Forms and Frequency of Sanctions against General Practitioners and Family Medicine Specialists in Macedonia.

OBJECTIVE: The goal of this study is to evaluate the reasons for sanctioning and the types of sanctions used on general medicine primary healthcare practitioners (GM-PHPs) in the Republic of Macedonia. MATERIALS AND METHOD: This is a cross-sectional study for which we used an anonymous survey. This survey was distributed in a printed and electronic form to GM-PHPs in different parts of Macedonia and 438 of them responded. We used the SPSS statistical program to process the quantitative data. RESULTS: The GM-PHPs' sex was not associated with the sanctioning in the univariable analysis, but it was in the multivariable. GM-PHPs with ≥30 years of experience have 8.7 times higher odds to be sanctioned than those with ≤5 years of experience. GM-PHPs that worked in the hospital or ≤19 km from the nearest hospital were significantly more frequently sanctioned. The most common three reasons for sanctioning were: "Financial consumption of prescriptions and referrals above the agreed amount", "Higher rate of sick leaves and/or unjustified sick leaves" and "Unrealized preventative goals or education". "Financial sanction by scale" was the most common type of sanction - 49.8% of participants. GM-PHPs who followed the guidelines, but were exposed to violence by patients or their family/companion were sanctioned significantly more frequently. CONCLUSIONS: In our sample, we can observe that in the univariable analysis age, years of experience, family medicine speciality, the distance of the workplace from the nearest hospital and violence are associated with sanctioning. In the multivariable analysis: sex, years of experience, the distance of the workplace from the nearest hospital and violence are associated with sanctioning. The majority of sanctions were financial sanctions (84.5%).

The Frequency and Form of Controls by HIIS over Primary Health Care Physicians in Slovenia.

OBJECTIVE: The aim of this study was to evaluate the pattern of controls and sanctions by the Health Insurance Institute (HIIS) over primary healthcare practitioners (PHCPs) in Slovenia, the reasons for sanctions and the violence against PHCPs if they followed the HIIS rules. MATERIALS AND METHODS: We performed analyses using survey data from a cross-sectional study, across public health centres and individual contractors in which 1,458 PHCPs were invited to answer a questionnaire anonymously via an online system used to collect data for the Slovenian Medical Chamber and the Association of General Practice/Family Medicine of South-East Europe. Quantitative data were presented by descriptive statistics and analysed using Pearson's chisquared test. RESULTS: Responses were obtained from 462 female and 138 male PHCPs. Of the total number of 600 participants, 430 were family medicine specialists. 263 (43.8%) responded that they have been sanctioned for various reasons. PHCPs that are more likely to be sanctioned include family medicine specialists and individual contractors. PHCPs working in areas smaller than 20 000 inhabitants were sanctioned in a bigger proportion than their counterparts. Monetary penalties levied against those working at health centres were usually covered by the health centre. Family medicine specialists, more often than other PHCPs experienced violence from patients or patients' relatives if they followed HIIS rules. CONCLUSION: Family medicine specialists are sanctioned more frequently than other PHCPs, individual contractors are sanctioned more frequently than public healthcare PHCPs and PHCPs in working area with a population less than 20.000 are more frequently sanctioned than those working in an area with a bigger population count.

Workplace Violence and Sanctioning of Family Medicine Physicians Due to the Rules of Health Insurance Funds in the Western Balkan.

INTRODUCTION: After family medicine's famous beginnings in the early 60's through introduction of the world's first family medicine specialization, with transitional changes and war also come changes in former Yugoslavia's healthcare systems. AIM: The primary aim of this article is to analyze frequency and causes of sanctioning of family physicians by Health insurance funds in the countries of former Yugoslavia. The secondary aim is to evaluate frequency and types of workplace violence family physicians experienced due to insurance boundaries for patients. METHODS: The comparative, cross-sectional survey was carried out from October 2017 to February 2018. Study participants were general practitioners' (GPs), family physicians (FPs) and those without a specialty designation but providing family medicine services in one of the five Western Balkans countries: Croatia, Slovenia, Serbia, Macedonia and Bosnia and Herzegovina (B&H). The questionnaire was designed for the purpose of the study. RESULTS: Forty-nine percent of participating physicians have been sanctioned by Health Insurance Fund and 77. 5% has been exposed to workplace violence. The most common type of violence was verbal (76.6%). Financial penalties according to the scale had the highest rates in Macedonia (73.9%) and Slovenia (43.9%). CONCLUSION: It is necessary to educate creators of healthcare policies, doctors and patients for the purpose of establishing partner relations which would lead to strengthening of primary healthcare, but also to a more efficient healthcare system.