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Do all respond alike? A difference-in-differences analysis of how GPs' financial motivation impacted contacts when the COVID-19 pandemic hit Denmark
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DOI：10.1016/j.healthpol.2026.105612.png)
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Abstract
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Background: The onset of the COVID-19 pandemic raised an immediate need for remote access to health care. Danish policymakers therefore introduced fees for remote contacts in general practice. The GPs could charge a fee for video consultations and for a regular consultation performed over the telephone, which was a higher fee than for a standard telephone consultation. Objective: To assess whether GPs' financial motivation impacted changes in contacts in general practice when the pandemic hit. Methods: We combine unique survey data on GPs' financial motivation from 2019 (before the pandemic) with rich register data on their practices' reimbursed contacts and other characteristics from 2015 to 2020 (the first year of the pandemic). Using a difference-in-differences framework, we estimate whether practices with more financially motivated GPs responded differently to the pandemic. Results: We find that practices with more financially motivated GPs tend to provide relatively more contacts per patient in response to the pandemic. In some months, an increase in financial motivation of 0.1 (on the motivation scale from 0 to 1) yields 2.9 to 5.6 additional contacts per 1000 enlisted patients. This is driven by a more frequent use of the new fees for remote contacts. We also find indication of some substitution from low- to highfee telephone contacts. Conclusion: Our findings suggest that using remote fees to appeal to GPs' financial motivation may have created inequity in access to care when the pandemic hit. Policymakers should therefore also consider other ways to motivate GPs to ensure equitable care delivery.
Keywords:
Inequity in access
Fee-for-service
Incentives
Financial motivation
General practice
Health policy
COVID-19
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