How to pay primary care physicians for SARS-CoV-2 vaccinations: An analysis of 43 EU and OECD countries

Abstract

Vaccinations are crucial to fighting SARS-CoV-2, and high coverage rates can in most countries probably only be achieved with the involvement of primary care physicians (PCPs). We aimed to explore how SARS-CoV-2 vaccination payment schemes in 43 countries differ with regard to the (i) type of payment scheme, (ii) amount paid, (iii) degree of bundling, and (iv) use of pay-for-performance elements. We collected information on payments and health system characteristics, such as PCP income and employment status, in all EU and OECD countries over time. We regressed the payment amount on the income of PCPs for countries with activity-dependent schemes using a linear regression (OLS), and we interpreted the residuals of this regression as a vaccination payment index. The majority of countries (30/43) had chosen payment schemes that reward PCPs for the activity they perform. Seventeen countries paid less per vaccination than the income-adjusted average, whereas 13 countries paid more. Twelve countries used pay-for-performance elements.

Keywords: COVID-19; Payment schemes; Primary care physicians; Reimbursement; Tariff schemes.

Fig. 1

Total payment for first vaccination against SARS-CoV-2 in relation to average annual PCP income (in US$). Description: This graph displays the relationship between the average annual PCP income (in US$) (x-axis) and the total payment for the first vaccination against SARS-CoV-2 (in US$) (y-axis). Each dot represents one country/jurisdiction. The blue line is the regression line between the annual PCP income and total payment. It shows a positive relationship between annual PCP income and total payment. The gray area displays the 95%-confidence interval. Note: This figure includes only countries using activity-dependent payments. AUS = Australia, AUT = Austria, BGR = Bulgaria, CAN-BC = Canada (British-Columbia), CAN—ON = Canada (Ontario), CHE = Switzerland, CZE = Czech Republic, CYP = Cyprus, DNK = Denmark, ENG = England, EST = Estonia, FIN = Finland; FRA = France, GER = Germany, GRC = Greece, IRL = Ireland, ITA = Italy, JPN = Japan, KOR = Korea (Republic), LTU = Lithuania, LVA = Latvia, LUX = Luxembourg, NIR = Northern Ireland, NLD = The Netherlands, NOR = Norway, NZL = New Zealand, POL = Poland, ROU = Romania, SCO = Scotland, SVK = Slovak Republic, SVN = Slovenia, SWE = Sweden, USA = United States (Medicare), WLS = Wales.

Fig. 2

Vaccination payment index in countries with activity-dependent payment schemes. Description: This figure displays the vaccination payment index, i.e. the difference between the amount a country pays for the first vaccination against SARS-CoV-2, and its income-adjusted average payment in ascending order. A negative value means that a country pays less for the first vaccination than the income-adjusted average payment, a positive value means that a country pays more for the first vaccination than the income-adjusted average payment.