Background
Hungary | Italy | Spain | Lithuania | Finland | Estonia | Germany | |
---|---|---|---|---|---|---|---|
Model type | PHC based on individual generalists | PHC based on individual generalists | PHC based on individual generalists and PHC based on group practices | PHC based on group practices | PHC through health centers | PHC through health centers | PHC based on choice of specialists’ services |
Model homogenity | Mainly solo practices | 75% solo practices | 40% solo practices, 60% group practices | 75% group practices | 100% health centers | 100% health care centers | Mainly ambulatory care specialists in solo practices and some polyclinics |
PC practice ownership | Private | Private | Private | 75% public, 25% private | 98% public | Public | Solo practices are private |
Employment type of GP | Private enterpreneurs | Private enterpreneurs | Private enterpreneurs | Mostly employees | Employees | Mostly employees | Private entrepreneurs in practices and employed professionals in policlinics |
Hungary | Italy | Spain | Lithuania | Finland | Estonia | Germany | |
Payment methods | Capitation and some extra on the basis of the practice characteristics, P4P scheme based on quality indicators | Capitation | Capitation (73%), fees for services (15%), basic allowance (10%), other (2%) | Capitation (85%), fee for service (9%), bonus for the performance (6%) | Salary and additional fee for service, and bonuses for performance. | Salary and capitation (15%) | Mixture of fees per time period and per medical procedure |
Gatekeeper for referrals | Yes | Yes | Yes | Yes | Yes | Yes | Not characteristic, but national incentives promote the gategeeping role of GPs |
Methods
Indicator | Estonia | Finland | Germany | Hungary | Italy | Lithuania | Spain | Total |
---|---|---|---|---|---|---|---|---|
Gender
| ||||||||
Male | 1 | - | 4 | 2 | 3 | 3 | 4 | 17 |
Female | 9 | 6 | 5 | 6 | 7 | 8 | 6 | 47 |
Age (years)
| NA | |||||||
<31 | - | - | - | - | 1 | - | ||
31-40 | 2 | - | 1 | 1 | 4 | 3 | ||
41-50 | 3 | 3 | 3 | 4 | 3 | |||
51-60 | 5 | 4 | 7 | 6 | 2 | 4 | ||
>60 | - | 2 | - | - | - | - | ||
Occupation
| ||||||||
GP | 6 | 3 | 5* | 5 | 3 | 5 | 5 | 32 |
Pediatrician | - | - | 1 | 1 | 3 | 2 | 1 | 8 |
Internist | - | - | -* | - | 2 | - | 2 | |
Gynaecologist or other specialist | - | - | 3 | - | 1 | - | - | 4 |
Nurse | 4 | 3 | - | 2 | 3 | 2 | 4 | 18 |
Total
|
10
|
6
|
9
|
8
|
10
|
11
|
10
|
64
|
Indicator | Estonia | Finland | Germany | Hungary | Italy | Lithuania | Spain | Total |
---|---|---|---|---|---|---|---|---|
Gender
| ||||||||
Male | 4 | 4 | 4 | 3 | 5 | 4 | 3 | 27 |
Female | 3 | 4 | 4 | 8 | 4 | 5 | 6 | 34 |
Age (years)
| NA | |||||||
<31 | 1 | - | 2 | 2 | 3 | 1 | ||
31-40 | 1 | 1 | 3 | 1 | 1 | |||
41-50 | 1 | 3 | 2 | 2 | 1 | 2 | ||
51-60 | 1 | 3 | 2 | 2 | 2 | 2 | ||
>60 | 3 | 1 | 2 | 3 | 2 | 3 | ||
Education
| NA | |||||||
Secondary, or vocational training | 5 | 7 | 3 | 3 | 3 | 7 | ||
Higher degree | 2 | 1 | 8 | 6 | 6 | 2 | ||
Total
|
7
|
8
|
8
|
11
|
9
|
9
|
9
|
61
|
Participants
Running focus group discussions
Data analysis
Results
Dimensions/Criteria | How addressed during discussion |
---|---|
APPROPRIATENESS
| |
Competency/skill
| Professional training |
Continuous medical education | |
Competency in PHC practice/services | |
Gate-keeping | |
Comprehensiveness
| Preventative services |
Long-term care for chronic condition | |
Provisiond of other non-medical services (social services) | |
Holistic approach | |
Coordination/continuity
| Usual source of care (first contact with new health problems, care for the majority of health problems) |
Long-term follow-up | |
Patient record continuity | |
Referral process between PHC and specialist | |
Professional decision making procedure
| Use of evidence based practice guidelines |
Involvement of patients | |
Timeliness
| Classification of cases by urgent needs |
Effectiveness
| Improving of health status |
Minimalisation of unnecessary visit | |
Provision of care is adapted to practice setting and enviroment | |
Safety
| Information safety |
Reporting critical incidents | |
Infection control | |
Care without mistakes | |
Practice management
| Medical equipment |
Non-medical eqiupment | |
Quality management tools | |
ACCESSIBILITY - EQUITY
| |
Geographical access
| Access via telecommunication tools |
Access in time (office hours, length of one visit) | |
Availibility in time; staff
| Appointment system |
Waiting time | |
DIMENSIONS/CRITERIA
|
How addressed during discussion
|
ACCESSIBILITY - EQUITY
| |
Availibility in time; staff
| Capacity of human resources in the practices |
Home visits | |
Equity
| Financial constrains |
Provision services to people in different age groups | |
Provision services to people at risk of social exclusion | |
Provision services to disabled people | |
PATIENT CENTEREDNESS
| |
Communication skills
| Patient/family education with reference to adherence |
Interpersonal attributes
| Kindness of staff |
Privacy/confidentiality
| Privacy of the visit |
Privacy of patient information | |
Acceptability
| Comfort of the waiting room, conditions of the premises |
Community oriented health care
| Community based programs |