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dc.contributor.authorKraft, Kristian Bandlien
dc.contributor.authorHoff, Eivor Hovde
dc.contributor.authorNylenna, Magne
dc.contributor.authorMoe, Cathrine Fredriksen
dc.contributor.authorMykletun, Arnstein
dc.contributor.authorØstby, Kristian Amundsen
dc.description.abstractBackground Fee-for-service is a common payment model for remunerating general practitioners (GPs) in OECD countries. In Norway, GPs earn two-thirds of their income through fee-for-service, which is determined by the number of consultations and procedures they register as fees. In general, fee-for-service incentivises many and short consultations and is associated with high service provision. GPs act as gatekeepers for various treatments and interventions, such as addictive drugs, antibiotics, referrals, and sickness certification. This study aims to explore GPs’ reflections on and perceptions of the fee-for-service system, with a specific focus on its potential impact on gatekeeping decisions.<p> <p>Methods We conducted six focus group interviews with 33 GPs in 2022 in Norway. We analysed the data using thematic analysis.<p> <p>Results We identified three main themes related to GPs’ reflections and perceptions of the fee-for-service system. First, the participants were aware of the profitiability of different fees and described potential strategies to increase their income, such as having shorter consultations or performing routine procedures on all patients. Second, the participants acknowledged that the fees might influence GP behaviour. Two perspectives on the fees were present in the discussions: fees as incentives and fees as compensation. The participants reported that financial incentives were not directly decisive in gatekeeping decisions, but that rejecting requests required substantially more time compared to granting them. Consequently, time constraints may contribute to GPs’ decisions to grant patient requests even when the requests are deemed unreasonable. Last, the participants reported challenges with remembering and interpreting fees, especially complex fees. <p>Conclusions GPs are aware of the profitability within the fee-for-service system, believe that fee-for-service may influence their decision-making, and face challenges with remembering and interpreting certain fees. Furthermore, the fee-for-service system can potentially affect GPs’ gatekeeping decisions by incentivising shorter consultations, which may result in increased consultations with inadequate time to reject unnecessary treatments.en_US
dc.identifier.citationKraft, Hoff, Nylenna, Moe, Mykletun, Østby. Time is money: general practitioners’ reflections on the fee-for-service system. BMC Health Services Research. 2024;24(1)en_US
dc.identifier.cristinIDFRIDAID 2262292
dc.relation.journalBMC Health Services Research
dc.rights.holderCopyright 2024 The Author(s)en_US
dc.rightsAttribution 4.0 International (CC BY 4.0)en_US
dc.titleTime is money: general practitioners’ reflections on the fee-for-service systemen_US
dc.typeJournal articleen_US
dc.typePeer revieweden_US

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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's license is described as Attribution 4.0 International (CC BY 4.0)