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Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries

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  • Kristian Bolin

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  • Anna Lindgren
  • Björn Lindgren
  • Petter Lundborg

    ()

Abstract

We analysed the relative importance of individual versus institutional factors in explaining variations in the utilisation of physician services among the 50+ in ten European countries. The importance of the latter was investigated, distinguishing between organisational (explicit) and cultural (implicit) institutional factors, by analysing the influence of supply side factors, such as physician density and physician reimbursement, and demand side factors, such as co-payment and gate-keeping, while controlling for a number of individual characteristics, using cross-national individual-level data from SHARE. Individual differences in health status accounted for about 50 percent of the between-country variation in physician visits, while the organisational and cultural factors considered each account for about 15 percent of the variation. The organisational variables showed the expected signs, with higher physician density being associated with more visits and higher co-payment, gate-keeping, and salary reimbursement being associated with less visits. When analysing specialist visits separately, however, organisational and cultural factors played a greater role, each accounting for about 30 percent of the between-country variation, whereas individual health differences only accounted for 1 percent of the variation.
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  • Kristian Bolin & Anna Lindgren & Björn Lindgren & Petter Lundborg, 2009. "Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries," International Journal of Health Economics and Management, Springer, vol. 9(1), pages 83-112, March.
  • Handle: RePEc:kap:ijhcfe:v:9:y:2009:i:1:p:83-112
    DOI: 10.1007/s10754-008-9048-9
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    Cited by:

    1. Pablo Cos & Enrique Moral-Benito, 2014. "Determinants of health-system efficiency: evidence from OECD countries," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 69-93, March.
    2. Ansgar Wübker, 2014. "Explaining variations in breast cancer screening across European countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(5), pages 497-514, June.
    3. Mohamed Ali Ben Halima & Thierry Debrand & Camille Regaert, 2012. "Sick Leaves: Understanding Disparities Between French Departments," Working Papers DT50, IRDES institut for research and information in health economics, revised Oct 2012.
    4. Kristian Bolin & Daniel Hedblom & Anna Lindgren & Bjorn Lindgren, 2010. "Asymmetric Information and the Demand for Voluntary Health Insurance in Europe," NBER Working Papers 15689, National Bureau of Economic Research, Inc.
    5. Omar Paccagnella & Vincenzo Rebba & Guglielmo Weber, 2013. "VOLUNTARY PRIVATE HEALTH INSURANCE AMONG THE OVER 50s IN EUROPE," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 289-315, March.
    6. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    7. Thierry Debrand & Nicolas Sirven, 2009. "What are the Motivations of Pathways to Retirement in Europe: Individual, Familial, Professional Situation or Social Protection Systems?," Working Papers DT28, IRDES institut for research and information in health economics, revised Oct 2009.
    8. Lambrelli D & O’Donnell O, 2009. "Why Does the Utilization of Pharmaceuticals Vary So Much Across Europe? Evidence from Micro Data on Older Europeans," Health, Econometrics and Data Group (HEDG) Working Papers 09/06, HEDG, c/o Department of Economics, University of York.
    9. Thierry Debrand & Nicolas Sirven, 2009. "Quelles sont les motivations des départs à la retraite en Europe : situation personnelle, familiale, professionnelle, ou rôle de la protection sociale ?," Working Papers DT26, IRDES institut for research and information in health economics, revised Jun 2009.
    10. Bíró, Anikó, 2013. "Copayments, gatekeeping, and the utilization of outpatient public and private care at age 50 and above in Europe," Health Policy, Elsevier, vol. 111(1), pages 24-33.
    11. Poulsen, Camilla Aavang, 2014. "Introducing out-of-pocket payment for General Practice in Denmark: Feasibility and support," Health Policy, Elsevier, vol. 117(1), pages 64-71.
    12. Mohamed Ali Ben Halima & Thierry Debrand & Camille Regaert, 2011. "Arrêts maladie : comprendre les disparités départementales," Working Papers DT39, IRDES institut for research and information in health economics, revised Feb 2011.
    13. Aïda Solé-Auró & Montserrat Guillén & Eileen Crimmins, 2012. "Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(6), pages 741-754, December.
    14. Cylus, Jonathan & Papanicolas, Irene, 2015. "An analysis of perceived access to health care in Europe: How universal is universal coverage?," Health Policy, Elsevier, vol. 119(9), pages 1133-1144.

    More about this item

    Keywords

    Healthcare utilisation; Physician visits; Cross-country analysis; SHARE; Europe; I11; I18;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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