Häkkinen Unto
National Research and Development Centre for Welfare and Health, Siltasaarenkatu 18 A, FIN-00531 Helsinki, Finland.
Soc Sci Med. 2002 Nov;55(9):1523-37. doi: 10.1016/s0277-9536(01)00285-4.
The determinants of use of physician services in Finland in 1987 and 1996 were studied to evaluate how the utilisation altered over this period, which saw fairly radical changes in Finnish health care and the entire economy. We used econometric methods to describe the changes in structure and level of utilisation. The study was based on the Finnish Health Care Surveys of 1987 and 1996, which were nationally representative cross-sectional samples of the total non-institutionalised population. Visits to a doctor were analysed using a two-part model (logit +truncated negative binomial regression). Structural changes were tested by a Chow-type test and changes in utilisation level by a dummy variable indicating the year of study. Analyses were made separately for four different age groups: children aged 0-6 and 7-17, and adults aged 18-64 and over 64 years. The change in utilisation of physician services over the nine-year period was a product of both structural and level changes. Except in the youngest age group, both types of changes occurred in the second part of the utilisation model, which implies that they were more associated with supply side factors than demand factors. Among young children, the type of day-care seems to have been an important determinant of physician utilisation. Although its effect decreased considerably over the period, the total number of visits to a doctor in 1996 was still about 30% greater among children in nursery care than those at home. The rise in self-reported chronic illness was an important explanation of the increase in utilisation of doctors' services, especially among children. Among adults aged 18-64, the most important structural change was an increase of the effect of self-rated health status variables on utilisation. Inequity in utilisation of services persisted with respect to income. In conclusion it can be stated that Finland's tax-based and locally decentralised health care system adapted quite well to the radical changes experienced during the study period.
对1987年和1996年芬兰医生服务利用的决定因素进行了研究，以评估这一时期利用率的变化情况，在此期间芬兰医疗保健和整个经济都发生了相当大的变化。我们采用计量经济学方法来描述利用率的结构和水平变化。该研究基于1987年和1996年的芬兰医疗保健调查，这是全国范围内具有代表性的非机构化总人口横断面样本。使用两部分模型（logit+截断负二项回归）分析就医情况。通过Chow型检验来检验结构变化，通过表示研究年份的虚拟变量来检验利用率水平的变化。分别对四个不同年龄组进行了分析：0至6岁和7至17岁的儿童，以及18至64岁和64岁以上的成年人。在这九年期间，医生服务利用率的变化是结构变化和水平变化共同作用的结果。除了最年幼的年龄组外，这两种变化都发生在利用模型的第二部分，这意味着它们与供给侧因素的关联比与需求因素的关联更大。在幼儿中，日托类型似乎是医生服务利用的一个重要决定因素。尽管在此期间其影响大幅下降，但1996年接受托儿所照料的儿童看医生的总次数仍比在家照料的儿童约多30%。自我报告慢性病的增加是医生服务利用率上升的一个重要原因，尤其是在儿童中。在18至64岁的成年人中，最重要的结构变化是自评健康状况变量对利用率的影响增加。在服务利用方面，收入不平等现象依然存在。总之，可以说芬兰基于税收且地方分散的医疗保健系统很好地适应了研究期间经历的巨大变化。
