title: Patient experiences with family medicine: a longitudinal study after the Dutch health care reforms in 2006.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: Scientific Institute for Quality in Healthcare (IQhealth care), Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
authors: Pieter
authors: P
authors: van den Hombergh
authors: Master Physician Assistant, HAN University of Applied Sciences, PO Box 9029, Nijmegen, 6500 JK, The Netherlands.
authors: Arna
authors: A
authors: van Doorn-Klomberg
authors: Centre for Primary Care, Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.|Centre for Research and Action in Public Health (CeRAPH), University of Canberra, Building 22, Floor B, University Drive, Bruce, ACT 2617, Australia.
authors: Stephen
authors: S
authors: Campbell
authors: Scientific Institute for Quality in Healthcare (IQhealth care), Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.|Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius-Arkaden, Turm West, INF 130.3, Heidelberg, 69120, Germany.
authors: Michel
authors: M
authors: Wensing
authors: Scientific Institute for Quality in Healthcare (IQhealth care), Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands. Joze.Braspenning@radboudumc.nl.
authors: Jozé
authors: J
authors: Braspenning
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006123:Group Practice / Q000706:statistics & numerical data; D018166:Health Care Reform; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009819:Office Visits / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000639:trends*; D012051:Reimbursement Mechanisms; D011795:Surveys and Questionnaires
keywords: Health care reform; Investment in Family Medicine; Patient experience; Payment system; Practice performance; Primary care; Quality of care