Change in determinants of use of physician services in Finland between 1987 and 1996.

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.