A new integrated mixed payment model for general practitioners in Belgium

Belgian primary care faces a number of challenges, exacerbated by the COVID-19 pandemic: an
increasing percentage of elderly people, changing family structures, a shrinking labour market,
health inequities, rapid and sometimes costly technological innovations, etc. The ‘quintuple aim’
was set as a goal to organise equitable and cost-effective, high-quality care to secure the health of
citizens and the well-being of healthcare workers. There’s a growing consensus that a dominantly
fee-for-service system is not fit to respond to the challenges. This article proposes a third mixed
payment model, besides the 2 existing models, i.e. a fee for service and a capitation model. In this new
model, the general practitioner’s income will be based for 60/70% on capitation and for 40/30% on fee
for service. The income via capitation will depend on the characteristics of the patient population
(age, socioeconomic status and maybe gender). Important conditions to implement this new model
are a complete registration of all citizens in a primary care practice as well as monitoring of the
number of consultations and home visits. Importantly, all forms of teleconsultations will be paid
under the capitation part and the face-to-face encounters under the fee-for-service system. This new
mixed model may cause some income shifts between general practitioners. Therefore, a thorough
simulation at practice and care provider level is necessary before implementation.