Olivarius N D, Jensen F I, Gannik D, Pedersen P A
Central Research Unit of General Practice, Panum Institute, Copenhagen, Denmark.
Health Policy. 1994 Mar;28(1):15-22. doi: 10.1016/0168-8510(94)90017-5.
This study aims at characterizing the group of people who want to have the right to consult any general practitioner or practising specialist without referral on condition of part self-payment, as opposed to the group of people who choose to be registered with a general practice that offers free services but controls further access to the health care system. All adults or a 10% sample of those listed in nationwide Danish registers were examined cross-sectionally for social and demographic factors and utilization of primary and secondary health care. A minority, which totals 3% of the population, chose free choice of doctor and part self-payment. On average, this group is older and has a higher income. Its mortality and its utilization of general practice and hospital services are lower, and its use of practising specialists is higher, than the majority. Among the persons who chose free choice and self-payment, the pattern of utilization is more likely to be due to a wish for free choice and for specialized medical care than to high morbidity. Dissatisfaction caused by restrictions on self-referral to specialists can be met by offering an option of a parallel system of free choice of doctor on condition of part self-payment.
一类是希望有权在部分自费的情况下无需转诊即可咨询任何全科医生或执业专科医生的人群；另一类是选择在提供免费服务但控制进一步进入医疗保健系统的全科诊所登记的人群。对丹麦全国登记册中列出的所有成年人或10%的样本进行了横断面研究，以了解社会和人口因素以及初级和二级医疗保健的利用情况。占总人口3%的少数人选择了自由选择医生和部分自费。平均而言，这一群体年龄较大且收入较高。与大多数人相比，该群体的死亡率、全科诊所和医院服务的利用率较低，而执业专科医生的利用率较高。在选择自由选择和自费的人群中，利用模式更可能是出于对自由选择和专科医疗护理的愿望，而不是因为发病率高。通过提供一种在部分自费条件下自由选择医生的平行系统选项，可以解决因限制自行转诊至专科医生而引起的不满。
