Häkkinen U, Rosenqvist G, Aro S
National Research and Development Centre for Welfare and Health, Health Services Research Unit, Helsinki, Finland.
Health Econ. 1996 Sep-Oct;5(5):421-34. doi: 10.1002/(SICI)1099-1050(199609)5:5<421::AID-HEC222>3.0.CO;2-D.
At the start of the 1990s, the economic situation in Finland deteriorated radically. During the depression (1991-93), health care expenditure decreased by about 10%, and was associated with considerable changes in Finnish health care. This paper reports studies of the determinants of use of physician services in Finland in the 1990s. The particular aim was to evaluate how utilization altered during the economic depression and during the changes in the health care system. Using econometric methods, an attempt was made to describe the changes in structure and level of utilization. The study was based on annual computer-assisted telephone interviews made during 1991-94. Visits to a doctor were analysed using a two-part model (logit and truncated negative binomial regression). Structural changes were tested by Chow-type tests and changes in the level of utilization by chronologically defined dummy variables for each year. The most significant changes (both in structure and level) occurred in the model explaining the number of visits (negative binomial regression) of chronically ill persons. Variables describing the continuity of care seem to be more important determinants of visits to a doctor than certain other availability and socioeconomic variables.
20世纪90年代初，芬兰的经济形势急剧恶化。在经济衰退期间（1991 - 1993年），医疗保健支出下降了约10%，并与芬兰医疗保健领域的重大变化相关联。本文报告了对20世纪90年代芬兰医生服务使用决定因素的研究。特别目的是评估在经济衰退期间以及医疗保健系统变革期间利用率是如何变化的。运用计量经济学方法，试图描述利用率的结构和水平变化。该研究基于1991 - 1994年期间每年进行的计算机辅助电话访谈。使用两部分模型（逻辑回归和截断负二项回归）分析看医生的情况。通过Chow型检验来检验结构变化，通过按年份顺序定义的虚拟变量来检验利用率水平的变化。在解释慢性病患者就诊次数（负二项回归）的模型中出现了最显著的变化（在结构和水平方面）。描述医疗连续性的变量似乎比某些其他可及性和社会经济变量更能决定看医生的情况。
