Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

More documents

Recommendations

Info

90 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 Belgium is no exception. Health professions, at different levels, have a strong role in developing policies : this can be seen through the numerous executive and consultative bodies (particularly within the Social insurance institution RIZIV/INAMI) in which medical representatives sit along with government bodies and are allowed to wield considerable influence on the policy process 194 : National Committee of Physicians and Sickness Funds, Committee for Medical Evaluation and Control, Planning Commission , National Council for Hospital Facilities, etc. Belgium is clearly a country which provides many opportunities to interest groups to influence or block a policy. Although this could be sometimes considered as a hurdle to policy changes 195 , the Belgian situation is clearly that of pluralism. This situation makes stakeholder analysis an important tool for developing solutions in Belgium. This chapter aims at assessing the political power side of the problem and the political feasibility of policies for improving GPs’ attraction, recruitment and retention through a stakeholders’ analysis. Stakeholders are defined as “persons or groups that have interests in an issue, including those with some role in making a decision or its execution” 192 . A stakeholders’ analysis can be defined as “an approach, a tool or set of tools for generating knowledge about actors to understand their behavior, intentions, interrelations and interests; and for assessing the influence and resources they bring to bear on decision-making” 196 . This stakeholders’ analysis will help to understand the interests and influence of individuals or groups both within and outside the organization of general practice. 6.2 OBJECTIVES This stakeholders analysis has four objectives: • To describe stakeholders’ understanding of the challenges faced by general practice in Belgium; • To identify the policy options more likely to be supported aiming at improving the GP’s career; • To identify the criteria and factors making the stakeholders more likely to support or oppose some policy options; • To identify implementation details of the policy options more likely to be supported. 6.3 METHOD OF THE STAKEHOLDER SURVEY 6.3.1 Design This survey used a multi-criteria analysis (MCM) 197 , a tool to support decision among different options and several criteria (see appendix 5.1.). It aims at combining comparability between interviewees while accommodating each respondent’s perspective. MCM has been used in the health sector for obesity prevention 198 or selection of anti-psychotic drugs 199 . Multi-criteria analysis has the following characteristics 197 : • To identify alternative ways to solve a problem (GPs’ attraction, retention and recruitment): policy options. • To suggest criteria allowing the appraisal of those policies: policy criteria. • To score each option on each criteria. • To weigh each criteria in order to reflect its relative importance.
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 91 6.3.2 Development of the questionnaire The questionnaire was developed through several processes: review of previous instruments, cognitive testing (see appendix 5.4, 5.11 and 5.12), expert reviews and broader testing. Once the lay-out and content of the questionnaire was decided, cognitive testing was used to improve the wording, understanding and organization of the questions. Cognitive testing is a method that improves the link between the underlying concepts and the questions 200 , 201 . This method is fully described in the appendix 5.4. This cognitive testing was carried out with different profiles of persons: some were GPs with a practice (=3), some were GPs without any practice (=2), some did not work in general practice but had a general knowledge of the themes (=3). Several experts, who had used the same methodology in their works before, revised the questionnaire and gave their advice about specific problematic points. A few qualitative interviews were also conducted to have a deeper insight into the content of the policies and to improve the formulation of the policies in French and Flemish. Finally a broader testing was carried out with 10 persons. 6.3.3 Identification of policy options The policies have been identified in several steps (see appendix 5.2). First, the extensive literature review carried out in the first part of the study identified several policy options and factors that may contribute to improve retention/recruitment of GPs. These policy options were then screened according to the Belgian context. This was done in the second part of the study, particularly through qualitative interviews of leavers and medical students. Finally, the list of policies was compared to recent policy reviews carried out either by the European Observatory 2 or by the Belgian Institutions: the KCE report 72B on medical supply 7 , the Visitatie Report 202 , or the study related to General practice Emergency study 203 , as well as policies being currently under discussion or being developed in Belgium, such as the DMG, Impulseo I, Impulseo II, the numerus clausus, etc. After a long process, the researchers identified 24 policies, grouped in four themes (for the list in French and Flemish, see appendices 5.11 and 5.12): • Teaching and training policies (4 policies): o To select the students of medicine by taking into account their social and communication competencies in addition to their knowledge in exact sciences. o To develop a clinical activity linked with the Academic Centers of General Practice. o To integrate a general practice approach in the general practice courses of the Master (including the courses of the specialty), by learning the priority problems from a public health perspective or by associating specialists and general practitioners o To organize compulsory training courses in general practice for all the students of the Master • Financing and payment policies (5 policies) o To increase the consultation fees of the general practice o To allocate a fixed price per patient in addition of the other act remunerations (for example : global medical file) o To diversify the remuneration modalities of the general practice by combining wage-earning and act remuneration o To improve the financial incentives for the installation in geographical zones less covered
Page 1 and 2:
Huisartsgeneeskunde: aantrekkingskr
Page 3 and 4:
Huisartsgeneeskunde: aantrekkingskr
Page 5:
Layout : Van Moer Wim Brussel, 27 o
Page 8 and 9:
ii Huisartsgeneeskunde: aantrekking
Page 10 and 11:
iv Huisartsgeneeskunde: aantrekking
Page 12 and 13:
vi Huisartsgeneeskunde: aantrekking
Page 14 and 15:
viii Huisartsgeneeskunde: aantrekki
Page 16 and 17:
2 Making General Practice Attractiv
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
10 Making General Practice Attracti
Page 26 and 27:
Age group 12 Making General Practic
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Total 7th year students inscribed r
Page 50 and 51:
Page 52 and 53:
Page 54 and 55: 40 Making General Practice Attracti
Page 114 and 115: 100 Making General Practice Attract
Page 150 and 151: Wettelijk depot : D/2008/10.273/63
Page 152 and 153: 38. Baarmoederhalskankerscreening e
show all

Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?