Use of primary health care services according to the different degrees of obesity in the Girona Health Region, Spain

Abstract

Our main hypothesis in this paper was that, once controlled for age and gender, the use of primary health care services of people in each of the groups defined by their degree of obesity (i.e. normal weight, overweight and obese) did not correspond to the need for care implied by the level of risk of the group he/she belonged to. This fact could reflect some inequity in the utilisation of such services. Using a survey of the general population from the Girona Health Region, Spain, carried out during the fourth quarter of 2002, we have found that: first, the probability of primary health care use decreased with income for GPs (until 1200 Euro) and increased for specialists (from 1500 Euro). Second, we could conclude by confirming our hypothesis, i.e. there was more probability of obese individuals using general practice care, public in particular, and less probability of them using specialists, private in particular, than the rest of individuals. Third, we conclude that the use of multilevel (also hierarchical or mixed) models could explain most of our original findings in this paper.

Physician Consultations According to Different BMI Levels of the Greek General Population

“…Two reasons might explain our findings. First, the fact that the rate of physician consultations in the total sample was high (64.2%), a finding which has been also reported in other studies [18]. Secondly, the high consultation rate of the obese population, in relation to the fact that the majority of obese users (67%) have made three or more visits during a one year period imply that the obese population are heavy users of primary care and impose an additional burden on the health care sector in terms of impaired health.…”

Factors determining access to and use of primary health care services in the Girona Health Region (Spain)

“…Due to the fact that we have found the greatest likelihood of more frequent visits in those individuals with the lowest socioeconomic capacities (for both groups of immigrants and for native users), it is reasonable to think that when more frequent visits (and specialized treatment) are required, users with greater spending power use alternative private services [18,21]. Equally plausible is the theory that a poor socioeconomic situation means worse morbidity and therefore a greater need for use.…”

“…Note that the baseline effect has only been supposed as random effect in the second part of the model Eq. 4 due to problems with identification [18].…”

“…Therefore (and in line with the principal-agent theory), we suppose that initial contact with these services depends solely on need variables or, if not, due to moderators of these (age and gender). On the other hand, the use of these services more than once is also influenced by non-need variables [16,18,22,23] (See Table 2). …”

“…Because need for care must be distinguished from the demand for care and from the use of health services [14], one of the most common ways of explaining the decisionmaking process in the consumption of health care are principal-agent models [15]: the doctor (agent) determines use on behalf of the patient (principal), after the latter has made initial contact with the health services [16][17][18]. So, from a quantitative viewpoint, what is important is to identify which factors influence the user's decision to contact the health services, and which elements determine the quantity of service consumed.…”