Abstract
Summary Although there is a substantial literature on the determinants of demand for primary care, few studies have been able to examine how these determinants respond to higher supply. Some demand studies include supply variables or regional dummy variables to allow for different supply conditions. A few have tested for marginal effects of supply variables attributed at a highly aggregated geographic level. However, relatively little is known about whether there is a supply constraint and how demand responses differ across population groups. We used information from a household survey of 60,806 individuals for whom we had detailed information on supply and access conditions. As in many surveys, the annual measure of utilisation is a grouped count and we estimate a grouped negative binomial model (NegBin2) of the determinants of demand for general practitioner (GP) visits by Maximum Likelihood. We exploit a variable on which respondents were asked to report the convenience with which they were able to access GP services. We demonstrate the significance of this variable in determining the number of GP visits. We then examine which demand determinants are correlated with reported convenience. Finally, we compare the demand equations for respondents reporting unconstrained access to GPs with respondents reporting constrained access. We find that being unemployed has a significant positive effect on GP visits for individuals who reported poor access. People who own a car and reported a good access to GPs have significantly higher visits.
Highlights
1.1 Objective The purpose of this paper is to identify significant determinants of the demand for GP visits and to investigate how such demand determinants respond to higher supply.1.2 Data The primary data source for the analysis is the 1999–2002 Scottish Household Survey (SHS) data collected by a team from Market and Opinion Research International and Taylor Nelson Sofres on behalf of the Scottish Executive
We begin by discussing results on the determinants of GP visits followed by the effects of lower supply on mean GP visits and comparing models with low and high supply of GP services
The nature of the distribution of GP visits indicated that a large proportion of observations (33%) clustered at 1–2 GP visits; and 13% of respondents reported having made more than ten visits in the previous year (Table 1)
Summary
1.2 Data The primary data source for the analysis is the 1999–2002 Scottish Household Survey (SHS) data collected by a team from Market and Opinion Research International and Taylor Nelson Sofres (formerly NFO Social Research) on behalf of the Scottish Executive. The first part of the survey collected information including: household composition, housing characteristics, tenure, vehicles available to the household, occupation and type of industry employing the person, highest income in the household and total household income. Teckle / Sutton information on an individual basis (random adult) relating housing experiences (including homelessness), qualifications, use of private and public transport, employment status, income from employment and other sources, health measures and GP visits. Respondents were asked how convenient it was to use services (including GP services)
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