Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
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KCE Reports 90 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion 89<br />
6 CHAPTER 6: WHAT ARE THE POLICIES TO<br />
BE IMPLEMENTED IN BELGIUM TO IMPROVE<br />
ATTRACTION, RECRUITMENT AND<br />
RETENTION OF THE GENERAL<br />
PRACTITIONERS: A STAKEHOLDERS’<br />
ANALYSIS<br />
6.1 INTRODUCTION<br />
The previous chapter id<strong>en</strong>tified in the international literature the policies influ<strong>en</strong>cing<br />
attraction, recruitm<strong>en</strong>t and ret<strong>en</strong>tion of g<strong>en</strong>eral practitioners. However, the<br />
transferability of such policies in Belgium may be questionable. For example, many<br />
policies target urban/rural medical d<strong>en</strong>sities differ<strong>en</strong>ces. Although those differ<strong>en</strong>ces exist<br />
in Belgium, they may be not that important than in the US. This last part of the study<br />
id<strong>en</strong>tifies policies that could be implem<strong>en</strong>ted in Belgium to improve the GPs’ career.<br />
The stakeholders will appraise them.<br />
What makes good policies can be assessed following differ<strong>en</strong>t perspectives. Broadly,<br />
two paradigms are cont<strong>en</strong>ding : the rationalist perspective and the pluralist theory<br />
191<br />
.The former states that decisions are made through a rational process by considering<br />
all the options and their consequ<strong>en</strong>ces especially on the costs 192 . According to the<br />
latter perspective, rationality involves many considerations (and not only costeffectiv<strong>en</strong>ess)<br />
and power is widely distributed into the society so that no one has<br />
<strong>en</strong>ough power to <strong>en</strong>force a specific solution whatever its cost-effici<strong>en</strong>cy in solving the<br />
problem. As figure 1 suggests, policies do not get onto the ag<strong>en</strong>da according to some<br />
logical series of stages but wh<strong>en</strong> the 3 streams of problems-id<strong>en</strong>tification, solutions and<br />
political power intersect 193 .<br />
Figure 1: Kingdon’s three stream model of ag<strong>en</strong>da setting<br />
Source Adapted from Kingdon (1984)<br />
This pluralist paradigm applies to primary care in Europe. Governance in primary care is<br />
strongly rooted in self-regulation and mechanisms of network interaction 2 .