© 2004 by European Journal of Public Health
Health services |
Differences in older adults' use of primary and specialist care services in two Nordic countries
Anna Liisa Suominen-Taipale1,2,*, Seppo Koskinen2, Tuija Martelin2, Jostein Holmen3 and Roar Johnsen11 Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway, 2 Department of Health and Functional Capacity, KTL (National Public Health Institute), Helsinki, Finland, 3 HUNT Research Centre, Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Verdal, Norway
Background: The aim of the study was to compare elderly persons' self-reported use of physician services and associated sociodemographic factors and self-rated health in two Nordic countries with different health care systems, Finland and Norway. Methods: Population based, cross-sectional surveys conducted in Norway (1995–97) and in Finland (1997) were employed. In the Norwegian data a total of 7,919 individuals, and in the Finnish data 1, 500 individuals, aged 65–74 years old were included in the samples. The outcome variables were having visited a general practitioner, a specialist or both during the past 12 months. Associations between utilization of physician's services and sociodemographic factors and self-rated health were analysed by multiple logistic regression. Results: Approximately the same proportion of elderly in Norway and Finland reported having visited a physician during the previous 12 months. Finnish elderly more often visited a specialist compared to Norwegians. Self-rated health was strongly associated with visits to a specialist in both countries and to a GP in Norway. In Finland visits to a GP were only weakly connected with self-rated health. The use of specialist services increased with increasing education in both countries and in Finland the association was steeper than in Norway. Marital status was not consistently associated with visiting a physician. Conclusions: Higher rates of specialist care among the elderly in Finland may indicate a more efficient gate-keeping role among Norwegian general practitioners or inducement caused by two overlapping service sectors. Inconsistent associations between utilization and health variables may be due to cultural differences.
Keywords: cross-sectional survey, elderly, health care utilization
Received 22 January 2003. Accepted 1 July 2003.
* Correspondence: Anna Liisa Suominen-Taipale, PhD, KTL/TTO, Mannerheimintie 166, FIN-00300 Helsinki, Finland, tel. +358 9 4474 8296, fax +358 9 4474 8924, e-mail: liisa.suominen-taipale{at}ktl.fi