Bolin Kristian, Lindgren Anna, Lindgren Björn, Lundborg Petter
Lund University Centre for Health Economics, Lund, Sweden.
Int J Health Care Finance Econ. 2009 Mar;9(1):83-112. doi: 10.1007/s10754-008-9048-9. Epub 2008 Nov 14.
We analysed the relative importance of individual versus institutional factors in explaining variations in the utilisation of physician services among the 50+ in ten European countries. The importance of the latter was investigated, distinguishing between organisational (explicit) and cultural (implicit) institutional factors, by analysing the influence of supply side factors, such as physician density and physician reimbursement, and demand side factors, such as co-payment and gate-keeping, while controlling for a number of individual characteristics, using cross-national individual-level data from SHARE. Individual differences in health status accounted for about 50% of the between-country variation in physician visits, while the organisational and cultural factors considered each accounted for about 15% of the variation. The organisational variables showed the expected signs, with higher physician density being associated with more visits and higher co-payment, gate-keeping, and salary reimbursement being associated with less visits. When analysing specialist visits separately, however, organisational and cultural factors played a greater role, each accounting for about 30% of the between-country variation, whereas individual health differences only accounted for 11% of the variation.
我们分析了个体因素与机构因素在解释十个欧洲国家50岁及以上人群对医生服务利用情况差异方面的相对重要性。通过分析供应方因素（如医生密度和医生薪酬）和需求方因素（如共付费用和把关制度）的影响，同时控制一些个体特征，利用来自“健康、退休和晚年生活调查”（SHARE）的跨国个体层面数据，研究了后者的重要性，并区分了组织（显性）和文化（隐性）机构因素。健康状况的个体差异约占各国医生就诊差异的50%，而所考虑的组织和文化因素各占差异的约15%。组织变量显示出预期的迹象，较高的医生密度与更多的就诊次数相关，而较高的共付费用、把关制度和薪资薪酬与较少的就诊次数相关。然而，在单独分析专科就诊时，组织和文化因素发挥了更大的作用，各占各国之间差异的约30%，而个体健康差异仅占差异的11%。
