Download the report (150 p.) - KCE

More documents

Recommendations

Info

108 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 6.6.4 Summary: new policies according to the stakeholders Some major themes emerged in the new policies mentioned by the stakeholders: 1. The society is changing. The patient should be educated to use properly the health care system. The young GPs privilege their private life to a career and are not ready to accept any patient’s will. The current tendency to work in group practices seems a solution for most problems including duty, continuity and training. 2. Medicine is changing with a growing bulk of information. This implies a modification of the lectures, of the continuous medical education and of the selection of the information by the GP to decrease the workload. The organization of the profession should be under the responsibility of the GPs themselves: the promotion of some spots to install a practice, the follow-up of the duty service, the links with hospitals, specialists and other health care professionals from the first line. 3. The GP’s role in the health care system is crucial: he knows best the patient. However, the increasing need for scientific knowledge urges for a multidisciplinary approach (during training, during practice and in all aspects of collaboration). 4. Money is not essential although it is necessary and it will help to overcome some great difficulties (duty, computing). Other incentives are more important e.g., social status, maternity leaves, help in socially deprived zones. 6.7 WHY DO THE STAKEHOLDERS PREFER SOME POLICIES? 6.7.1 Introduction In the previous part, policies were prioritized according to their scores or ranks. However, this does not explain why some policies are preferred or discarded. Even if some policies got a decent score, none reached a majority as the first-preferred policy: the highest mean rank was 1.81 for the integration of a GPs’ perspective into the master courses (teaching topic) and 1. 91 for the support of an evolving career (work-life topic). Conversely, very popular policies being today considered or having been recently implemented (such as the increase of the consultation fees) received a low support (mean rank of 2.69). If one wishes to implement a policy, it is important to anticipate why some policies are either preferred or rejected. Understanding the hurdles to be faced is a first step into figuring out how to take them seriously into account or to bypass them. There are two ways of doing that: considering policy criteria and stakeholders characteristics. First, health policy decision making depends on how well these policies meet different values, that we called “the criteria”. According to previous researches on health care 198 , 204 , 207 , the choice of a particular policy depends on how well it fulfils the values that a stakeholder has in mind. In this research the policies to improve GP’s attraction, recruitment and retention were assessed on 4 criteria (see method). The first question to ask is therefore “What is the contribution of these criteria to the stakeholder’s choice?” Second, another tenet of this research is that different policies can command varying support from different groups, because groups do not have the same objectives, do not face the same accountability rules and, finally, do not share the same socialization and decision-making opportunities. For example, GPs may feel much more responsible for their patient while policy-makers may feel much more liable for the society perspective. But there are many characteristics that matter. Indeed, a stakeholder belongs to different interest groups, to different language communities, he may have been trained as a physician or not, he may work for an organisation having high or low power on the issue. Stakeholders may have different understanding of the issues and may have, as an
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 109 6.7.2 Method individual, a different influence on the policy process. The second section of this chapter aims at answering the following question: does who you are and the group to which you belong command the policy you will support or discard? This approach analyzes criteria weights in general. But these weights can have very different meanings depending on the topic and on the precise alternative the stakeholder is facing. Another approach is to analyze the choice made by the stakeholder and to relate it to the criteria value. The influence of the criteria on the choice will use the conditional logit while the analysis of stakeholder characteristics will use the multinomial logit. The difference between these two techniques is that the multinomial logit (MNL) analyzes the choice probabilities in relation to the stakeholder’s characteristics whereas in the Mc Fadden conditional logit model the choice probability depends on the choice characteristics, that is on the criteria 221 . In the conditional logit model, each observation is an alternative. That is for each topic, an individual has as many observations as there are policies to be chosen. For example, the teaching topic had 4 policies scored by 102 stakeholders, which results in 408 observations. Thus, in conditional logit, the observation is the choice. Because the individual tends to be repeated, we introduced correlation across choices (an individual is repeated n time where n is the number of policies: 4 for teaching, 5 for financing, 5 for work-life balance and 10 for organization policies). To account for such correlation, a multinomial probit was used. SAS version 9 was used to estimate these two models, respectively with proc mdc and proc genmod. 6.7.3 Results: influence of criteria 6.7.3.1 Overall analysis The first part of this result section analyzes the average mean value given to each criterion. These values are the weight that stakeholders were willing to give to each policy criteria in general. The interviewees were asked to make their weighting with two perspectives: a societal perspective and a GP’s perspective. From a societal perspective, the most important criterion was the attractiveness of the general practice with a weight of 83.7 (table 10). Cost-benefit to the society and accessibility of care had a tied-second position (with a weight of 76) while acceptance by the other professionals had the lowest weight 53 33 . There were differences between group types (figures 9 and 10) although none of them were statistically significant under the Kruskal-Wallis sum of rank test. Policy-makers and media gave a higher weight to the cost-benefit to the society and acceptance by other professionals was more important for the universities and the unions than for the other groups. From the GP’s perspective, quality of life was the most important criterion, next to clinical interest, income and work-environment. The criterion of the power of the GPs had the lowest weight (53.7). There were slight differences between stakeholders groups (figure 9). None of them was statistically significant (under the F-test) except for autonomy (F=3.5, p
Page 1 and 2:
Making general practice attractive:
Page 3 and 4:
Making general practice attractive:
Page 5:
Layout : Wim Van Moer Brussels, 27t
Page 8 and 9:
ii Making General Practice Attracti
Page 10 and 11:
iv Making General Practice Attracti
Page 12 and 13:
vi Making General Practice Attracti
Page 14 and 15:
2 Making General Practice Attractiv
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
10 Making General Practice Attracti
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71: 58 Making General Practice Attracti
Page 112 and 113: 100 Making General Practice Attract
Page 148 and 149: Registration of copyright : D/2008/
show all

Download the report (150 p.) - KCE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?