Calnan M, Groenewegen P P, Hutten J
Centre for Health Services Studies, University of Kent, Canterbury, U.K.
Soc Sci Med. 1992 Jul;35(2):209-16. doi: 10.1016/0277-9536(92)90168-p.
A hypothetical model was proposed for explaining the relationship between general practitioners' system of payment and the amount of time spent in patient and non-patient work. It was hypothesized that GPs reactions to higher workload vary according to the payment system. In this paper we compare two health care systems which have both mixed systems of payment of GPs. In England and Wales up until April 1990 GPs are partly paid by capitation (approx 45% of their income), partly by allowance (38% of their income) and for a much smaller part fee for service (18% of their income). In the Netherlands GPs are paid by capitation for the publicly insured patients (63% of the average practice list) and fee for service for the privately insured patients. We expect (among other things) a stronger, positive relationship between list size and hours worked in the Netherlands and a comparably strong, negative relationship between list size and booking intervals in the Netherlands and in England and Wales. Drawing on data collected from national surveys of GP workload in the Netherlands and England and Wales these propositions were examined. The results of this comparative analysis showed some support for the propositions in that the relation between list size and number of hours worked in patient related activities is stronger in the Dutch setting than in England and Wales, and about the same strength for the relationship between list size and booking intervals.
提出了一个假设模型，用于解释全科医生的薪酬体系与花在患者工作和非患者工作上的时间之间的关系。假设全科医生对更高工作量的反应因薪酬体系而异。在本文中，我们比较了两种都采用全科医生混合薪酬体系的医疗保健系统。在英格兰和威尔士，直到1990年4月，全科医生的薪酬部分按人头支付（约占其收入的45%），部分按津贴支付（占其收入的38%），还有一小部分按服务收费（占其收入的18%）。在荷兰，全科医生为参加公共保险的患者按人头收费（占平均诊所名单的63%），为参加私人保险的患者按服务收费。我们预计（除其他外），在荷兰，名单规模与工作时长之间的正相关关系更强，而在荷兰以及英格兰和威尔士，名单规模与预约间隔之间的负相关关系强度相当。利用从荷兰以及英格兰和威尔士全科医生工作量的全国性调查中收集的数据，对这些命题进行了检验。这一比较分析的结果为这些命题提供了一些支持，即名单规模与患者相关活动工作时长之间的关系在荷兰比在英格兰和威尔士更强，而名单规模与预约间隔之间的关系强度大致相同。
