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.