Strengthening the use of preventive services in primary care has become the key to solving the problem of a global increase in healthcare expenditures caused by aging populations and chronic diseases. In practice, whether devoting effort to preventive services can be a strategic decision when the limited working time keeps a general practitioner (GP) busy with diagnosis and treatment. Based on the above motivations and challenges, we are the first to focus on the conflict between treatment services and preventive services of a GP with limited service capacity in the healthcare field. This paper considers a public health system consisting of a funder, a GP, a specialist, and a pool of delay-sensitive residents. Four payment schemes are investigated in terms of encouraging the GP to deliver preventive services: (i) fee for service (FFS), (ii) capitation, (iii) GP fundholding, and (iv) penalty scheme. The result shows that the GP fundholding scheme and the penalty scheme are more effective in encouraging preventive service provision in primary care, whereas the other two schemes may result in underinvestment in preventive services. Further, we compare the performance of the GP fundholding scheme and penalty scheme by applying the optimal reimbursement, which refers to the amount that maximizes social welfare. Compared with the GP fundholding scheme, the penalty scheme can incentivize preventive services with lower expenditures for the funder. There are two additional interesting findings: (1) A larger reimbursement discourages the GP from delivering preventive services. (2) An increased marginal treatment cost always incentivizes the GP to allocate more working time to preventive services, thereby reducing the referral rate and saving costs. Counterintuitively, increasing the marginal cost of preventive services may also encourage the GP to deliver preventive services. Our analysis sheds light on how to encourage preventive service provision in primary care through payment schemes.

加强初级保健中预防性服务的使用已成为解决人口老龄化和慢性病导致全球医疗保健支出增加问题的关键。在实践中，当有限的工作时间让全科医生 (GP) 忙于诊断和治疗时，是否致力于预防服务可以成为一项战略决策。基于上述动机和挑战，我们首先关注医疗领域服务能力有限的全科医生的治疗服务与预防服务之间的冲突。本文考虑了一个由资助者、全科医生、专家和对延误敏感的居民组成的公共卫生系统。在鼓励全科医生提供预防性服务方面，研究了四种支付方案：（i）服务费（FFS），(ii) 按人头计费，(iii) GP 资金持有，以及 (iv) 惩罚计划。结果显示，GP 基金持有计划和惩罚计划在鼓励初级保健提供预防性服务方面更有效，而其他两种计划可能导致预防性服务投资不足。此外，我们通过应用最优报销来比较 GP 基金持有计划和惩罚计划的表现，最优报销是指使社会福利最大化的金额。与GP基金持有计划相比，惩罚计划可以激励预防性服务，而资助者的支出较低。还有两个有趣的发现：（1）较大的报销会阻碍全科医生提供预防性服务。(2) 增加的边际治疗成本总是会激励全科医生将更多的工作时间分配给预防服务，从而降低转诊率并节省成本。与直觉相反，增加预防服务的边际成本也可能鼓励全科医生提供预防服务。我们的分析揭示了如何通过支付计划鼓励初级保健中的预防性服务提供。