Regional differences in adherence to the experimental remuneration scheme for family doctors to january 2000
DOI:
https://doi.org/10.32385/rpmgf.v19i3.9937Keywords:
Family Doctor, Payment System, Professional Satisfaction, Incentives, Organization and Administration, Health System ReformAbstract
In this paper we explore the reasons leading to differences in adherence to the experimental payment system (EPS) until January 2000. Adherence was defined as the forwarding of declarations of intention by a group of doctors starting a negotiation process with the administration on the terms for a work program. Semi-structured interviews to a selected sample of key informants who had a role in the conception and implementation of the EPS were performed. Content analysis of the interviews was made for EPS characteristics, measures taken to disseminate knowledge and information about the EPS, lessons learned in the process, payment of other health professionals, expectations about the evolution of the EPS and reasons for the regional differences in adherence to EPS. This study shows communication deficiencies between the different levels of health administration, because of different perceptions of the project between those who conceived it and those who had implementation responsibilities. It seems it is possible to have management responsibilities in the National Health Service (NHS) explicitly ignore national strategies and programs. Factors indicated for different regional adherence are on the whole of two kinds: relating to local characteristics and related to health administration commitment and the assumption, either explicit or not, of the EPS as a priority. Most probably different adherence levels are more related to administration commitment than to local factors. Openness and availability of the administration to this project was paramount. A clearer process for defining national priorities, how to involve in the definition of projects those who will be responsible for their implementation and improving communication between the different levels of the health administration seem necessary steps. Mechanisms binding NHS managers to national strategies, along with accountability measures, are essential.Downloads
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