Remuneration of GP services: time for more explicit objectives? A review of the systems in five industrialised countries.

The paper examines the nature and use of GP remuneration systems as instruments of health policy in five different countries--Australia, Canada, Denmark, Norway and the UK. Since doctors are not naturally efficient, they need to be encouraged to adopt efficient practices. The paper indicates that while there are great differences in the nature and level of remuneration across the five countries, there is little evidence that policy-makers in these countries have given adequate thought to how to use remuneration to influence the activities of GPs. In all five countries except the UK the objectives of GP services are somewhat vague and largely non-operational. The designs of the remuneration systems seem directed more towards deciding doctors' income levels and controlling public expenditure than towards meeting health care objectives. The remuneration for similar services varies widely across the five study countries. There is a need to clarify what the objectives of general practice are and thereafter to experiment more with GP remuneration systems to determine how best to get doctors to meet these objectives efficiently.