Relationship between Having a Home Doctor and Outpatient Utilization.

Abstract

While universal insurance coverage should eliminate or substantially reduce financial and certain structural barriers to medical care, inequity in utilization of care may continue to exist. We conducted a questionnaire survey of a national random sample of 4500 Japanese age 16 or over in October, 1995. Separate analyses were conducted to predict the physician visit rates for the entire respondents (N=3395) and for those with chronic conditions (N=777). Forty-three percent of the total subjects reported an ambulatory physician visit within the past three months. About 17% of subjects with one chronic condition and 14% of those with two or more chronic conditions did not have any physician visits within recent three months. The regression model demonstrated that having a home doctor, as well as comorbidity and perceived health status, is significantly associated with outpatient visit both among all subjects (p < 0.0001) and among those with chronic conditions (p < 0.01). The Japanese health system still has unevenness in outpatient resource utilization. This mainly pertains to whether they have their own regular physician. The failure of some persons with chronic diseases to be seen requires further investigation.

International perspectives on general internal medicine and the case for “globalization” of a discipline

“…23,24 It is only in the late 1980s and early 1990s that formal training programs for outpatient primary care have developed, along with corresponding professional societies-the Japanese Academy of Family Medicine (1986) and the Japanese Society of General Medicine (1994). [25][26][27] A recognizable discipline of GIM has emerged from these entitites, and the typical profile predominantly involves outpatient primary care, although the short history of the discipline and heterogeneous nature of training paths taken by Japanese General Internists dictate that some are also involved in various forms of inpatient care, and even occasionally front-line emergency room care.…”

International Perspectives on General Internal Medicine and the Case for "Globalization" of a Discipline

“…As a result, primary care has historically been provided by hospital‐based physicians from a variety of training backgrounds who move their practices to the outpatient setting in mid‐to‐late career 23,24 . It is only in the late 1980s and early 1990s that formal training programs for outpatient primary care have developed, along with corresponding professional societies—the Japanese Academy of Family Medicine (1986) and the Japanese Society of General Medicine (1994) 25–27 . A recognizable discipline of GIM has emerged from these entitites, and the typical profile predominantly involves outpatient primary care, although the short history of the discipline and heterogeneous nature of training paths taken by Japanese General Internists dictate that some are also involved in various forms of inpatient care, and even occasionally front‐line emergency room care.…”