In the Danish tax-funded universal healthcare system, all residents have free access to a GP for medical advice or referrals to the secondary healthcare system (gatekeeper system). Virtually all residents (98%) are listed with a specific general practice.3 The list of each practice comprises approximately 1600 patients per GP.4 At the time of data collection, approximately 30% of practices were solo practices, 45% consisted of two to three GPs, and 25% consisted of four GPs or more.4 GPs work as independent primary care contractors for the health authorities and are remunerated through a mix of per capita and fee-for-service payments.5 Remunerated services include, for example, daytime consultations, email consultations, telephone contacts, home visits, laboratory services, and specific chronic care services (see below). Invoices for the provided services are sent to the Regional Health Administration who perform automated checks. They also check if there are practice outliers regarding use of specific services and, if so, they contact the practice for an explanation or correction. Data on remunerated services, reported by the practices using specific service codes, are available from the Danish National Health Service Register at the level of practices.6 GP chronic care services
The annual chronic care consultation: a consultation dedicated to a specific chronic condition; it can be provided once a year per condition (with a maximum of four conditions per year) and may include a patient health overview, medication review, lifestyle talk, and goal setting. The remuneration is approximately 2.5 times that of an ordinary consultation. Chronic care procedures: para-clinical measurements related to chronic care management, including blood glucose measurements, electrocardiograms, lung function tests, and home blood pressure measurements. Outreach home visits: home visits initiated by the GP for frail individuals aged >70 years to provide an overview of the health situation. Talk therapy: this encompasses psychotherapy provided by the GP in consecutive sessions (a maximum of seven sessions per year) for patients with mental health conditions.7
|