Overview of primary care payment systems and the mode of care provision in 31 European countries
| Country | Primary care payment | Does 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 |
|---|---|---|---|---|
| Austria | Fee-for-service | No need and no incentive to obtain referral | No incentive and no requirement to register | Solo practice |
| Belgium | Capitation/fee-for-service | Financial incentives to obtain a referral, but direct access is possible | No requirement to register, but there are financial incentives to do so | Solo practice |
| Bulgaria (15), (16) | Capitation/fee-for-service/other | Primary care physician referral is required | No incentive and no requirement to register | Solo practice |
| Cyprus (17) | Fee-for-service | No need and no incentive to obtain referral | No incentive and no requirement to register | Group practice |
| Czech Republic | Capitation/fee-for-service/pay for performance | No need and no incentive to obtain referral | No incentive and no requirement to register | Solo practice |
| Denmark | Capitation/fee-for-service | Financial incentives to obtain a referral, but direct access is possible | No requirement to register, but there are financial incentives to do so | Solo practice |
| England | Capitation/fee-for-service/pay for performance | Primary care physician referral is the usual way to access secondary care, but direct access is possible | No incentive and no requirement to register | Group practice |
| Estonia | Capitation/fee-for-service/pay for performance/other | Primary care physician referral is required | Registration required | Solo practice |
| Finland | Global budget | Primary care physician referral is required | Registration required | Group practice |
| Former Yugoslav Republic of Macedonia (18) | Capitation/other | Financial incentives to obtain a referral, but direct access is possible | Registration required | Solo practice |
| Germany | Fee-for-service | No need and no incentive to obtain referral | No requirement to register, but there are financial incentives to do so | Solo practice |
| Greece | Global budget | No need and no incentive to obtain referral | No incentive and no requirement to register | Group practice |
| Hungary (15), (16) | Capitation/pay for performance/global budget | Primary care physician referral is required | No incentive and no requirement to register | Solo practice |
| Iceland | Fee-for-service/global budget | No need and no incentive to obtain referral | No incentive and no requirement to register | Group practice |
| Ireland (17) | Capitation/fee-for-service | Primary care physician referral is required | No incentive and no requirement to register | Group practice |
| Italy | Capitation | Primary care physician referral is required | Registration required | Group practice |
| Latvia | Capitation/fee-for-service/pay for performance/fixed payments | Financial incentives to obtain a referral, but direct access is possible | Registration required | Group practice |
| Lithuania | Capitation/fee-for-service/pay for performance/global budget | Primary care physician referral is required | Registration required | Group practice |
| Luxembourg | Capitation/fee-for-service | No need and no incentive to obtain referral | No incentive and no requirement to register | Solo practice |
| Malta (15), (16) | Fee-for-service | Financial incentives to obtain a referral, but direct access is possible | No incentive and no requirement to register | Solo practice |
| Netherlands | Capitation/fee-for-service/pay for performance | Primary care physician referral is required | No incentive and no requirement to register | Group practice |
| Norway | Capitation/fee-for-service | Primary care physician referral is required | Registration required | Group practice |
| Poland | Capitation/fee-for-service | Primary care physician referral is required | No incentive and no requirement to register | Group practice |
| Portugal | Capitation/pay for performance/global budget | Primary care physician referral is required | Registration required | Group practice |
| Romania (15), (16) | Capitation/fee-for-service | Financial incentives to obtain a referral, but direct access is possible | Registration required | Solo practice |
| Slovakia (15), (16) | Capitation/fee-for-service/other | Financial incentives to obtain a referral, but direct access is possible | Registration required | Solo practice |
| Slovenia | Capitation/fee-for-service | Primary care physician referral is required | Registration required | Group practice |
| Spain | Capitation/fee-for-service/global budget | Primary care physician referral is required | Registration required | Group practice |
| Sweden | Capitation/fee-for-service | Primary care physician referral is required | No incentive and no requirement to register | Group practice |
| Switzerland | Capitation/fee-for-service | Financial incentives to obtain a referral, but direct access is possible | No requirement to register, but there are financial incentives to do so | Solo practice |
| Turkey | Global budget | No need and no incentive to obtain referral | Registration required | Group practice |
Source: Organisation for Economic Co-operation and Development Health Systems Characteristics Survey (19) except where noted otherwise.