Primary/ambulatory care: General practitioners and pediatricians (GPs) are paid on a capitation basis. LHUs can also pay additional allowances for the delivery of planned care to specific patients (e.g., home care for chronically ill patients), for reaching performance targets, or for delivering additional treatments (e.g., medications, flu vaccinations), sometimes related to performance, and are regulated under national and regional contracts. Capitation is adjusted for age and accounts for approximately 70 percent of the overall payment. The variable portion comprises fee-for-service (FFS) payment for specific treatments, including minor surgery, home care, preventive activities, and taking care of chronically ill patients. It also may include a portion related to performance in order to reward effective cost containment on pharmaceuticals, laboratory tests, and therapeutic treatments prescribed by the GP.
The payment levels, duties, and responsibilities of GPs are determined in a collective agreement signed every three years by consultation between the central government and the GPs’ trade unions.