Differences in older adults' use of primary and specialist care services in two Nordic countries.
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.
Suominen-Taipale
Anna Liisa
AL
Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. liisa.suominen-taipale@ktl.fi
Koskinen
Seppo
S
Martelin
Tuija
T
Holmen
Jostein
J
Johnsen
Roar
R
D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D009664:Norway; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012647:Self-Assessment; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013038:Specialization