Prestige and make the specialty of family medicine mandatory in universities, establish a system of mandatory rotation of specialists in health centers, improve the remuneration conditions of doctors through stable contracts (40.8% of those in the public system are temporary) and incentives for volume and job location. These are some of the measures proposed by the Center for Economic Policies EsadeEcPol to reduce the pressure on primary care.
In a detailed document, the think tank points out overcrowding as one of the primary problems and alludes to several formulas to discourage the unnecessary use of outpatient clinics. In this regard, he mentions a recent experience in Japan in which the establishment of a symbolic price for pediatric visits led to a considerable drop in demand among healthy children, while it remained the same among sick children. “This resulted in an increase in the efficiency of the system after channeling the resources to those who needed them the most”, concludes the report. Likewise, it proposes that possible additions or similar formulas be tested, such as the possibility of returning the payment when the visit is justified, the use of non-economic disincentives or the shadow invoice mechanism (inform the user on the cost of care).
The work starts from the indicators on the deterioration of the AP in Spain, which in the last decade has fallen in the assessment of users (from 7.38 to 6.19). 29% admitted in a survey this year that they went to the emergency room instead of the GP because of the waiting time for the appointment. The percentage of public health expenditure in AP is stagnant (15.1% in 2002 and 14% at present), while it has risen 9 points, to a current 64%, in specialized care. “For the AP to have the resolutive character that characterizes it and to be able to guarantee effective universality, it needs to be equipped with the necessary resources and to be managed efficiently”, the work points out.
EsadeEcPol thinks that Denmark can be a mirror for Spain: GP doctors have more income than those in hospital care, a third part of the remuneration is determined by the number of patients of the doctor’s fee and the conditions of the contract they are renegotiated every two years.
