Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area.
BACKGROUND
Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors.


METHODS
Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models.


RESULTS
Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care.


CONCLUSIONS
This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.
Pappa
Evelina
E
Faculty of Social Sciences, Hellenic Open University, Patras, Greece. evepappa@central.ntua.gr <evepappa@central.ntua.gr>
Niakas
Dimitris
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006115:Greece / Q000453:epidemiology; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011320:Primary Health Care / Q000706:statistics & numerical data; D017149:Private Sector / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D012959:Socioeconomic Factors