GPS' CHOICE OF SERVICES IN A PUBLIC HEALTH CARE SYSTEM WITH FINANCIAL INCENTIVES

Purpose: The Norwegian Health Care Coordination Reform aims at moving services from hospitals to primary care as much as possible. Being the cornerstone of primary care, general practitioners (GPs) are reimbursed in part by fee-for-service. The aim of the study was to investigate whether GPs in practice meets the objectives of the Coordination Reform. 

Method: We used the complete national GP reimbursement registry for the period 2006 – 2013. We included GPs who had at least 1,000 office visits each of the study years. We extracted data on GPs’ gender, age, number of patients on the list, practice setting (urban/rural), and number of minor surgical procedures and IUD insertions per year.

Result: In total 5048 (96.7%) of practicing GPs met the inclusion criteria among which 74.0% and 75.9% were reimbursed at least once for minor surgery and IUD-insertion, respectively. During the study period, the mean annual number of minor surgical procedures per GP increased from 12.7 to 16.1 while the number IUD decreased from 6.4 to 5.2. Female GPs performed less minor surgery and more IUD-insertions than their male colleagues. GPs in rural areas performed more minor surgery and less IUD-insertions than those in urban areas. Young GPs (<30) performed the most minor surgery while GPS aged 40-49 performed most IUD insertions. GPs above age 60 performed fewer of both procedures.

Logistic regression analyses showed that male doctors were more likely to perform minor surgery (OR 2,84 (95% CI 2,68 - 3,02)), but less likely to perform IUD-insertions compared to their female colleagues (OR 3,98 (95% CI 3,69 - 4,29)), while other covariates were insignificant.

Conclusion: We show that approximately one in four GPs never offered minor surgical procedures or IUD-insertion any time during the eight year period, indicating that the Coordination Reform has not been successful. Further, we show that gender influence the likelihood of what type of health care offer the patients in Norway get. We also show that there is a decline in procedures despite a “fee-for-service” payment for the GP, indicating that economic compensation might not be a deciding factor for GPs in Norway when choosing to perform IUD-insertions.