AI Article Synopsis
- The study assesses the impact of Estonia's pay-for-performance quality system on family doctors' workload, comparing those in the system to those not participating.
- The proportion of participating family doctors increased significantly from 2005 to 2011, leading to more visits and higher workloads for those involved in the quality system.
- While there was an increase in primary care visits and a shift in nurse workloads, home visits declined for both groups, suggesting the system affects overall staff dynamics and potentially necessitates more staff to meet demands.
Article 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.
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