title: Access points to the different levels of health care and demographic predictors in a country without a gatekeeping system. Results of a cross-sectional study from Austria.
abstract: BACKGROUND
  The challenges for health care systems are evident both in terms of costs and of healthy life expectancy. It was the aim of this study to assess the access points towards the different levels of care and predictors for consulting a specialist without having consulted a general practitioner (GP), a common way of access to the Austrian health care system, a system without gatekeeping function.
  
  
  METHODS
  The database used for this analysis was the Austrian Health Interview Survey 2006-07, with data from 15 474 people. Statistical analyses included descriptive statistics as well as multivariate logistic regression models.
  
  
  RESULTS
  In the 12 months before the survey, 78.8% consulted a GP, 67.4% consulted a specialist, 18.6% visited an outpatient department and 22.8% had a hospital stay at least once. Overall, 15.1% visited a specialist, 8.5% an outpatient department and 8.1% a hospital without consulting a GP concomitantly. One of the main reasons for direct specialist use was a preventive check-up visit. Tertiary education and migration background increased significantly the chance of having been to a specialist without GP contact for both sexes.
  
  
  CONCLUSIONS
  The overall access rates for specialists as well as the access rates for specialist without GP consultations were high. The findings point into the direction of a benefit through a structurally supported advocacy role for primary health care professionals. The knowledge gained could contribute to the health policy debate on the importance of coordination and continuity with special respect to demographic factors showing the importance of target-group-specific interventions.
authors: 1 Department of General Practice and Family Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.
authors: Kathryn
authors: K
authors: Hoffmann
authors: K Viktoria
authors: KV
authors: Stein
authors: Manfred
authors: M
authors: Maier
authors: Anita
authors: A
authors: Rieder
authors: Thomas E
authors: TE
authors: Dorner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D020793:Gatekeeping; D058006:General Practice / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D055815:Young Adult