Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
6.1.1.1. Thee
Netherlands
Two Dutch stud
bulletin from th
thesis study wri
The ‘Vereniging
all (approx 130
Million inhabita
posts, based on
GP cooperativ
consultation in
Giesbers 103 dies/sources have
e Vereniging Huis
itten by Giesbers
(20
patients belon
consulted an e
author assumed
their medical p
model, estimate
expensive com
times more exp
6.1.1.2. Den
1
e been identified for the cost analy
sartsenposten Ne ederland
103
.
g Huisartsenposteen
Nederland is a
0) after-hours posts,
covering the
ants. It publishes a yearly bulletin
n a survey amongg
its members. In 2
es (125) were € 225 Million. T
GP cooperatives is € 63, i.e. about
009) analyzed thhe
medical and
ging to one ODDC
(“het Weesh
emergency departtment
(ED) witho
d that those patients
would have ha
roblem. His studyy,
based on hypo
es that ED care ( (estimated around
pared to care provided
by the usua
pensive comparedd
to care provided
nmark
102 ysis: the
and a master
a powerful organizzation
of
e Dutch populatioon
of 16
n about the costss
of the
2009, the total costs
of all
The cost per afteer-hours
t € 14 per inhabitaant.
financial data’s of 203
huis” in Nijmegeen)
who
out referral by a GGP.
The
ad to consult the ODC for
otheses and a calculation
d € 256) is 5 timees
more
al GP (around € 48)
and 3
by ODC (around € 92).
The Research Unit for GP at the Aarhus Univ versity provided detailed
financial data, bbut
the total amouunt
spend on after r-hours care is misssing.
The fee per pattient
contact is paaid
by the regions s but the costs forr
running
the GP cooperaative
are paid by the GP organizat tion. All GPs pay a yearly
sum of € 268.25
to the GP organization.
This sum m covers the workk
related
to the planning of shifts, IT-suppoort,
transportation n during shifts, etcc.
Affter-Hours
Primaary
Care
TTable
12 : Fees eearned
by Danissh
GPs accordinng
to type of meedical
aact
and time of thhe
day (€)
CContact
type:
Mon-Fri from 4 MMon-Fri
10-12 p.m. and
00-8
-10 p.m.
a.m.
Sat from 8 a.m. SSat
8-12 p.m. and 00-88
a.m.
to 10 p.m. SSundays
and holidayss
8-12
p.m. and 00-8 a.mm.
TTelephone
consultation
11.67
14.89
TTelephone
contact (wwith
referral to
cconsultation
in the clinic)
5.1
6.3
CConsultation
in clinicc
(face-to-face
ccontact)
24.01
29.91
HHome
visits
33.4
40.91
SSource:
Research UUnit
for General Praactice
of the Universsity
of Aarhus
66.1.1.3.
Unitedd
Kingdom
In
UK, the National
Audit Office sccrutinizes
public e
oof
the British Parlliament.
Its 2006 report gives glo
pprovision
of after-hhours
care and soome
useful cost da
AAfter-hours
services
are funded byy
a combination of
ccentral
developmeent
funds. Since April 2004, GPs
rresponsibility
of orrganizing
after-hoours
services but
aaverage
of € 6.8880
and pass on reesponsibility
to the
( PCT). The systemm
lays on contracct
and tendering:
ddirectly
influenced by the pay rate thhat
the GP asks to
A total amount off
€ 369 Million wwas
available for
hhours
services in 2005-2006, allocated
by the Depa
aamount
is undereestimated:
a surveey
by The Nation
PPCTs
reported thaat
the contractuaal
cost of providin
wwas
€ 423 Million and the actual coost
was € 436 Mill
inndicate
that the ccosts
of after-hours
are higher in P
TThe
National Audit
Office concludees
that a model w
uurban
area cannott
be transferred too
a rural area
TThe
survey also sshows
a wide dis
aand
other factors pplay
a role: the av
bbe
nearly doubled during a bank ho
104 expenditures on b
bal information o
atas
.
stribution of pay r
verage weekday e
oliday, when the a
104 behalf
on the
.
f GP contributionss
and
s may opt out oof
the
they give up yearrly
an
eir Primary Care Trust
PCT expenditurees
are
o the PCT.
the provision of afterartment
of Health.
This
nal Audit Office among
ng after-hours serrvices
ion. These resultss
also
PCTs from rural aareas.
which works well in an
rates for GPs. Ruurality
evening rate (€ 677)
can
verage rises to €1119.
55