original plans envisaged that existing gps would progressively gain recognition as family physicians provided they completed ten days of preliminary orientation followed by a twoyear programme of specialist training efforts are being made however to increase the number of primary care doctors and reduce the list size for each doctor from current levels each public hospital service is paid by package rates that bundle prices for outpatient and inpatient services established by the social security institute within a global budget that is negotiated between the social security institution ssi and the ministry of health the payment of staff involves a salary and a performancebased component