Jusot Florence, Or Zeynep, Sirven Nicolas
Université Paris-Dauphine, LEDA-LEGOS, Place du Maréchal de Lattre de Tassigny, 75 775 Paris Cedex 16, France & Irdes (Institute for Research and Information on Health Economics), 10 rue Vauvenargues, 75018 Paris, France.
IRDES, Institute for Research and Information on Health Economics, 10 rue Vauvenargues, 75018 Paris, France.
Eur J Ageing. 2011 Oct 21;9(1):15-25. doi: 10.1007/s10433-011-0201-9. eCollection 2012 Mar.
Prevention has been identified as an effective strategy to lead healthy, active and independent lives in old age. Developing effective prevention programs requires understanding the influence of both individual and health system level factors on utilisation of specific services. This study examines the variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey. The models used allow for the impact of individual level demand-side characteristics and supply-side health systems features to be separately identified. The analysis shows significant variations in preventive care utilisation both within and across European countries. In all countries, controlling for individual health status and country-level systemic differences, higher educated and higher income groups use more preventive services. At the health system level, high public health expenditures and high GP density is associated with a high level of preventive care use, but specialist density does not appear to have any effect. Moreover, payment schemes for GPs and specialists appear to significantly affect the incentives to provide preventive health care. In systems where doctors are paid by fee-for-service the utilisation of all health services, including cancer screening, are higher.
预防已被确认为一种有效的策略，可让人在老年时过上健康、积极且独立的生活。制定有效的预防计划需要了解个体因素和卫生系统层面因素对特定服务利用情况的影响。本研究通过汇总欧洲健康、老龄化与退休调查（Survey of Health Ageing and Retirement in Europe）两轮调查以及英国家庭跟踪调查（British Household Panel Survey）的数据，考察了14个欧洲国家50岁及以上人群预防服务利用情况的差异。所使用的模型能够分别识别个体层面需求方特征和供应方卫生系统特征的影响。分析表明，欧洲国家内部和国家之间的预防保健利用情况存在显著差异。在所有国家，在控制个体健康状况和国家层面的系统性差异后，受教育程度较高和收入较高的群体使用更多的预防服务。在卫生系统层面，高公共卫生支出和高全科医生（GP）密度与高水平的预防保健使用相关，但专科医生密度似乎没有任何影响。此外，全科医生和专科医生的支付方案似乎会显著影响提供预防性医疗保健的激励措施。在按服务收费支付医生报酬的系统中，包括癌症筛查在内的所有卫生服务的利用率都更高。
