General practitioners’ incentives and practice style: A descriptive registry study of earnings variation in Norway

BACKGROUND: In Norway, 80% of general practitioners (GPs) are self-employed, remunerated through a mix of fee-for-service and capitation (FFS/CAP) payments, while the remaining 20% are salaried. OBJECTIVE: To examine which types of practice styles are most likely to be incentivised under the FFS/CAP system. METHODS: Using nationwide registry data from 2021 (N = 2546 GPs), we compare GPs' practice styles, such as consultation frequency, consultation duration, and procedure fee utilisation, across different earning levels. RESULTS: Among self-employed GPs, high-earning GPs earn 40% more from FFS per patient compared to their low-earning counterparts (€178 versus €127). Consultation frequency explains nearly half (48%) of this difference, as high-earning GPs conduct more consultations per patient (3.43 versus 2.53). However, despite the higher frequency, patients of high-earning GPs spend less time in consultations yearly (35 versus 38 min) due to shorter average consultation duration (15 versus 20 min). The remaining earning difference is attributed to greater utilisation of procedure fees by high-earning GPs (5.6 versus 3.9 procedures per patient), with fees for prolonged consultation, medication review, and talking therapy contributing most. The practice style of low-earning GPs resembles salaried GPs. CONCLUSIONS: Our interpretation is that high-earning GPs appear to respond more strongly to financial incentives in the FFS/CAP system compared to low-earning GPs. This suggests that the FFS/CAP system incentivises high consultation frequency, short consultation duration and high procedure fee utilisation. Policymakers should balance the use of financial incentives to increase capacity and efficiency against side-effects of overprovision or gatekeeping conditions.