APH 2006, 64, 175-183:

GP attitudes towards health, prevention and poverty in deprived communities:
does working with capitation or fee-for-service make a difference ?

B. Art, C. Snauwaert, B. Masureel, J. De Maeseneer

Keywords: attitude, capitation, fee-for-service, poverty, preventive medicine, primary health care

Objectives: To explore general practitioners’ attitudes towards health, poverty and prevention and to examine if payment system or practice setting plays a role.

Design: a qualitative study using semistructured interviews.

Setting: two neighbouring deprived inner-city areas in Ghent, Belgium.

Participants: 20 general practitioners.

Main outcome measures: practice and payment type. Respondents’ definitions of health and poverty, attitudes towards poverty and preventive medicine. Reasons for not practising preventive medicine.

Results: Concerning the definition of health and disease, illness provoking factors, attitudes towards other cultures, identifying thresholds in access to primary care, no differences were noted between the different payment systems or practice settings. Attitudes towards poverty did show differences. Preventive medicine was viewed as an important part of general practice, although solo GPs were more negative about their own role in prevention. A gradient was found in the extent to which
preventive medicine was practised from single-handed practice over group to health centre.

Conclusions: The findings of this small sample study suggest it does make a difference whether you work alone or in group as a GP, in order to fulfil the complex task of primary care in a deprived city area. Whether working in group has a positive effect on your attitudes or vice versa remains unclear. Working with capitated or fee-for-service reimbursement seems less important.