title: The Ecology of Medical Care in Norway: Wide Use of General Practitioners may not Necessarily Keep Patients out of Hospitals.
abstract: BACKGROUND
  Our aim was to investigate the pattern of self reported symptoms and utilisation of health care services in Norway.
  
  
  METHODS
  With data from the cross-sectional Tromsø Study (2007-8), we estimated population proportions reporting symptoms and use of seven different health services. By logistic regression we estimated differences according to age and gender.
  
  
  RESULTS
  In this study 12,982 persons aged 30-87 years participated, constituting 65.7% of those invited. More than 900/1000 reported symptoms or health problems in a year as well as in a month, and 214/1000 and 816/1000 visited a general practitioner once or more in a month and a year, respectively. The corresponding figures were 91/1000 and 421/1000 for specialist outpatient visits, and 14/1000 and 116/1000 for hospitalisations. Physiotherapists were visited by 210/1000, chiropractors by 76/1000, complementary and alternative medical providers by 127/1000, and dentists by 692/1000 in a year. Women used most health care services more than men, but genders used hospitalisations and chiropractors equally. Utilisation of all services increased with age, except chiropractors, dentists and complementary and alternative medical providers.
  
  
  CONCLUSIONS
  Almost the entire population reported health related problems during the previous year, and most residents visited a general practitioner. Yet there were high rates of inpatient and outpatient specialist utilisation. We suggest that wide use of general practitioners may not necessarily keep patients out of specialist care and hospitals.
  
  
  BACKGROUND
  the authors would like to thank Tor Anvik for a significant contribution in developing the idea for the study, Tom Wilsgård for useful discussions about the statistical analyses and Jarl-Stian Olsen for graphic design of the figures. They would also thank the people of Tromsø and The Tromsø Study for giving data to this study. Northern Norway Regional Health Authority and The University of Tromsø funded this research.
authors.affiliation: National Centre for Integrated Care and Telemedicine, University Hospital of Northern Norway , Tromso.
authors.forename: Anne Helen
authors.initials: AH
authors.lastname: Hansen
authors.affiliation: National Centre of Rural Medicine and General Practice Research Unit, Department of Community Medicine, University of Tromsø
authors.forename: Peder A
authors.initials: PA
authors.lastname: Halvorsen
authors.affiliation: Department of Community Medicine, University of Tromsø , Norway.
authors.forename: Olav Helge
authors.initials: OH
authors.lastname: Forde
keywords: cross-sectional study; general practitioner; health care utilisation; hospitalisation; specialist