Department of Public Health and Primary Health Care, University of Bergen, Norway.
Eur J Gen Pract. 2012 Dec;18(4):212-8. doi: 10.3109/13814788.2012.702208. Epub 2012 Jul 19.
Mortality and morbidity rates differ markedly across social strata, resulting in different needs for health services. The utilization of GP services may be higher in groups with lower socioeconomic status (SES), although findings differ when taking health needs into account.
The aim of this study was to assess the association between the SES of list populations and the characteristics of GP practices, consultation rates, and income per patient in a fee-for-service financing model.
A cross-sectional register-based study, including all Norwegian specialist GPs practising in 2008. After grouping GP lists into five levels based on a constructed index of SES, associations between SES and GP practice characteristics were analysed by analysis of variance and linear regression.
GP lists with the lowest SES had higher consultation rates (regression coefficient, 0.31; P < 0.001) and a higher total fee-for-service (regression coefficient, 104; P < 0.001) than lists with the highest SES. Laboratory use in consultations was less frequent in the lowest SES group (regression coefficient, -3.1; P < 0.001). No differences were found in the frequency of long consultations or fee-for-service per consultation. The frequency of multidisciplinary meetings was 2.5 times higher in the lowest SES group compared to the highest SES group.
The findings indicate a markedly higher utilization of GP services in list populations with a lower SES, compensated by a higher annual GP income per patient. However, consultation characteristics, such as time spent with patients and use of laboratory tests, did not increase with lower SES lists.
不同社会阶层的死亡率和发病率差异显著，导致对卫生服务的需求不同。尽管在考虑健康需求时，结果有所不同，但社会经济地位（SES）较低的群体对全科医生（GP）服务的利用率可能更高。
本研究旨在评估在按服务收费的融资模式下，名单人群的 SES 与 GP 实践特征、就诊率和每位患者收入之间的关系。
这是一项基于注册的横断面研究，包括 2008 年所有在挪威执业的专科 GP。根据 SES 构建指数将 GP 名单分为五个等级，然后通过方差分析和线性回归分析 SES 与 GP 实践特征之间的关系。
SES 最低的 GP 名单的就诊率较高（回归系数为 0.31；P < 0.001），总按服务收费也较高（回归系数为 104；P < 0.001），而 SES 最高的 GP 名单则较低。SES 最低的组中，在咨询中使用实验室检查的频率较低（回归系数为-3.1；P < 0.001）。咨询时间长短或每次咨询的按服务收费没有差异。SES 最低的组中多学科会议的频率是 SES 最高组的 2.5 倍。
研究结果表明 SES 较低的名单人群对 GP 服务的利用率明显更高，这由每位患者的 GP 年收入较高来补偿。然而，咨询特征，如与患者的相处时间和实验室检查的使用，并未随 SES 较低的名单而增加。
