General Practitioners and Specialists: What’s a Fair Price?

During the first congress of the Belgian College of General Practitioners, held on November 15 and 16 in Namur, Belgium, a workshop tackled the question, “What is the fair price for general practitioners (GPs) and specialists?” The session addressed familiar challenges such as an aging population, the rising burden of related chronic diseases, and a healthcare workforce shortage. Discussions centered on rethinking provider compensation and reorganizing care delivery.

“In Belgium, as elsewhere, the hospital-centered model has reached its limits,” said workshop Co-moderator Lawrence Cuvelier, a GP in Brussels and president of Groupement Belge des Omnipraticiens, a union for French-speaking GPs in Belgium.

Healthcare spending in Belgium now accounts for 10% of the country’s GDP, up from 7% just a few years ago. This growth stems from factors including longer life expectancy accompanied by a rise in chronic diseases and comorbidities, costly but essential technological advances, and rising patient expectations for faster, more personalized, and comprehensive care.

At the same time, hospital stays are getting shorter, placing greater demands on outpatient care, without reducing the complexity of medical conditions.

New Care Model

To better understand the distribution of care between general medicine and specialized care, Cuvelier introduced the concept of complexity/complication. “Complex care requires specific training or technology, while complicated care involves multiple factors,” he explained. “For example, a diabetic patient with lactose intolerance requires complicated follow-up.”

Indeed, the current hospital-centered model assumes that most complex care must occur in a hospital setting. However, many interventions could be managed outside of hospitals. Technologies such as teleconsultation and telemonitoring offer solutions to alleviate hospital congestion and free up budgets.

“As GPs, our future roles are evolving,” Cuvelier said. “With shorter hospital stays, we will increasingly have to provide complicated care. Take patients with deep vein thrombosis, for example. They used to be hospitalized for 10 days, but now they receive outpatient treatment.”

Despite such advances, hospitals remain under financial pressure. Rising deficits and high operating costs threaten their long-term viability. “Reorganization is necessary to avoid hitting a wall,” Cuvelier added.

Value-Based Healthcare

Gilbert Bejjani, MD, an anesthesiologist and vice president of the Belgian Medical Association, presented the concept of value-based healthcare as a potential solution. Introduced by Michael E. Porter, PhD, of Harvard Business School, Boston, this model focuses on restructuring healthcare delivery toward measurable outcomes that have high impact and matter most to patients.

Its core principles include improving care quality by reducing unnecessary procedures and standardizing pathways, which can also curb expenditure. Another priority is controlling costs through an emphasis on primary care and prevention. Finally, value-based healthcare aims to enhance the patient experience by integrating their needs and expectations into the design of care.

In the United States, Accountable Care Organizations illustrate this approach, said Bejjani. These groups of providers offer coordinated care, with financial incentives tied to performance improvements. Results have shown reduced costs and higher patient satisfaction.

According to Bejjani, three strategies could transform primary care: Delegating simple or standardized tasks to paramedical professionals, such as nurses or pharmacists; leveraging technology for chronic disease management; and standardizing clinical pathways for common conditions.

“For diabetic patients, routine monitoring via telemonitoring would suffice,” Bejjani noted. “In Germany, a weight-based telemonitoring system for heart failure patients has reduced hospitalizations while maintaining quality follow-up,” he added.

Technology With Human Touch

Technological innovations, such as artificial intelligence, are often seen as a solution to ease the burden on healthcare systems. In dermatology, for example, artificial intelligence tools can detect suspicious lesions with accuracy comparable with that of doctors. However, this transition must be accompanied by ethical considerations to preserve the human connection, which is essential in the doctor-patient relationship. “There’s no incompatibility between technology and humanism, but we must evolve toward something new,” Bejjani emphasized.

This story was translated fromMediQuality using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.