The doctor, the patient, and their contract. III. Alternative contracts: are they viable?

Abstract

When change is proposed there are always alternative courses of action and any choice between these alternatives needs to take account of their relative advantages and disadvantages. Here we examine five further options. The first is to return to a form of remuneration for general practitioners that is determined solely by capitation payments. The second is to rely on payments per items of service. The third is to choose a salaried service. The fourth is to rely on private practice, allowing market forces to determine both quality and rewards. The fifth is to move to a form of national health service that is funded, as it is now, out of taxation but combining entrepreneurial and competitive elements with the profession controlling the standards. We conclude that the development of a good practice allowance, along the lines described in our previous paper, represents the best choice at this time for the public, the government, and the profession