Table 1:

Overview of primary care payment systems and the mode of care provision in 31 European countries

CountryPrimary care paymentDoes primary care control access to secondary care?Patient required or encouraged to register with a primary care physician or practice?Predominant form of primary care provision
AustriaFee-for-serviceNo need and no incentive to obtain referralNo incentive and no requirement to registerSolo practice
BelgiumCapitation/fee-for-serviceFinancial incentives to obtain a referral, but direct access is possibleNo requirement to register, but there are financial incentives to do soSolo practice
Bulgaria15,16Capitation/fee-for-service/otherPrimary care physician referral is requiredNo incentive and no requirement to registerSolo practice
Cyprus17Fee-for-serviceNo need and no incentive to obtain referralNo incentive and no requirement to registerGroup practice
Czech RepublicCapitation/fee-for-service/pay for performanceNo need and no incentive to obtain referralNo incentive and no requirement to registerSolo practice
DenmarkCapitation/fee-for-serviceFinancial incentives to obtain a referral, but direct access is possibleNo requirement to register, but there are financial incentives to do soSolo practice
EnglandCapitation/fee-for-service/pay for performancePrimary care physician referral is the usual way to access secondary care, but direct access is possibleNo incentive and no requirement to registerGroup practice
EstoniaCapitation/fee-for-service/pay for performance/otherPrimary care physician referral is requiredRegistration requiredSolo practice
FinlandGlobal budgetPrimary care physician referral is requiredRegistration requiredGroup practice
Former Yugoslav Republic of Macedonia18Capitation/otherFinancial incentives to obtain a referral, but direct access is possibleRegistration requiredSolo practice
GermanyFee-for-serviceNo need and no incentive to obtain referralNo requirement to register, but there are financial incentives to do soSolo practice
GreeceGlobal budgetNo need and no incentive to obtain referralNo incentive and no requirement to registerGroup practice
Hungary15,16Capitation/pay for performance/global budgetPrimary care physician referral is requiredNo incentive and no requirement to registerSolo practice
IcelandFee-for-service/global budgetNo need and no incentive to obtain referralNo incentive and no requirement to registerGroup practice
Ireland17Capitation/fee-for-servicePrimary care physician referral is requiredNo incentive and no requirement to registerGroup practice
ItalyCapitationPrimary care physician referral is requiredRegistration requiredGroup practice
LatviaCapitation/fee-for-service/pay for performance/fixed paymentsFinancial incentives to obtain a referral, but direct access is possibleRegistration requiredGroup practice
LithuaniaCapitation/fee-for-service/pay for performance/global budgetPrimary care physician referral is requiredRegistration requiredGroup practice
LuxembourgCapitation/fee-for-serviceNo need and no incentive to obtain referralNo incentive and no requirement to registerSolo practice
Malta15,16Fee-for-serviceFinancial incentives to obtain a referral, but direct access is possibleNo incentive and no requirement to registerSolo practice
NetherlandsCapitation/fee-for-service/pay for performancePrimary care physician referral is requiredNo incentive and no requirement to registerGroup practice
NorwayCapitation/fee-for-servicePrimary care physician referral is requiredRegistration requiredGroup practice
PolandCapitation/fee-for-servicePrimary care physician referral is requiredNo incentive and no requirement to registerGroup practice
PortugalCapitation/pay for performance/global budgetPrimary care physician referral is requiredRegistration requiredGroup practice
Romania15,16Capitation/fee-for-serviceFinancial incentives to obtain a referral, but direct access is possibleRegistration requiredSolo practice
Slovakia15,16Capitation/fee-for-service/otherFinancial incentives to obtain a referral, but direct access is possibleRegistration requiredSolo practice
SloveniaCapitation/fee-for-servicePrimary care physician referral is requiredRegistration requiredGroup practice
SpainCapitation/fee-for-service/global budgetPrimary care physician referral is requiredRegistration requiredGroup practice
SwedenCapitation/fee-for-servicePrimary care physician referral is requiredNo incentive and no requirement to registerGroup practice
SwitzerlandCapitation/fee-for-serviceFinancial incentives to obtain a referral, but direct access is possibleNo requirement to register, but there are financial incentives to do soSolo practice
TurkeyGlobal budgetNo need and no incentive to obtain referralRegistration requiredGroup practice
  • Source: Organisation for Economic Co-operation and Development Health Systems Characteristics Survey19 except where noted otherwise.