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Regional variation in health care utilization in Sweden: The importance of demand-side factors
Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics. Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). Norwegian Social Res NOVA, Oslo, Norway.ORCID iD: 0000-0002-7143-8793
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School (from 2013). Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics. Williams Coll, Dept Econ, Williamstown, MA 01267 USA.ORCID iD: 0000-0003-1113-7478
2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 403Article in journal (Refereed) Published
Abstract [en]

Background: Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources. Methods: In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors. Results: The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits. Conclusion: 50-67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.

Place, publisher, year, edition, pages
London, UK: BioMed Central, 2018. Vol. 18, no 1, article id 403
Keywords [en]
Demand, Health care utilization, Panel data, Random effects, Regional variation, adult, article, demography, general practitioner, human, mortality, outpatient, panel study, population health, socioeconomics, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Health Care Service and Management, Health Policy and Services and Health Economy Economics
Research subject
Economics
Identifiers
URN: urn:nbn:se:kau:diva-68061DOI: 10.1186/s12913-018-3210-yISI: 000434085000004Scopus ID: 2-s2.0-85048002649OAI: oai:DiVA.org:kau-68061DiVA, id: diva2:1223988
Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2018-06-28Bibliographically approved

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Jakobsson, NiklasSvensson, Mikael

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Department of Economics and StatisticsKarlstad Business School (from 2013)
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Health Care Service and Management, Health Policy and Services and Health EconomyHealth Care Service and Management, Health Policy and Services and Health EconomyEconomics

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