Eero Merilind1, Katrin Vðstra2, Rauno Salupere3, Anastassia Kolde4, Ruth Kalda5. 1. Department of Family Medicine, University of Tartu, Nõmme Kliinik, Pärnu mnt 289-1, Tallinn 11621, Estonia. Eero.Merilind@arst.ee. 2. Health Insurance Fund, Estonia. 3. Klaster Baltic, Estonia. 4. Institute of Mathematical Statistics, University of Tartu, Estonia. 5. Department of Family Medicine, University of Tartu, Estonia.
Abstract
BACKGROUND: The quality system in Estonia is a payfor-performance scheme, rewarding family doctors for the quality of care they provide. This study examines the impact of the quality system on the workload of family doctors in Estonia. AIM: The aim of this study was to explore differences in the workload of family doctors participating in the clinical quality system and those not participating. METHODS: The study was conducted using a database from the Estonian Health Insurance Fund, which consists of health-related data for 96% of the Estonian population. The study compared the workload of Estonian family physicians in two groups: those participating in the quality system and those not. RESULTS: During the observation period 2005-2011, the proportion of family doctors participating in the clinical quality system increased from 48.2% to 69.2%. The total number of visits in primary care increased also and there was a difference in workload between the two groups. Doctors participating in the quality system performed more primary (initial) and secondary (follow-up) visits. The number of visits per doctor was also higher for those participating in the quality system. There was a shift to visits carried out by nurses, which showed an increased workload for nurses in the quality system during the observation period compared with a stable workload for those outside the system. The number of home visits decreased in both groups. CONCLUSION: Pay-for-performance had a notable impact on the workload of the primary care team and its members. Paying more attention to detecting chronic diseases in their early stages, recalling patients for general health check-ups and immunising children may have an effect on health status, but also requires increased staff levels.
BACKGROUND: The quality system in Estonia is a payfor-performance scheme, rewarding family doctors for the quality of care they provide. This study examines the impact of the quality system on the workload of family doctors in Estonia. AIM: The aim of this study was to explore differences in the workload of family doctors participating in the clinical quality system and those not participating. METHODS: The study was conducted using a database from the Estonian Health Insurance Fund, which consists of health-related data for 96% of the Estonian population. The study compared the workload of Estonian family physicians in two groups: those participating in the quality system and those not. RESULTS: During the observation period 2005-2011, the proportion of family doctors participating in the clinical quality system increased from 48.2% to 69.2%. The total number of visits in primary care increased also and there was a difference in workload between the two groups. Doctors participating in the quality system performed more primary (initial) and secondary (follow-up) visits. The number of visits per doctor was also higher for those participating in the quality system. There was a shift to visits carried out by nurses, which showed an increased workload for nurses in the quality system during the observation period compared with a stable workload for those outside the system. The number of home visits decreased in both groups. CONCLUSION: Pay-for-performance had a notable impact on the workload of the primary care team and its members. Paying more attention to detecting chronic diseases in their early stages, recallingpatients for general health check-ups and immunising children may have an effect on health status, but also requires increased staff levels.