Line Bjørnskov

Background:

Traditionally, GPs in Denmark have been organised in solo practices with a small number of practice personnel. It is however becoming more prevalent that GPs share practices and personnel with each other and within the last decades new organisation forms have arisen. The trend of organising GPs in larger shared practises is caused by different motivations, one of them being the possibility to share costs of practice personnel, equipment, buildings, etc. and also the opportunity for GPs to substitute and complement each other thereby increasing the potential of specialisation and the flexibility in working hours and job tasks. Furthermore, Denmark, as many other European countries, experiences a lack of GPs, especially in the rural areas of the country. The health authorities believe that the organisation of GPs in large shared practices can mitigate some of the problems with GP shortages and increase efficiency if GPs share practice personnel and if nurses, secretaries, laboratory technicians etc. take over some of the tasks that the GP traditionally performed.

Aim:

The aim of this project is to investigate GPs’ preferences for organisational issues in general practice in order to explore 1) whether GPs’ preferences are consistent with the ideas of the health authorities, 2) whether GPs’ preferences are consistent with their patients’ preferences (which entails preference elicitation of the patients as well), and 3) whether upcoming GPs have the same preferences regarding the organisation of primary care as their coming GP colleagues, the health authorities, and the patients.

Method:

The obvious methodological framework to investigate the preferences for the organisation of primary care – a complex and compounded good, is the discrete choice experiment that relies upon the trade-offs between different characteristics of a good. The discrete choice experiment is a stated preference method based on random utility theory and it is consistent with Lancaster’s economic theory of value. Random utility theory allows the researcher to elicit preferences for multidimensional goods, from which models of preferences can be estimated from a statistical choice model that explains the observable choices. In the discrete choice experiment individuals are asked to indicate their preferred general practice from a set of hypothetical general practices with different characteristics. It is assumed that the individuals choose the alternative which maximises utility and that they have well-behaved preferences. By comparing the weights of two attributes it is possible to calculate the marginal rate of substitution and thereby get an idea of the attributes’ importance relative to each other. If one of the attributes is a cost attribute it is possible to calculate the marginal willingness to pay for the other attributes included in the survey.