title: Does the organizational structure of health care systems influence care-seeking decisions? A qualitative analysis of Danish cancer patients' reflections on care-seeking.
abstract: OBJECTIVE
  The absence of a more significant improvement in cancer survival in countries such as the UK and Denmark may be partly rooted in delayed care-seeking among cancer patients. Past research on patient delay has mainly focused on patient characteristics (e.g. sociodemographic and psychological factors and symptom recognition) as causes of delayed care-seeking, while few studies have examined how the organizational structure of health care systems may influence patients' reflections on seeking care. The aim of this study was to explore this relationship.
  
  
  METHODS
  The analysis presented is based on semi-structured interviews with 30 cancer patients and their families.
  
  
  RESULTS
  The article raises two hypotheses on the relationship between structural elements of a health care system and people's reflections on seeking health care: (1) Gatekeeping introduces an asymmetrical relationship between the patient and the GP which potentially results in self-restricting care-seeking, (2) Continuity in the doctor-patient relationship may negatively influence patient reflections on access to health care, as the focus shifts from the medical issues of the consultation to reflections on how to properly interact with the GP and the system in which she/he is situated.
  
  
  CONCLUSIONS
  It is concluded that these hypotheses form a sound basis for further primary care research on how the organizational structure of health care systems influences patient reflections on access to medical care.
authors.affiliation: Research Unit for General Practice, Research Center for Cancer Diagnosis in Primary Care, Department of Public Health, University of Aarhus, Bartholins Alle 2, Aarhus, Denmark. rsa@alm.au.dk
authors.forename: Rikke Sand
authors.initials: RS
authors.lastname: Andersen
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
authors.forename: Flemming
authors.initials: F
authors.lastname: Bro
authors.forename: Jens
authors.initials: J
authors.lastname: Søndergaard
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000458:organization & administration*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D020793:Gatekeeping / Q000458:organization & administration; D058006:General Practice / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires