A new integrated mixed payment model for general practitioners in Belgium

Johan Vansintejan, Jan De Maeseneer, Jan De Lepeleire, Thibault Detremerie

Research output: Contribution to journalArticlepeer-review


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.
Translated title of the contributionA new integrated mixed payment model for general practitioners in Belgium
Original languageDutch
Number of pages9
JournalTijdschrift voor Geneeskunde
Publication statusPublished - 6 Mar 2023


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