Effective policy mechanisms for an equitable geographical distribution of general practitioners: a qualitative comparative analysis of the accessibility of primary care in Europe

Abstract

Objectives: To explore the effectiveness of four different policy mechanisms in achieving a more equitable geographical distribution of general practitioners (GPs) in European countries. The following mechanisms were analysed: (1) interventions during medical training; (2) financial incentives; (3) quotas to allocate GPs to regions and (4) capitation-based remuneration.

Methods: A macro-comparative method, namely, fuzzy set qualitative comparative analysis, was employed to explore the distributional effectiveness of the four mechanisms. A literature review yielded information on the use of these mechanisms in the 21 European countries included, while country-specific equity in the geographic GP distribution served as the outcome variable.

Results: Quotas determining the number of GPs per region proved to be highly effective in producing an equitable GP distribution if calculated based on health care needs. Remunerating GPs largely through capitation payments also proved to be an effective policy mechanism. Financial bonuses to GPs practising in under-served areas and interventions during medical training had little or no impact.

Conclusion: Several high income countries have a maldistribution of primary care physicians to the detriment of rural or socially deprived areas. Policy makers have instituted a variety of policies to counter this. This study helps to identify mechanisms which are likely to be more and less effective.

Keywords: geographic variations; health equity; primary care.