The calculation of the Belgian General Practitioner revised
Madelon Kroneman, NIVEL
21 April 2009
Income development of General Practitioners in eight European countries from 1975 to 2005: The calculation of the Belgian General Practitioner revised. M. Kroneman, P. Meeus, J. van der Zee and W. Groot
(M.Kroneman, J. van der Zee and W. Groot are the authors of the original paper, P. Meeus is affiliated to RIZIV/INAMI, the Belgium Institute of Illness and Disability Insurances).
In the paper ‘Income development of General Practitioners in eight European countries from 1975 to 2005, published in BMC Health Services Research in January 2009, the income of Belgian GPs appeared to be the lowest of the eight countries (Kroneman, Van der Zee and Groot, 2009). In the conclusion of the paper, the question was raised whether the figure for Belgium was realistic, because the calculation was not based on real production data but on a discussion paper on GP-activities dating from 2002. Recently data on actual production of GPs in Belgium have become available, which enable a more realistic calculation of the income of these GPs in 2005 (Meeus, 2008). The data have been provided by RIZIV (the Belgium Institute of illness and disability insurances). Taking into account the criteria and choices that were used to make the income figures comparable among countries, a new estimation of the income of the full-time Belgium GP was made, see Table 1 (Table 1 can be found at: http://www.nivel.nl/pdf/The_calculation_of_the_Belgian_General_Practitioner_revised.pdf).
Analysis of the differences In Belgium, there are different categories of general practitioners and each category has a different tariff for consultations. In the NIVEL study, the revenues were calculated based on tariffs for a physician who has finished formal education as a GP and has agreed to the tariff scheme that was negotiated by RIZIV, the sickness funds and the GPs. The RIZIV tariffs are, however, based on a physician who is also accredited. This physician has, in addition, agreed to continuous education and thus may charge a higher tariff. The RIZIV study showed that 92.9% of the GPs were accredited in 2005, which makes it more appropriate to use the higher tariffs for consultations. If we had used the higher tariff of 18.84 euro in the NIVEL study, the revenues would have been 7,270 euro higher.
The most important difference between the NIVEL and RIZIV figures, however, is the number of home visits of patients. Whereas the number of home visits used by NIVEL is based on theoretical assumptions, the number of home visits established by RIZIV is based on declarations by GPs. Since there is a large variation in the productivity of Belgian GPs, RIZIV distinguishes three models of full-time GPs: low, medium and high productive GPs (Profielencommissie “Algemeen Geneeskundigen”, 2008). Since about two third of the GPs fitted the medium model, this model is used to estimate the income of a full-time GP in Belgium. The number of home visits in this model is about twice as high compared to the NIVEL estimate.
Summarizing, the main part of the differences is based on an underestimation of the number of home visits in the NIVEL study.
References Kroneman M, Van der Zee J, Groot W. Income development of General Practitioners in eight European countries from 1975 to 2005, BMC Health Services Research, vol. 9, 2009, nr. 26
Meeus P. INAMI, Rapport annuel 2007: IV partie, Registre des médecins généralistes, nombre et profil des médecins généralistes en 2005, p 67-73.
Profielencommissie “Algemeen Geneeskundigen”, Informatiecampagne 2008 van de Profielencommissie “Algemeen Geneeskundigen”: Synthese van de persoonlijk activiteitsverslagen 2005 [Information campaign 2008 of the profile committee “General Practitioners”: Synthesis of the personal activity records 2005], RIZIV, 2008. http://www.inami.fgov.be/care/nl/doctors/promotion-quality/info/pdf/summary.pdf
The calculation of the Belgian General Practitioner revised
21 April 2009
Income development of General Practitioners in eight European countries from 1975 to 2005: The calculation of the Belgian General Practitioner revised.
M. Kroneman, P. Meeus, J. van der Zee and W. Groot
(M.Kroneman, J. van der Zee and W. Groot are the authors of the original paper, P. Meeus is affiliated to RIZIV/INAMI, the Belgium Institute of Illness and Disability Insurances).
In the paper ‘Income development of General Practitioners in eight European countries from 1975 to 2005, published in BMC Health Services Research in January 2009, the income of Belgian GPs appeared to be the lowest of the eight countries (Kroneman, Van der Zee and Groot, 2009). In the conclusion of the paper, the question was raised whether the figure for Belgium was realistic, because the calculation was not based on real production data but on a discussion paper on GP-activities dating from 2002. Recently data on actual production of GPs in Belgium have become available, which enable a more realistic calculation of the income of these GPs in 2005 (Meeus, 2008). The data have been provided by RIZIV (the Belgium Institute of illness and disability insurances). Taking into account the criteria and choices that were used to make the income figures comparable among countries, a new estimation of the income of the full-time Belgium GP was made, see Table 1 (Table 1 can be found at: http://www.nivel.nl/pdf/The_calculation_of_the_Belgian_General_Practitioner_revised.pdf).
Analysis of the differences
In Belgium, there are different categories of general practitioners and each category has a different tariff for consultations. In the NIVEL study, the revenues were calculated based on tariffs for a physician who has finished formal education as a GP and has agreed to the tariff scheme that was negotiated by RIZIV, the sickness funds and the GPs. The RIZIV tariffs are, however, based on a physician who is also accredited. This physician has, in addition, agreed to continuous education and thus may charge a higher tariff. The RIZIV study showed that 92.9% of the GPs were accredited in 2005, which makes it more appropriate to use the higher tariffs for consultations. If we had used the higher tariff of 18.84 euro in the NIVEL study, the revenues would have been 7,270 euro higher.
The most important difference between the NIVEL and RIZIV figures, however, is the number of home visits of patients. Whereas the number of home visits used by NIVEL is based on theoretical assumptions, the number of home visits established by RIZIV is based on declarations by GPs. Since there is a large variation in the productivity of Belgian GPs, RIZIV distinguishes three models of full-time GPs: low, medium and high productive GPs (Profielencommissie “Algemeen Geneeskundigen”, 2008). Since about two third of the GPs fitted the medium model, this model is used to estimate the income of a full-time GP in Belgium. The number of home visits in this model is about twice as high compared to the NIVEL estimate.
Summarizing, the main part of the differences is based on an underestimation of the number of home visits in the NIVEL study.
References
Kroneman M, Van der Zee J, Groot W. Income development of General Practitioners in eight European countries from 1975 to 2005, BMC Health Services Research, vol. 9, 2009, nr. 26
Meeus P. INAMI, Rapport annuel 2007: IV partie, Registre des médecins généralistes, nombre et profil des médecins généralistes en 2005, p 67-73.
Profielencommissie “Algemeen Geneeskundigen”, Informatiecampagne 2008 van de Profielencommissie “Algemeen Geneeskundigen”: Synthese van de persoonlijk activiteitsverslagen 2005 [Information campaign 2008 of the profile committee “General Practitioners”: Synthesis of the personal activity records 2005], RIZIV, 2008. http://www.inami.fgov.be/care/nl/doctors/promotion-quality/info/pdf/summary.pdf
Competing interests
There are no competing interests