Patients' Views of Direct Access to Specialists

Tabenkin, Hava; Gross, Revital; Brammli, Shuli; Shvartzman, Pesach

doi:10.1001/jama.279.24.1943

Cited by 24 publications

(34 citation statements)

References 12 publications

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“…Among patients with the same comorbidity level, higher income (3rd and 4th quartiles) was associated with significantly lower use of SHC. An association between low education and higher use of health care services after adjustment for comorbidity [25] and preference for direct access to specialists among highly educated individuals has been observed before [26]. In our studied population the risk of having SHC costs was higher for individuals with education level 4, which may mean higher demands for specialist care or better access to SHC.…”

Section: Discussionsupporting

confidence: 67%

Distance to hospital and socioeconomic status influence secondary health care use

Zieliński

Borgqúist

Halling

2013

Scandinavian Journal of Primary Health Care

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ObjectiveThe aim of this study was to investigate how distance to hospital and socioeconomic status (SES) influence the use of secondary health care (SHC) when taking comorbidity into account.Design and settingA register-based study in Östergötland County.SubjectsThe adult population of Östergötland County.Main outcome measuresOdds of SHC use in the population and rates of SHC use by patients were studied after taking into account comorbidity level assigned using the Adjusted Clinical Groups (ACG) Case-Mix System. The baseline for analysis of SES was individuals with the lowest education level (level 1) and the lowest income (1st quartile).ResultsThe study showed both positive and negative association between SES and use of SHC. The risk of incurring SHC costs was 12% higher for individuals with education level 1. Individuals with income in the 2nd quartile had a 4% higher risk of incurring SHC costs but a 17% lower risk of emergency department visits. Individuals with income in the 4th quartile had 9% lower risk of hospitalization. The risk of using SHC services for the population was not associated with distance to hospital. Patients living over 40 km from hospital and patients with higher SES had lower use of SHC services.ConclusionsIt was found that distance to hospital and SES influence SHC use after adjusting for comorbidity level, age, and gender. These results suggest that GPs and health care managers should pay a higher degree of attention to this when planning primary care services in order to minimize the potentially redundant use of SHC.

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Section: Discussionsupporting

confidence: 67%

Distance to hospital and socioeconomic status influence secondary health care use

Zieliński

Borgqúist

Halling

2013

Scandinavian Journal of Primary Health Care

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“…Younger people usually have less severe illnesses and, therefore, feel confident in their ability to choose the right specialist. 14 Membership in a sickness fund. This may also be true for members of private insurance, most of whom are better educated.…”

Section: Discussionmentioning

confidence: 99%

“… 13 Only one Israeli study assessed patients' opinions about gatekeeping and direct access to specialists. 14 We designed a survey to assess patients' opinions and preferences for health care settings in the future. Looking to the experience in the United States with managed care, we focused on the 4 aspects most central to managed care settings and gatekeeping arrangements: (1) encouragement of first‐contact care by generalists rather than specialists, 2,4 (2) acceptance of continuing provision of health services from the same primary care physician for a longer period of time, 3 (3) access to specialist or hospital services coordinated (i.e., not strictly controlled) by the primary care physician as case manager, 7,11 and (4) the role of financial incentives to persuade patients to accept this primary care physician as their gatekeeper.…”

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confidence: 99%

Will german patients accept their family physician as a gatekeeper?

Himmel

Dieterich²,

Kochen³

2000

J Gen Intern Med

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OBJECTIVE:Looking to the experience in the United States with managed care and the possible introduction of gatekeeping in the near future in Germany, we performed a population-based survey to examine preferences for future gatekeeping arrangements. DESIGN:Cross-sectional telephone survey. SETTING:Four health districts in Thuringia (formerly East Germany) and Lower Saxony (formerly West Germany). PARTICIPANTS:Out of a random sample of 644 adults in the 4 districts, 415 persons (64.4%) took part in the survey. MEASUREMENTS AND MAIN RESULTS:

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“…R MS E A i s t h e r o o t me a n s q u a r e e r r o r o f a p p r o x i ma t i o n . (12). In that case, these factors and groups should be investigated further.…”

Section: CL I N I C a L Ch A R A C T E Ri S T I C S I N T H E Mu L mentioning

confidence: 98%

Population-level Preferences for Primary Care Physicians' Characteristics in Japan: A Structural Equation Modeling

et al. 2010

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Patients' Views of Direct Access to Specialists

Cited by 24 publications

References 12 publications

Distance to hospital and socioeconomic status influence secondary health care use

Distance to hospital and socioeconomic status influence secondary health care use

Will german patients accept their family physician as a gatekeeper?

Population-level Preferences for Primary Care Physicians' Characteristics in Japan: A Structural Equation Modeling

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