This chapter examines payment schemes for general practitioners (GPs) or primary care physicians. These include fee for service, capitation, and salary. In their role as gatekeepers, GPs hold a unique position in the health care system. The only way in which patients can get access to hospitals and specialist care in many countries is following referral from a GP. Hence if GPs are permissive in making referrals, they put increased pressure on hospitals' resources. Much of the literature on GP remuneration has been concerned with efficiency in terms of value for money within primary care only. Activity-based remuneration systems appear to improve efficiency and are therefore preferred to salary systems in which doctors have no financial incentive to increase productivity. However, given the important role of GPs in the referral decisions and hence the cost consequences of their choices in secondary care, given also the use of pharmaceuticals and the costs of sick leave, any evaluation of the efficiency of a remuneration system must focus on the wider resource impact outside the GP practice. Exercises and suggested readings are included at the end of the chapter.
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