Article Figures & Tables
Figures
- Figure 1:
Conceptual framework of patient-centredness of Stewart and colleagues (9) and the operationalization in the current study.
- Figure 2:
Mean score for person-centred care. Note: FYR = former Yugoslav Republic.
Tables
- Table 1:
Overview of primary care payment systems and the mode of care provision in 31 European countries
Country Primary care payment Does primary care control access to secondary care? Patient required or encouraged to register with a primary care physician or practice? Predominant form of primary care provision Austria Fee-for-service No need and no incentive to obtain referral No incentive and no requirement to register Solo practice Belgium Capitation/fee-for-service Financial incentives to obtain a referral, but direct access is possible No requirement to register, but there are financial incentives to do so Solo practice Bulgaria (15), (16) Capitation/fee-for-service/other Primary care physician referral is required No incentive and no requirement to register Solo practice Cyprus (17) Fee-for-service No need and no incentive to obtain referral No incentive and no requirement to register Group practice Czech Republic Capitation/fee-for-service/pay for performance No need and no incentive to obtain referral No incentive and no requirement to register Solo practice Denmark Capitation/fee-for-service Financial incentives to obtain a referral, but direct access is possible No requirement to register, but there are financial incentives to do so Solo practice England Capitation/fee-for-service/pay for performance Primary care physician referral is the usual way to access secondary care, but direct access is possible No incentive and no requirement to register Group practice Estonia Capitation/fee-for-service/pay for performance/other Primary care physician referral is required Registration required Solo practice Finland Global budget Primary care physician referral is required Registration required Group practice Former Yugoslav Republic of Macedonia (18) Capitation/other Financial incentives to obtain a referral, but direct access is possible Registration required Solo practice Germany Fee-for-service No need and no incentive to obtain referral No requirement to register, but there are financial incentives to do so Solo practice Greece Global budget No need and no incentive to obtain referral No incentive and no requirement to register Group practice Hungary (15), (16) Capitation/pay for performance/global budget Primary care physician referral is required No incentive and no requirement to register Solo practice Iceland Fee-for-service/global budget No need and no incentive to obtain referral No incentive and no requirement to register Group practice Ireland (17) Capitation/fee-for-service Primary care physician referral is required No incentive and no requirement to register Group practice Italy Capitation Primary care physician referral is required Registration required Group practice Latvia Capitation/fee-for-service/pay for performance/fixed payments Financial incentives to obtain a referral, but direct access is possible Registration required Group practice Lithuania Capitation/fee-for-service/pay for performance/global budget Primary care physician referral is required Registration required Group practice Luxembourg Capitation/fee-for-service No need and no incentive to obtain referral No incentive and no requirement to register Solo practice Malta (15), (16) Fee-for-service Financial incentives to obtain a referral, but direct access is possible No incentive and no requirement to register Solo practice Netherlands Capitation/fee-for-service/pay for performance Primary care physician referral is required No incentive and no requirement to register Group practice Norway Capitation/fee-for-service Primary care physician referral is required Registration required Group practice Poland Capitation/fee-for-service Primary care physician referral is required No incentive and no requirement to register Group practice Portugal Capitation/pay for performance/global budget Primary care physician referral is required Registration required Group practice Romania (15), (16) Capitation/fee-for-service Financial incentives to obtain a referral, but direct access is possible Registration required Solo practice Slovakia (15), (16) Capitation/fee-for-service/other Financial incentives to obtain a referral, but direct access is possible Registration required Solo practice Slovenia Capitation/fee-for-service Primary care physician referral is required Registration required Group practice Spain Capitation/fee-for-service/global budget Primary care physician referral is required Registration required Group practice Sweden Capitation/fee-for-service Primary care physician referral is required No incentive and no requirement to register Group practice Switzerland Capitation/fee-for-service Financial incentives to obtain a referral, but direct access is possible No requirement to register, but there are financial incentives to do so Solo practice Turkey Global budget No need and no incentive to obtain referral Registration required Group practice Source: Organisation for Economic Co-operation and Development Health Systems Characteristics Survey (19) except where noted otherwise.
- Table 2:
Bivariate associations between financially driven postponement of care and person-centredness and strength dimensions of the primary care system
Dimension Postponement of general practitioner visit owing to financial reasons; mean score ± SD t (95% CI) No
n = 7589Yes
n = 799Person-centredness* 5.389 ± 1.435
n = 71645.180 ± 1.570
n = 7423.530 (0.094–0.330) Structure† 2.248 ± 0.132 2.195 ± 0.105 13.326 (0.046–0.061) Access† 2.261 ± 0.133 2.194 ± 0.138 13.031 (0.057–0.077) Continuity† 2.359 ± 0.053 2.355 ± 0.047 2.294 (0.001–0.008) Coordination† 1.727 ± 0.213 1.647 ± 0.189 11.231 (0.067–0.094) Comprehensiveness† 2.370 ± 0.162 2.323 ± 0.175 7.201 (0.031–0.056) Variable Model; OR (95% CI)‡ A.0 A.1.0 A.4.0 A.4.1 A.4.2 Patient sex (reference: male) Female – 0.896 (0.752–5.185) 0.909 (0.758–1.091) 0.908 (0.757–1.090) 0.91 (0.759–1.092) Patient age (demeaned) – 0.999 (0.993–7.078) 1.001 (0.995–1.006) 1.001 (0.995–1.007) 1.001 (0.995–1.007) Income (reference: middle and high income) Low income – 2.065 (1.731–118.140) 2.048 (1.707–2.458) 2.059 (1.716–2.470) 2.042 (1.702–2.450) General practitioner sex (reference: male) Female – 1.05 (0.857–8.227) 1.041 (0.844–1.284) 1.054 (0.855–1.300) 1.031 (0.836–1.272) General practitioner age (demeaned) – 0.999 (0.989–7.078) 1.001 (0.991–1.011) 1.001 (0.991–1.011) 1.001 (0.991–1.011) Location of general practitioner practice (reference: urban) Rural – 0.921 (0.713–5.605) 0.858 (0.655–1.125) 0.858 (0.655–1.125) 0.857 (0.653–1.126) Person-centred care – – 0.923 (0.869–0.981) 0.921 (0.867–0.979) 0.924 (0.870–0.982) Structure – – 0.031 (0.004–0.234) – – Process Access – – – 0.01 (0.001–0.084) – Comprehensiveness – – – – 0.151 (0.020–1.112) Intercept, variance ± SD −2.682 ± 0.166 −2.972 ± 0.194 5.201 ± 2.303 7.723 ± 2.406 1.937 ± 2.42 Variance ± SD country 0.738 ± 0.215 0.787 ± 0.232 0.571 ± 0.177 0.474 ± 0.152 0.723 ± 0.217 Variance ± SD general practitioner 0.978 ± 0.141 1.023 ± 0.151 1.069 ± 0.159 1.07 ± 0.16 1.07 ± 0.159 Variance partition coefficient country, % 14.75 – – – – Variance partition coefficient general practitioner, % 19.54 – – – – Note: CI = confidence interval, OR = odds ratio, SD = standard deviation.
↵* The full model is provided in Appendix 1, available at www.cmajopen.ca/content/6/2/E176/suppl/DC1.
↵† Controlled for patient and general practitioner characteristics.
↵‡ Except where noted otherwise.
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