Kroneman Madelon W, Van der Zee Jouke, Groot Wim
Netherlands Institute of Health Services Research, Utrecht, The Netherlands.
BMC Health Serv Res. 2009 Feb 9;9:26. doi: 10.1186/1472-6963-9-26.
This study aims to gain insight into the international development of GP incomes over time through a comparative approach. The study is an extension of an earlier work (1975-1990, conducted in five yearly intervals). The research questions to be addressed in this paper are: 1) How can the remuneration system of GPs in a country be characterized? 2) How has the annual GP income developed over time in selected European countries? 3) What are the differences in GP incomes when differences in workload are taken into account? And 4) to what extent do remuneration systems, supply of GPs and gate-keeping contribute to the income position of GPs?
Data were collected for Belgium, Denmark, Germany, Finland, France, the Netherlands, Sweden and the United Kingdom. Written sources, websites and country experts were consulted. The data for the years 1995 and 2000 were collected in 2004-2005. The data for 2005 were collected in 2006-2007.
During the period 1975-1990, the income of GPs, corrected for inflation, declined in all the countries under review. During the period 1995-2005, the situation changed significantly: The income of UK GPs rose to the very top position. Besides this, the gap between the top end (UK) and bottom end (Belgium) widened considerably. Practice costs form about 50% of total revenues, regardless of the absolute level of revenues. Analysis based on income per patient leads to a different ranking of countries compared to the ranking based on annual income. In countries with a relatively large supply of GPs, income per hour is lower. The type of remuneration appeared to have no effect on the financial position of the GPs in the countries in this study. In countries with a gate-keeping system the average GP income was systematically higher compared to countries with a direct-access system.
There are substantial differences in the income of GPs among the countries included in this study. The discrepancy between countries has increased over time. The income of British GPs showed a marked increase from 2000 to 2005, due to the introduction of a new contract between the NHS and GPs.
本研究旨在通过比较研究的方法，深入了解全科医生收入的国际发展趋势。本研究是早期一项研究（1975 - 1990年，每五年进行一次）的延续。本文要解决的研究问题是：1）一个国家全科医生的薪酬体系如何特征化？2）在选定的欧洲国家，全科医生的年收入随时间如何发展？3）考虑工作量差异后，全科医生的收入有哪些差异？以及4）薪酬体系、全科医生供应和守门制度在多大程度上影响全科医生的收入状况？
收集了比利时、丹麦、德国、芬兰、法国、荷兰、瑞典和英国的数据。查阅了书面资料、网站并咨询了国家专家。1995年和2000年的数据于2004 - 2005年收集。2005年的数据于2006 - 2007年收集。
在1975 - 1990年期间，经通胀调整后，所有被审查国家的全科医生收入均有所下降。在1995 - 2005年期间，情况发生了显著变化：英国全科医生的收入升至最高水平。除此之外，顶端（英国）和底端（比利时）之间的差距大幅扩大。无论收入的绝对水平如何，执业成本约占总收入的50%。基于每位患者收入的分析得出的国家排名与基于年收入的排名不同。在全科医生供应相对较多的国家，每小时收入较低。薪酬类型似乎对本研究中各国全科医生的财务状况没有影响。在实行守门制度的国家，全科医生的平均收入比实行直接就诊制度的国家系统性地更高。
本研究涵盖的国家之间，全科医生的收入存在显著差异。随着时间的推移，各国之间的差异有所增加。由于英国国民医疗服务体系（NHS）与全科医生之间引入了新合同，英国全科医生的收入在2000年至2005年期间显著增加。
