Income development of General Practitioners in eight European countries from 1975 to 2005.

BACKGROUND: 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? METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Variations in influenza vaccination coverage among the high-risk population in Sweden in 2003/4 and 2004/5: a population survey.

BACKGROUND: In Sweden, the vaccination campaign is the individual responsibility of the counties, which results in different arrangements. The aim of this study was to find out whether influenza vaccination coverage rates (VCRs) had increased between 2003/4 and 2004/5 among population at high risk and to find out the influence of personal preferences, demographic characteristics and health care system characteristics on VCRs. METHODS: An average sample of 2500 persons was interviewed each season (2003/4 and 2004/5). The respondents were asked whether they had had an influenza vaccination, whether they suffered from chronic conditions and the reasons of non-vaccination. For every county the relevant health care system characteristics were collected via a questionnaire sent to the medical officers of communicable diseases. RESULTS: No difference in VCR was found between the two seasons. Personal invitations strongly increased the chance of having had a vaccination. For the elderly, the number of different health care professionals in a region involved in administering vaccines decreased this chance. CONCLUSION: Sweden remained below the WHO-recommendations for population at high risk due to disease. To meet the 2010 WHO-recommendation further action may be necessary to increase vaccine uptake. Increasing the number of personal invitations and restricting the number of different administrators responsible for vaccination may be effective in increasing VCRs among the elderly.

Bismarck or Beveridge: a beauty contest between dinosaurs.

BACKGROUND: Health systems delivery systems can be divided into two broad categories: National Health Services (NHS) on the one hand and Social Security (based) Health care systems (SSH) on the other hand. Existing literature is inconclusive about which system performs best. In this paper we would like to improve the evidence-base for discussion about pros and cons of NHS-systems versus SSH-system for health outcomes, expenditure and population satisfaction. METHODS: In this study we used time series data for 17 European countries, that were characterized as either NHS or SSH country. We used the following performance indicators: For health outcome: overall mortality rate, infant mortality rate and life expectancy at birth. For health care costs: health care expenditure per capita in pppUS$ and health expenditure as percentage of GDP. Time series dated from 1970 until 2003 or 2004, depending on availability. Sources were OECD health data base 2006 and WHO health for all database 2006. For satisfaction we used the Eurobarometer studies from 1996, 1998 and 1999. RESULTS: SSH systems perform slightly better on overall mortality rates and life expectancy (after 1980). For infant mortality the rates converged between the two types of systems and since 1980 no differences ceased to exist.SSH systems are more expensive and NHS systems have a better cost containment. Inhabitants of countries with SSH-systems are on average substantially more satisfied than those in NHS countries. CONCLUSION: We concluded that the question 'which type of system performs best' can be answered empirically as far as health outcomes, health care expenditures and patient satisfaction are concerned. Whether this selection of indicators covers all or even most relevant aspects of health system comparison remains to be seen. Perhaps further and more conclusive research into health system related differences in, for instance, equity should be completed before the leading question of this paper can be answered. We do think, however, that this study can form a base for a policy debate on the pros and cons of the existing health care systems in Europe.

Direct access in primary care and patient satisfaction: a European study.

OBJECTIVE: This study addressed the question to what extent gate-keeping or direct access to health care services influences the satisfaction with GP-services by the population in 18 European countries ("old" EU-countries plus Norway, Iceland and Switzerland). METHODS: Two datasets were collected. Firstly, country experts were asked to indicate for 17 different health care providers whether they were directly accessible. A direct accessibility scale was computed from the percentage of services that were directly accessible. Secondly, for patient satisfaction the EUROPEP study was used. This dataset contained information about patient satisfaction with general practitioners services in 14 European countries. RESULTS: If more health care providers were directly accessible in a country, patients showed a higher satisfaction with general practice than in countries where more referrals were required (Pearson's r = 0.54, p = 0.05). Satisfaction with organisational aspects of general practice (concerning amongst others waiting time and possibilities to make appointments) correlates significantly with a high score on our direct accessibility measure (Pearson's r = 0.67, p = 0.01). Satisfaction with patient physician communication (Pearson's r = 0.46, p = 0.10) and medical technical content of the care (Pearson's r = 0.41, p = 0.14) are not influenced by direct accessibility. CONCLUSIONS: Direct accessibility appeared to be important for patients. Apparently, if patients have freedom of choice for the type of health care provider, they evaluate the GP-services more positively. However, this mainly concerns satisfaction with organisational aspects of GP-services; the accessibility does not influence patient's judgement about the actual care provided by their GP.

Does a population survey provide reliable influenza vaccine uptake rates among high-risk groups? A case-study of The Netherlands.

All European countries have recommendations for influenza vaccination among the elderly and chronically ill. However, only a few countries are able to provide data on influenza uptake among these groups. The aim of our study is to investigate whether a population survey is an effective method of obtaining vaccination uptake rates in the different risk groups and to find out what reasons people give as to why they have accepted or refused influenza vaccination and whether this varies among the risk groups. A mail questionnaire was sent out to households in The Netherlands, the response rate was 73%. This resulted in data for 4037 individuals on influenza and influenza vaccination during the 2001-2002 influenza season. The uptake rates and size of different risk groups from the panel survey were comparable with other national representative sources (from the National Information Network of GPs (LINH) and Statistics Netherlands (CBS)). The main reason cited for undergoing vaccination was the existence of a chronic condition. The main reasons for refraining from vaccination were having enough resistance to flu and ignorance about the recommendations. In The Netherlands, the GP is the main administrator of influenza vaccines. We believe that population surveys may be useful for revealing influenza vaccination uptake rates for the groups at risk. When combined with questions about reasons for undergoing vaccination, the results may provide useful policy information and can be used to direct vaccination campaigns at under-vaccinated risk groups or to target the information campaign more effectively.