far too expensive for the society. Others think it is a current tendency
because it will offer economic comfort to the GP and allow him to better practice
medicine. However, the patients should not pay the out-of-pocket expense too much
though they should not believe the care is totally free. Diversifying the payment is a
good solution for most of the respondents, combining a fixed price for practicing, a
fixed price per patient (global medical record for example) and some additional
payments for special acts. Some interviewees suggested other forms of remuneration
linked to continuous training, to computing and to be on duty.
Choosing financing policies was more complicated as shown by the less contracted
scores and ranking of these policies compared to the learning policies. Figure 3 helps to
explain these results. Capitation in addition to other fee-for-service and the increase of
the consultation fees were both good for improving the attraction-retention of GPs and