REMUNERATION OF GP SERVICES - TIME FOR MORE EXPLICIT OBJECTIVES - A REVIEW OF THE SYSTEMS IN 5 INDUSTRIALIZED COUNTRIES

The paper examines the nature and use of GP remuneration systems as in struments of health policy in five different countries - Australia, Ca nada, Denmark, Norway and the UK. Since doctors are not naturally effi cient, they need to be encouraged to adopt efficient practices. The pa per indicates that while there are great differences in the nature and level of remuneration across the five countries, there is little evid ence that policy-makers in these countries have given adequate thought to how to use remuneration to influence the activities of GPs. In all five countries except the UK the objectives of GP services are somewh at vague and largely non-operational. The designs of the remuneration systems seem directed more towards deciding doctors' income levels and controlling public expenditure than towards meeting health care objec tives. The remuneration for similar services varies widely across the five study countries. There is a need to clarify what the objectives o f general practice are and thereafter to experiment more with GP remun eration systems to determine how best to get doctors to meet these obj ectives efficiently.