Patient-Chosen Gap Payment: an exploratory qualitative review of patients and general practitioner attitudes toward an alternative funding model for general practice
Daniel S. Epstein
A B , Christopher Barton A , Pallavi Prathivadi A and Danielle Mazza A
A Department of General Practice, Monash University, Building 1, 1/270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
B Corresponding author. Email: dan.epstein@monash.edu
Australian Journal of Primary Health 27(4) 259-264 https://doi.org/10.1071/PY20074
Submitted: 6 April 2020 Accepted: 10 December 2020 Published: 22 March 2021
Abstract
We explored patients’ and GPs’ perceptions of an alternative payment system, a Patient-Chosen Gap Payment, where a gap fee is determined by the patient based on their perceived value of the service, including the choice to pay nothing. Semi-structured, in-depth interviews held with GPs (n = 10) and patients (n = 10) were audio-recorded, transcribed and analysed for emerging themes. We found three emergent themes: (1) the cost of quality: health care was difficult to value for both GPs and patients; there was belief in universal coverage and the importance of quality, but trade-offs in quality of care were a common perception; (2) the doctor–patient relationship: patient-centred care was a common goal and perceived as a good measure of quality care and a way for patients to place a value on the service/care; and (3) the business of general practice: participants wanted to see sustainable business models for primary care that incentivised quality of care. A Patient-Chosen Gap Payment (PCGP) funding model could incentivise doctors to provide better care without limiting access to health care. Further research is needed to model real-world application.
Keywords: behavioural economics, gap fee, health economics, out-of-pocket costs, payment systems, primary care funding.
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