Give prestige and make the specialty of Family Medicine compulsory in universities, establish a system of compulsory rotation of specialists in health centers, improve the remuneration conditions of doctors through stable contracts and incentives based on volume and place of work. These are some of the measures proposed by the EsadeEcPol Center for Economic Policies to reduce the pressure of care in primary care.
In a detailed document, the think tank points to hyper-frequency as one of the primary problems and alludes to various formulas to discourage unnecessary use of outpatient clinics. In this sense, it refers to a recent experience developed in Japan whereby the establishment of a symbolic price in pediatric visits led to a considerable decrease in demand among healthy children, while it remained in the sick. "This meant an increase in the efficiency of the system by channeling resources to those who needed them most," the report concludes. Likewise, it cites possible additions or similar formulas, such as the possibility of return of payment when the visit is justified, the use of non-financial disincentives or the mechanism of the shadow invoice (informing the user about the cost of care).
The work is based on indicators on the deterioration of primary education in Spain, which in the last decade has fallen in user ratings (from 7.38 to 6.19). 29% admit in a recent survey that they went to the emergency room instead of the GP due to the waiting time for the appointment. The percentage of public healthcare spending in primary care is stagnant (15.1% in 2002 and 14% currently), while it has increased 9 points, up to the current 64%, in specialized care. "In order for primary education to have the decisive character that characterizes it and can guarantee effective universality, it must be endowed with the necessary resources and that these be managed efficiently", the work highlights.
EsadeEcPol believes that Denmark can be a mirror for Spain: primary care doctors have higher incomes than hospital care doctors, a third of the remuneration is determined by the number of patients in the quota and the contract conditions are renegotiated every two years.