Does patients’ choice of health centre doctor depend on the organization? A comparative study of four municipalities with different forms of service provision in Finland

Abstract

The aim of the study was to examine the use of physician services and the willingness to choose an health centre (HC) doctor rather than an alternative (i.e. private, occupational healthcare, other doctor) by the working age population in four municipalities in Finland. In a Southern municipality primary health care was contracted out to a non-profit organization whereas Eastern, Western and South-Western municipalities mainly provided services themselves. A mail survey of a random sample of the 15-64-age population was conducted in 2002 (n = 2,000, response rate 62%). Data were analyzed using descriptive statistics as well as bi- and multivariate logistic regression analyses. Of the respondents, 69% had visited an HC doctor during the past year, and of these, more than 40% had also visited another doctor outside the HC. The willingness to choose an HC doctor varied from 40% to 54% and was highest in the Southern municipality. When significantly associated variables - age, working status, perceived stress in life situation, access to an appointment, perceived interpersonal quality, and visits to doctors - were controlled for, the willingness to choose an HC doctor was, compared with the Southern municipality, less popular only in the Western municipality. The tendency to choose an HC doctor rather than an alternative was quite low, probably reflecting lack of attractiveness of HC to patients. However, contracting out service production did not additionally decrease patients' willingness to choose an HC doctor. More attention should be paid to improving access, interpersonal quality and continuity of care.