THE TROMSO STUDY - FACTORS AFFECTING PATIENT-INITIATED AND PROVIDER-INITIATED USE OF HEALTH-CARE SERVICES

The aim of this study was to examine factors influencing decisions involved in I) patient-intiated visits to general practitioners and II) provider-initiated use of referral services. The analyses were performed with regression models on a set of data from a comprehensive population study of 7369 men aged 20-61 and 6832 women aged 20-56. Marked gender differences appeared in both patient-initiated and physician-initiated health care use. Various health status dimensions were found to be important determinants of patient-initiated use, in particular self-rated health, physical distress and transitory morbidities. Further, having a primary provider was found to increase patient-initated use strongly. Among the health status measures only self-rated health and chronic disease appeared as important determinants of provider-initiated use. Age and years of education were negatively associated with GP visits and positively associated with the use of referral services. The higher rate of referral of patients with higher educational achievement indicates a social status bias among general practitioners, creating considerably inequitable access to referral services. Further, the analyses indicate that positive lifestyles are associated with increased health care consumption among men.