DOCTOR AND PATIENT CHARACTERISTICS AS MODIFIERS OF THE EFFECT OF A CHANGING REMUNERATION SYSTEM IN GENERAL-PRACTICE

The objectives of the study was to investigate the effects on general practitioners' activities of a change in their remuneration system fro m a capitation-based system to a mixed fee-per-item and capitation-bas ed system. It was our hypothesis that the effect of the change in remu neration varied between subgroups of doctors and patients as a result of the modifying effect of the doctors' age, sex, practice facilities, assistance, side jobs, and size of practice as well as patients' age, sex, and diagnostic group. The study was carried out as a follow-up w ith data collected from contact sheets completed by general practition ers in one period before a change in remuneration and two periods afte r. These data were supplemented by a questionnaire on doctors' charact eristics as well as by health insurance data on population characteris tics. The general increases in diagnostic and curative activities and reductions in referrals by general practitioners as a result of the ch ange were found to be quite similar across subgroups of doctors and pa tients. While, total contact rates changed little, the sex of doctors showed a modifying effect: male doctors tended to increase their conta ct rates compared to female doctors. This tendency was most prominent among female patients with non-infectious diseases. This study is part of a larger project carried out by a Danish-Dutch research group cons isting of the authors and Peter P. Groenewegen, Poul A. Pedersen, Pete r v. Scholten, Gavin Mooney, Mogens Trab Damsgaard, and Henk Flierman.