This study explores determinants of I) general practitioner (GP) visits and II) referrals (outpatient and hospitalization). The analyses were performed with regression models on a set of data from a comprehensive population study of 3533 men and 3578 women aged 40–42 in a county in Northern Norway. Among the various health status dimensions included, self-rated health was found to be the most important determinant, regardless of type of service. Factors, other than health status aspects affecting GP visits, were preoccupation with health and help seeking attitude. Volume of resources (GP per population), socio-demographic characteristics and social networks did not appear as important. Several inequitable effects were revealed on referrals: First, higher rate of referral of patients with higher educational achievement indicates a bias towards higher social status groups. Second, high GP/population ratio and residence in municipalities with referral care facilities were both found to be associated with higher probability of referral.
1. Barsky, A. J., The paradox of health. New Engl J Med1988; 318: 414–8.
2.
2. Mechanic, D., The concept of illness behaviour. Culture, situation and personal predisposition. Psychol Med1986; 16: 1–7.
3.
3. Crawford, R., Healthism and the medicalization of everyday life. Int J Health Serv1980; 10: 365–88.
4.
4. Illich, I.Limits to medicine. Medical nemesis: the expropriation of health. Middlesex: Penguin Books, 1977.
5.
5. McKinlay, J. B., Some approaches and problems in the study of the use of services – an overview. J Health Soc Behav1972; 13: 115–52.
6.
6. Andersen, R., Andersen, O. W.Trends in the use of health services. In: Freeman HE, et al., eds. Handbook of medical sociology. Englewood Cliffs NJ: Prentice-Hall, 1971. 371–91.
7.
7. Mechanic, D.Correlates of physician utilization: why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects?J Health Soc Behav1979; 20: 387–96.
8.
8. Melnyk, K. A.M., Barriers: A critical review of recent literature. Nurs Res1988; 37: 196–201.
9.
9. Andersen, A. S., Laake, P.. A causal model for physician utilization: Analysis of Norwegian data. Med Care1983; 21: 266–78.
10.
10. Andersen, R., Newman, J. F., Social and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q1973; 51: 95–123.
11.
11. Andersen, R., Aday, L. A.Access to medical care in U.S.: Realized and potential. Med Care1978; 16: 533–46.
12.
12. Andersen, A. S., Laake, P.. Who visits the physician?A model for utilization of physician services outside institution. Oslo-Kongsvinger1985 (Statistisk Sentralbyrå Publication 150).
13.
13. Fylkesnes, K., Johnsen, R., Førde, O. H., The Tromsø study: Factors affecting patient-initiated and provider-initiated use of health care services. Sociology Health & Illness1992; 14: 275–92.
14.
14. Ware, J. E.The assessment of health status. In: Aiken LH, Mechanic D, eds. Applications of social science to clinical medicine and health policy. New Jersey: New Brunswick, Rutgers University Press, 1986: 204–28.
15.
15. Liang, J., Self-reported physical health among aged adults. J Gerontol1986; 41, 248–60.
16.
16. Bjartveit, K., Foss, O. P., Gjervig, T., Lund-Larsen, P. G.The cardiovascular disease study in Norwegian counties. Background and organization. Acta Med Scand1979; Suppl. 634: 1–59.
17.
17. Jacobsen, B. K., Stensvold, I., Fylkesnes K, Kristiansen IS, Thelle, D. S., The Nordland health study. Design, description of population, attendance and questionnaire response. Scand J Soc Med1992; 3: 184–7.
18.
18. Dean, K., Conceptional, theoretical and methodological issues in self-care research. Soc Sci Med1989; 29: 117–23.
19.
19. Fylkesnes, K., Førde, O. H.The Tromsø-study: Predictors of self-evaluated health – has society adopted the expanded health concept?, Soc Sci Med1991; 32: 141–6.
20.
20. Fylkesnes, K., Førde, O. H., Determinants and dimensions involved in self-evaluation of health. Soc Sci Med1992; 35: 271–9.
21.
21. Pope, G. C.Medical conditions, health status, and health services utilization, Health Serv Res1988; 22: 857–77.
22.
22. Pilpel, D., Factors affecting health services utilization (HSU) II. Self-rated health and HSU for a population covered by an integrated, comprehensive prepayment plan. Public Health Rev1987; 15: 231–40.
23.
23. Weinberger, M., Darnell, J. C., Tierney, W. M., Martz, B. L., Hiner, S. L., Barker, J. et al., Self-rated health as a predictor of hospital admission and nursing home placement in elderly public housing tenants. Am J Public Health1986; 76: 457–9.
24.
24. Tessler, R., Mechanic, D., Psychological distress and perceived health status. J Health Soc Behav1978; 19: 254–62.
25.
25. Kaplan, G. A., Camacho, T., Perceived health and mortality: A nine-year follow up of the Human Population Laboratory cohort. Am J Epidemiol1983; 117: 292–304.
26.
26. Idler, E. L., Angel, R. J., Self-rated health and mortality in the NHANES-I epidemiologic follow-up study. Am J Public Health1990; 80: 446–52.
27.
27. Kaplan, G. Barell V Lusky, A., Subjective state of health and survival in elderly adults. J Gerontol1988; 43: 114–20.
28.
28. Mossey, J. M., Shapiro, E., Self-rated health: a predictor of mortality among the elderly. Am J Public Health1982; 72: 800–8.
30. Grimsmo, A.From being ill – to the patient role. The influence of social conditions on illness, self-care and professional help-seeking. Oslo, SIFF, Report no 1, Thesis, 1983. (In Norwegian)
31.
31. Freidson, E., Client control and medical practice. Am J Sociol1960; 65: 374–82.
32.
32. McKinlay, J. B., Social networks, lay consultation and help-seeking behaviour. Social Forces1973; 51: 275–91.
33.
33. Berkanovic, E., Telesky, C., Reeder, S., Structural and social psychological factors in the decision to seek medical care for symptoms. Med Care1981; 19: 693–709.
34.
34. Roland, M., Morris, R.. Are referrals by general practitioners influenced by the availability of consultants?Br Med J1988; 297: 599–600.
35.
35. Martin, D. P., Diehr, P., Price KF, Richardson, W. C., Effect of gatekeeper plan on health services use and charges: A randomized trial. Am J Public Health1979; 79: 1628–32.
