Introducing out-of-pocket payment for general practice in Denmark: feasibility and support.
OBJECTIVE
The financing of General Practice (GP) is a much-debated topic. In spite of out-of-pocket (OOP) payment for other primary health care provided by self-employed professionals, there is no OOP payment for the use of GP in Denmark. This article aims to explore the arguments, the actors and the decision-making context.


METHODS
An analysis of the healthcare-policy debate in Parliament and the media from 1990 until September 2012. The materials are parliamentary hearings/discussions and newspaper articles. Kingdon's model on Policy Windows and the Advocacy Coalition framework by Sabatier and Jenkins are used to investigate explanations.


RESULTS
The arguments from the proponents are: that OOP payment for GP will reduce pressure on the primary sector; that the current allocation of OOP payment in the sector is historically conditioned; and that resistance towards OOP payment is based on emotions. The main argument from the opponents is that OOP payment will increase social inequality in health.


CONCLUSIONS
There is little connection between the attitudes and ideological backgrounds of the political parties. Despite factors such as perceived expert/scientific evidence for OOP payment, changes of government, financial crisis and a market-based reform wave, no government has introduced OOP payment for GP. This article suggests that governmental positions, public- and especially health-professional support are important factors in the decision-making context.
Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark. Electronic address: caap@sund.ku.dk.
Camilla Aavang
CA
Poulsen
D001294:Attitude to Health; D003657:Decision Making; D003718:Denmark; D005382:Financing, Personal; D058006:General Practice / Q000191:economics*; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics; D006801:Humans; D011057:Politics
Advocacy coalition framework; Decision-making process; General Practice; Health political debate; Out-of-pocket payment; Policy windows; Support