Modes de rémunération des médecins généralistes : quelles conséquences ?
; ; et al
in Exercer (2015), 119
Introduction. The health reform law crystallizes the tensions between the different health system players. Besides the specific issue of third-party payment, which will be addressed in an upcoming article ... [more ▼]
Introduction. The health reform law crystallizes the tensions between the different health system players. Besides the specific issue of third-party payment, which will be addressed in an upcoming article, some professional organizations wish to strengthen fee for servicies while others call for more mixed forms of remuneration. Many economic analyses were conducted to study the benefits and limits of each mode of physician compensation. This article offers a synthesis of the literature about these modes: fee for service, capitation, payment performance and wage labor. Method. Collaborative literature analysis between doctors and health economist. The databases searched were MEDLINE, the Cochrane Library and CAIRN. Results. Each mode has specific benefits and limits for the financer, the physicians and the patients. Fee for services increases physician productivity but may increases health spending. Capitation and salary decrease care supply but might help to control health spending and to develop preventive activities. The effectiveness of pay for performance is now being questioned. The current trend is to promote mixed forms of remuneration, hoping to combine the advantages and limit the share of defects of each modality. The complexity of such systems makes it difficult to compare from one country to another. Discussion. The choice of a mode by the financer must take into account both the possible combinations of different payment methods and the developments or societal aspirations to meet population health needs. [less ▲]Detailed reference viewed: 16 (2 ULg)
Les médecins généralistes belges francophones peuvent-ils améliorer leurs performances en prévention ? Une étude qualitative
Vanmeerbeek, Marc ; Belche, Jean-Luc ; Lemaître, Anne-Françoise et al
in Exercer (2013), 107
Background In French-speaking Belgium, success in implementing preventive care remains below expectations, with a socioeconomic gradient. Could GPs contribute to reduce these differences? Objectives The ... [more ▼]
Background In French-speaking Belgium, success in implementing preventive care remains below expectations, with a socioeconomic gradient. Could GPs contribute to reduce these differences? Objectives The study aims at knowing the representations of French-speaking GPs towards their preventive healthcare. The results will be used in a survey assessing the determinants of their involvement in a more systematic and equitable preventive healthcare delivery. Methods We conducted semi-directed interviews with French-speaking GPs. The content was analyzed in a thematic way with reference to the Walsh & McPhee systems model of clinical preventive care to retrieve the predisposing, reinforcing, and enabling factors. Results Preventive healthcare was limited by GPs’ specific interests and psychology. Some clinical and relational skills were sometimes lacking. The information sources were sometimes of poor quality. The lack of organizational skills hindered collective management or systematization towards equity. Media and pharmaceuticals influenced preventive healthcare. GPs wished a specific funding; possibly by “Pay for Quality”. Self assessment was too rare to be a reinforcement factor. Preventive processes were often introduced in an opportunistic way, due to the lack of time. Data circulation and coordination between the various providers was poor. A primary care focused healthcare delivery was suggested. Conclusions Conditions to tackle health inequalities towards preventive healthcare don’t seem to be present at now. To achieve this goal, GPs should be more proactive and develop their practice in a more community-oriented way. However, more research is needed to assess their personal motivation for change. Health authorities should determine a delimitation of competencies and responsibilities and provide organisational support. [less ▲]Detailed reference viewed: 78 (28 ULg)
A la recherche du consensus : quelle méthode utiliser ?
; Vanmeerbeek, Marc
in Exercer (2011), 99
Consensus methods allow answering questions for which published information is lacking. Among these qualitative methods, the Delphi procedure and the nominal group technique provide quantitative ... [more ▼]
Consensus methods allow answering questions for which published information is lacking. Among these qualitative methods, the Delphi procedure and the nominal group technique provide quantitative estimations.They consist in a systematised and structured synthesis, based on iterative procedures (questionnaires or meetings), and can be conducted quickly and cheaply. They integrate empirical data available with the judgment and experience of the participants, possibly including patients’ representatives. These methods can limit domination effects and conflicts of interest. Examples of use are presented, especially in the field of quality of care assessment. The Delphi procedure does not require any face-to-face meeting and preserves anonymity of answers, whereas the nominal group technique offers more interactivity. [less ▲]Detailed reference viewed: 200 (18 ULg)