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Understanding the gap between need and utilization in outpatient care—The effect of supply-side determinants on regional inequities

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  • Ozegowski, Susanne
  • Sundmacher, Leonie

Abstract

The present study analyzes the effect of supply-side determinants on regional inequities in outpatient care. Inequities are measured by the degree of disparity between need for and actual utilization of outpatient health services in the 412 German districts. Outpatient care needs of each district are determined by applying the regression model of the German risk structure compensation scheme. We find that supply-side factors account for half of the model's coverage of regional inequities. The remaining regional variance explained by the model may be attributed to socioeconomic and (socio-)geographic determinants as well as price effects. Our findings call for strengthening the role of GPs as coordinators in the health care system, countering the geographic maldistribution of physicians and introducing adequate programs to improve the level of care in socially deprived districts. The study also highlights the importance of differentiating between need, demand and utilization of health services in order to understand the root causes of inequities.

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  • Ozegowski, Susanne & Sundmacher, Leonie, 2014. "Understanding the gap between need and utilization in outpatient care—The effect of supply-side determinants on regional inequities," Health Policy, Elsevier, vol. 114(1), pages 54-63.
    • Handle: RePEc:eee:hepoli:v:114:y:2014:i:1:p:54-63
    DOI: 10.1016/j.healthpol.2013.08.005
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    2. Salm, Martin & Wübker, Ansgar, 2017. "Causes of regional variation in healthcare utilization in Germany," Ruhr Economic Papers 675, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    3. Brenna, Elenka & Polistena, Barbara & Spandonaro, Federico, 2023. "Analysing outpatient care access for planning purposes: The Basilicata Region experience," Evaluation and Program Planning, Elsevier, vol. 99(C).
    4. Weinhold, Ines & Gurtner, Sebastian, 2018. "Rural - urban differences in determinants of patient satisfaction with primary care," Social Science & Medicine, Elsevier, vol. 212(C), pages 76-85.
    5. Daisy Duell & Maarten Lindeboom & Xander Koolman & France Portrait, 2019. "Practice variation in long‐term care access and use: The role of the ability to pay," Health Economics, John Wiley & Sons, Ltd., vol. 28(11), pages 1277-1292, November.
    6. Katharina Schley, 2018. "Health care service provision in Europe and regional diversity: a stochastic metafrontier approach," Health Economics Review, Springer, vol. 8(1), pages 1-11, December.
    7. Lavergne, Miriam Ruth & Barer, Morris & Law, Michael R. & Wong, Sabrina T. & Peterson, Sandra & McGrail, Kimberlyn, 2016. "Examining regional variation in health care spending in British Columbia, Canada," Health Policy, Elsevier, vol. 120(7), pages 739-748.
    8. Eva Kesternich & Olaf Rank, 2022. "Beyond patient-sharing: Comparing physician- and patient-induced networks," Health Care Management Science, Springer, vol. 25(3), pages 498-514, September.
    9. Volkert, Anna & Pfaff, Holger & Scholten, Nadine, 2020. "What Really Matters? Organizational Versus Regional Determinants of Hospitals Providing Medical Service Centres," Health Policy, Elsevier, vol. 124(12), pages 1354-1362.
    10. Kuhn, Michael & Ochsen, Carsten, 2019. "Population change and the regional distribution of physicians," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
    11. Wende, Danny & Kopetsch, Thomas & Richter, Wolfram F., 2020. "Planning health care capacities with a gravity equation," Ruhr Economic Papers 888, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    12. Herwartz, Helmut & Schley, Katharina, 2018. "Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany," Health Policy, Elsevier, vol. 122(3), pages 293-300.
    13. Danny Wende, 2019. "Spatial risk adjustment between health insurances: using GWR in risk adjustment models to conserve incentives for service optimisation and reduce MAUP," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(7), pages 1079-1091, September.
    14. Rouven Edgar Haschka & Katharina Schley & Helmut Herwartz, 2020. "Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 55-71, February.

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