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Differences of the quality of care experience: the perception of patients with either network or conventional health plans.

BACKGROUND
Various studies have been performed on differences in quality measures between different models of primary care with inconclusive results. In Switzerland, up to a third of the population chooses network health plans including gatekeeping to profit from lower premiums and almost half of GPs work in primary care networks.


OBJECTIVE
To determine differences in the quality of interpersonal care and practice management between patients consulting a physician organized in a GP network or in independent practice.


METHODS
We analysed data of the European Project on Patient Evaluation of General Practice Care (EUROPEP) questionnaire measuring the quality of the patient-physician interaction and practice management of 473 primary care physicians. From the 25178 patients who completed the questionnaire, 72.2% (18174) consulted a physician participating in a network and 27.8% (7004) a physician working in independent practice.


RESULTS
The overall answer pattern of EUROPEP questions shows that patients were generally more satisfied with physicians in independent practice. Particularly, questions within the domains 'relation and communication' and 'information and support' and to a lesser degree within 'Medical care' were significantly answered more favourable by patients of independent physicians. Stratification for chronic diseases showed that significant differences favouring independent physicians were less evident in patients with chronic diseases than in the non-chronic group.


CONCLUSIONS
The results show differences in the quality of interpersonal care and practice management experienced by patients consulting network-or independent physicians. Therefore, we suggest that efforts to reduce health care spending by promoting more integrated care must also focus on monitoring and improving patient perceived qualities.