چکیده (انگلیسی):

Background:In 2006 The Dutch Health Care system changed to a market oriented system. The GP remuneration
changed from ± 2/3 capitation patients and 1/3 private patients before 2006 to a mixed payment scheme. From
2006 onward every patient was insured and the GP received partly capitation, partly fees for consultations and for
specific services. This change coincided with many other organisational changes in General Practice care. Our
research question was if during the years after 2006 patient experiences of Dutch family practice had changed. We
also wanted to explore the influence of patient and practice characteristics on patient experiences. Data on patient
experiences were available from 2007 to 2012.
Method:In a series of annual cross sectional patient surveys the performance of GPs and practices was measured.
Patient sampling took place as a part of the Dutch accreditation program in 1657 practices involving 2966 GPs.
Patients’ experiences, gender, age, health status, and number of annual consultations were documented as well as
the type and location of practices. Linear regression analysis was used to examine time trends in patient
experiences and the impact of patient and practice characteristics.
Results:78,985 patients assessed the performance of 2966 GPs, and 45,773 patients assessed the organisation of
1657 practices. The number of patients with positive experiences increased significantly between 2007 and 2012;
respectively 4.8 % for GPs (beta 0.20 and p< 0.0001) and 6.6 % for practices (beta 0.10,p< 0.004). Higher age,
having no chronic illness, more frequent consultations and attending single-handed practices, predicted better
patient experiences.
Conclusions:In our evaluation of patient experiences with general practice care from 2007 to 2012 we found an
increase of 4.8 % for GPs and 6.6 % for practices respectively. This improvement is significant. While no direct
causation can be made, possible explanations may be found in the various reforms in Dutch family practice since
2006. More insight is needed into key determinants of this improvement before policymakers and care providers
can attribute the improvement to these reforms.