רופאים ראשוניים בישראל 1997: מאפיינים ותמורות בעידן של רפורמה

In light of the declared policy of strengthening primary health care, and following changes brought about in the Israeli health care system by the National Health Insurance Law, this article presents data on characteristics of primary care physicians presently employed by the sick funds, and examines whether changes took place in these characteristics in recent years. Knowledge of the characteristics of physicians employed by the primary health system and of the changes that have taken place in physician practice patterns can assist in policymaking regarding manpower planning, training programs, the organization of primary health care and workload manageÙ ment. Data on the characteristics of primary care physicians in 1997, and on perceived changes in their work, are based on a questionnaire mailed in 1997 to a representative sample of primary care physicians working in the sick funds. Eight hundred physicians were interviewed; the response rate was 86%. Data on primary care physicians from 1993 were based on a survey conducted that year among a representative national sample, in which 677 primary care physicians were interviewed and the response rate was 78%. The article presents personal characteristics of the physicians, including age, gender and professional training; organizational characteristics, including sick fund, employment conditions, clinic staff, geographic area and community size; and job characteristics, such as work hours, patient list size, the number of contacts with patients, and satisfaction. The changes in physician practice patterns are presented in the comparison of personal, organizational and job characteristics with data from the survey that was conducted in 1993. In addition, perceived job changes in 1995-1997 that were reported by the physicians in 1997 are presented. The findings indicate areas that decision makers should note in implementing policy aimed at strengthening primary care medicine as the health care system's primary stratum. These areas include the physicians' professional training levels, the preferred type of specialty, the content of advanced studies and enrichment courses, and workloads. Finally, the implications of the National Health Insurance Law on physician autonomy and on financial considerations in the process of care are discussed, as are involvement in sick fund marketing, member recruitment and physician job satisfaction.