Incentive structures in the primary health sector

This literature review has the aim of looking at how incentive structures in the Scandinavian countries’ primary health sector affect the work of primary care physicians and the treatment of patients, focusing on the quality parameters availability, time per consultation and continuity of care. Articles were used to define the remuneration methods and public sources to describe how they are implemented in the different countries. The literature describes four methods of remuneration; salary, capitation, fee for service and fee for performance. The Danish and Norwegian systems are similar in structure with remuneration through fee for service and capitation. Sweden has a heterogeneous system as much is decided regionally; the remuneration however is mainly based on capitation. The authors conclude that fee for service has the most beneficial effect on availability, though at a possible cost of time per consultation. In Denmark and Norway the primary care physicians own their clinics and act as entrepreneurs, which contribute more to continuity of care than the method of remuneration. The Swedish primary health sector scores bad on the parameters availability and continuity of care, and the authors argue that the current reform in Sweden will not necessarily deal with the fundamental causes for these problems.

Read the full article here (pdf).