Rutten F F, van der Gaag J
Health Serv Res. 1977 Fall;12(3):233-49.
Three independent sets of data are analyzed to investigate the determinants of referrals from general practitioners to specialists, the demand for specialist care, and the rapid increase in referrals and use of specialists in the Netherlands. Individual determinants of demand are examined with data from a three-man group practice; macroanalyses are conducted on cross-section data from all service areas of the Dutch Sickness Fund Organization for 1971 and 1973 and cross-section time-series data from all provinces for the period from 1960 to 1972. Regression coefficients are estimated for the number of referrals to specialists and the amount of care given by specialists, with respect to explanatory variables that induce both socioeconomic and care-supply factors. Results are discussed in light of M. Feldstein's classification of three types of care, in which for some types the physician is seen as generating the demand for care. The authors conclude that demand for specialist outpatient care is in large part supply-determined and that general practitioners substitute for specialists; they also suggest that the dual physician-payment system in the Netherlands (capitation for legally insured patients and fee-for-service for privately insured patients) contributes to increased use of specialist care.
分析了三组独立的数据，以研究荷兰全科医生向专科医生转诊的决定因素、专科护理需求以及转诊和专科医生使用量的快速增长。利用来自一个三人团体诊所的数据研究需求的个体决定因素；对荷兰疾病基金组织1971年和1973年所有服务区域的横截面数据以及1960年至1972年期间所有省份的横截面时间序列数据进行宏观分析。针对转诊给专科医生的数量和专科医生提供的护理量，估计相对于诱导社会经济和护理供应因素的解释变量的回归系数。根据M. 费尔德斯坦对三种护理类型的分类对结果进行了讨论，在这种分类中，对于某些类型的护理，医生被视为产生护理需求。作者得出结论，专科门诊护理需求在很大程度上由供应决定，全科医生替代了专科医生；他们还表明，荷兰的双重医生支付系统（法定参保患者按人头付费，私人参保患者按服务收费）导致专科护理使用量增加。
