status quo of quo vadis? - KCE
status quo of quo vadis? - KCE status quo of quo vadis? - KCE
20 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 Keypoints from the literature review • Most papers come from the UK, Australia and the Netherlands. The major elements in the development of quality systems are a national policy, a professional leadership and a careful choice of incentives for the GPs. • A systematic review concluded that peer reviews, practice audits and practice visits are the most common instruments used in the quality systems in general practice. There is a lack of literature about their effects on the quality of care, even if studies show the satisfaction of the participants. • The literature about the UK Quality Outcomes Framework analyses the positive and negative effects of a pay for quality system. The implementation of this scheme requires considerable budget and there is a lack of agreement about the choice of indicators that only reflect a small part of the GP daily work. • Three international initiatives refer to the measurement of quality in general practice i.e., the OECD clinical quality indicators, the European Practice Assessment instrument and the Maturity Matrix. • Many papers describe initiatives in self-selected practices and the results might not be applicable to the whole GP population. • There is a lack of evidence about the effect of any quality system on the outcomes at the patient level. 2.4 DESCRIPTION OF THE QUALITY SYSTEM IN THE FIVE SELECTED COUNTRIES This analysis begins with an overview of the characteristics of the health care systems of the five selected countries (see table 3). The information comes mainly from the ‘HIT Profiles’ of the European Observatory on Health Systems and Policies 80-84,5 and from the statistics of the Organisation for Economic Co-operation and Development 6 . The websites of professional bodies, national and international organisations completed this data source (see appendix 2). The appendix 3 displays the list of native experts who checked and completed the descriptions of their countries.
21 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 Table 3. Overview of the health care systems. Data from the European Observatory on Health Systems and Policies and from the OECD(#). (*significantly increasing because of a recent input in the NHS 85 ) All health systems included in this review aim to cover the entire population but their organisation differs in many respects. The role of the GPs ranges from gatekeeper to non gatekeeping and competition with specialists in primary care. UK AU NL GE FR BE Sources of financing Total health expenditure Tax-based Tax-based and contribution # Tax-based and contribution Contribution Tax-based and contribution Tax-based and contribution (2004, public and private US dollars per year - #) 2560(*) 3128 3094 3169 3191 3290 Total health expenditure as a percentage of GDP (#) 8.1 9.5 9.2 10.6 11.0 10.2 Public versus private expenditures as a percentage of GDP Aim to cover population Number of Phycians/100 000 Principle payment methods for GP Specialists working in primary care 83 68 (20.3 % out of pocket) 79(15 private and 6 out of pocket) 76.1 of households, increasing since 2004 87.8 71.4 Full Full Full Full Full Full 164 250 315 336 333 448 Capitation and quality points Fee for service, direct payment and bulk billing Capitation and fee for service, bulk billing 86 Fee for service Fee for service, direct payment Fee for service, direct payment, some capitation, direct payment No No No Yes Yes Yes GP acts as gatekeeper Yes Yes Yes Only is some plans No No
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21 Quality development in general practice in Belgium: <strong>status</strong> <strong>quo</strong> or <strong>quo</strong> <strong>vadis</strong> ? <strong>KCE</strong> Reports 76<br />
Table 3. Overview <strong>of</strong> the health care systems. Data from the European Observatory on Health Systems and Policies and from the<br />
OECD(#). (*significantly increasing because <strong>of</strong> a recent input in the NHS 85 )<br />
All health systems included in this review aim to cover the entire population but their organisation differs in many respects. The role <strong>of</strong> the GPs<br />
ranges from gatekeeper to non gatekeeping and competition with specialists in primary care.<br />
UK AU NL GE FR BE<br />
Sources <strong>of</strong> financing<br />
Total health expenditure<br />
Tax-based<br />
Tax-based and<br />
contribution #<br />
Tax-based and<br />
contribution<br />
Contribution<br />
Tax-based and<br />
contribution<br />
Tax-based and<br />
contribution<br />
(2004, public and private<br />
US dollars per year - #)<br />
2560(*) 3128 3094 3169 3191 3290<br />
Total health expenditure as<br />
a percentage <strong>of</strong> GDP (#)<br />
8.1 9.5 9.2 10.6 11.0 10.2<br />
Public versus private<br />
expenditures as a<br />
percentage <strong>of</strong> GDP<br />
Aim to cover population<br />
Number <strong>of</strong> Phycians/100<br />
000<br />
Principle payment methods<br />
for GP<br />
Specialists working in<br />
primary care<br />
83<br />
68 (20.3 % out <strong>of</strong><br />
pocket)<br />
79(15 private and 6<br />
out <strong>of</strong> pocket)<br />
76.1 <strong>of</strong><br />
households,<br />
increasing since<br />
2004<br />
87.8 71.4<br />
Full Full Full Full Full Full<br />
164 250 315 336 333 448<br />
Capitation and quality<br />
points<br />
Fee for service,<br />
direct payment<br />
and bulk billing<br />
Capitation and fee<br />
for service, bulk<br />
billing 86<br />
Fee for service<br />
Fee for service,<br />
direct payment<br />
Fee for service,<br />
direct payment,<br />
some capitation,<br />
direct payment<br />
No No No Yes Yes Yes<br />
GP acts as gatekeeper Yes Yes Yes<br />
Only is some<br />
plans<br />
No No
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