The Research Unit of Health Economics, University of Southern Denmark, Odense, Denmark.
Health Econ. 2012 Jun;21(6):619-32. doi: 10.1002/hec.1731. Epub 2011 Apr 12.
Because of problems with recruiting GPs to deprived areas in Denmark, it has been discussed whether the mixed remuneration scheme is flexible enough to compensate GPs serving patients with high need for services. The objective is to assess how patient heterogeneity affects list size, income and total utility of GPs operating under a mixed remuneration scheme. We adapt the model by Iversen (2004) as a theoretical framework for analysing the consequences of patient heterogeneity in a mixed remuneration system. We use a data set of Danish solo practitioners to analyse the effect of patient complexity on list size and income. From the theoretical model we find that higher levels of patient complexity lead GPs to choose a lower list size, whereas the effect on income is ambiguous. The effect on total utility (income and leisure) is, however, shown to be negative. Using empirical data from 1039 solo practices we find that patient complexity reduces both list size and income and conclude that a mixed per capita and fee for service remuneration system does not fully compensate practices with more complex patients. Differentiated per capita payment may represent a means of ensuring fair and equal income of GPs.
由于在丹麦贫困地区招聘全科医生存在问题，因此有人讨论混合薪酬方案是否足够灵活，以补偿为高服务需求患者服务的全科医生。目的是评估患者异质性如何影响在混合薪酬方案下运作的全科医生的名单规模、收入和总效用。我们采用 Iversen（2004 年）的模型作为理论框架，分析混合薪酬体系中患者异质性的后果。我们使用丹麦个体从业者的数据集来分析患者复杂性对名单规模和收入的影响。从理论模型中我们发现，更高水平的患者复杂性导致全科医生选择较低的名单规模，而对收入的影响则不明确。对总效用（收入和休闲）的影响则是负面的。利用来自 1039 个个体执业的实证数据，我们发现患者的复杂性降低了名单规模和收入，并得出结论，按人头和按服务收费的混合薪酬制度并不能完全补偿患者更复杂的实践。差异化的人头费支付可能是确保全科医生公平和平等收入的一种手段。
