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GP Voluntary Prepaid Fee for Better Service

Country: 
Neuseeland
Partner Institute: 
The University of Auckland
Survey no: 
(1)2003
Author(s): 
Health Policy Issues: 
Finanzierung, Vergütung
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein ja nein nein nein nein nein

Abstract

In New Zealand, general practitioners have been traditionally funded through fee-for-service payment. A single general practitioner has invited his patients to pay an annual fee of ?228.6 over and above the existing copayments for consultations. In return for the extra payment, the doctors is offering improved quality of service such as guaranteed appointments, direct cellphone access, home visits and longer consultations.

Purpose of health policy or idea

  • Objectives: To ensure the sustainable funding of a general practice and to provide a higher quality of service for people who are willing and able to pay.
  • Characteristics: This is a one-off idea introduced (so far) by a single general practitioner. This doctor has written to 700 of his patients and invited them to pay an annual fee of NZ $440 per year (NZ$660 per couple), over and above the existing copayments for consultations. In return for the extra payment, the doctors is offering improved quality of service such as guaranteed appointments, direct cellphone access, home visits and longer consultations. The GP recognises he will loose patients but hopes that he will be able to focus his energies on those people who are willing to pay more for his services.
  • Incentives: The scheme is likely to attract wealthy, high user patients who are willing to pay for a higher quality of service. These patients currently are not eligible for any subsidy from the government. Copayments for a GP consultation are set by each individual GP but average around NZ$42 per visit. The GP has an incentive to develop services that fit the needs of these types of patients.
  • Affected groups: 1) Prepaying patients: presumably they should receive a better service. 2) Ex-patients: Although the GP is still willing to provide services to people who do not pay the prepayment, prepaid patients will receive priority. Some patients have therefore changed to other GPs, either because they expect second-class treatment or simply because they are philosophically opposed to the scheme. 3) Other general practices in the area who benefit from additional patients.

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell innovativ innovativ
Kontroversität unumstritten kontrovers kontrovers
Strukturelle Wirkung marginal marginal fundamental
Medienpräsenz sehr gering gering sehr hoch
Übertragbarkeit sehr systemabhängig recht systemabhängig systemneutral

Political and economic background

This is a small initiative introduced only by one general practitioner to date. It is reported here because the introduction of Primary Health Organisations and the shift towards capitation funding of general practice across the country more widely could result in much dissension amongst GPs (See Questionnaire reported as No. New Zealand – 1). One possible response to this dissension is a more general shift towards the complete private funding of general practice through mechanisms such as the one described here. While this particular initiative was driven by the perceived under-funding of general practice, rather than by the move to PHOs, the move to PHOs could stimulate further development or similar initiatives.

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein ja nein nein nein nein nein

Origins of health policy idea

This idea was apparently generated and implemented by a single general practitioner. It is entirely new for New Zealand, where general practice has traditionally been funded on a fee-for-service basis, either by the government (through subsidies) or by patients (through copayments). However the scheme has obvious parallels with prepaid schemes elsewhere, especially in the USA. An important difference appears to be the maintenance of a relatively high copayment for each consultation over and above the prepayment.

Stakeholder positions

  • Although the idea has not as yet spread to other GPs, the Royal College of GPs has expressed an understanding of the motivation that lies behind the scheme. That is a desire to provide a higher quality of service to fewer patients.
  • The scheme has attracted criticism from the Minister of Health on the grounds that it is contrary to the national goal of reducing inequalities in access to and use of health services.
  • The scheme has also attracted some criticism from public commentators, also on the grounds of equity. Even so, there is an element of support for the notion of "let the market decide if this is a winner or not". If people are willing to pay for the extra service, they should be allowed to do so.

Influences in policy making and legislation

No

Adoption and implementation

Because this is a small, isolated initiative, developed by a single practitioner, none of these questions are relevant – yet! However if the idea spreads more widely to other practices, then more stakeholders will be involved. I’ll report at a later date if this occurs.

Monitoring and evaluation

No. The impact will be for the market to decide.

Expected outcome

This policy will a) increase the price of general practice consultations (b) reduce access by lower income groups c) increase inequalities in access to services d) improve the quality of service for high income groups. While all of these are obviously contrary to national policy objectives, the GP concerned would possibly regard these outcomes of proof of the success of his scheme.

References

Empfohlene Zitierweise für diesen Online-Artikel:

. "GP Voluntary Prepaid Fee for Better Service". Health Policy Monitor, 20030507. Available at http://www.hpm.org/survey/nz/a1/1