Specialist consultations in primary health care—A possible substitute for hospital care?

Exploring the small area variation and spatial patterns in outpatient treatments

“…Distance to the nearest hospital has a positive impact which contradicts most of the findings in the literature (Blais 1993;Gregory et al 2000;Groenewegen 1991;Lin et al 2002;Linnala et al 2006;Mooney et al 2000;Pedersen 2005;Ricketts et al 2001;Roemer 1961;Shwartz et al 1994;Thomsen 1985;Thomsen and BarnerRasmussen 1992); however, the effect is insignificant when spatial spillover is accounted for. This may indicate that findings of previous studies rely on too simplistic specifications, i.e.…”

“…GP expenditure appears to be unrelated to the number outpatient treatments. The influence of GP expenditure was a priori expected to be negative because GP visits could be a substitute for outpatient hospital treatment as proven in previous studies (Groenewegen 1991;Linnala et al 2006;Ricketts et al 2001;Shwartz et al 1994;Thomsen and Barner-Rasmussen 1992). A negative coefficient for 'Hospital 9 GP exp.'…”

“…These factors will include the presence of a hospital within the borders of the municipality, distance to the nearest hospital, GP expenditure and GP density. One may hypothesize that bed supply influence utilisation and that hospitalisation rates are inversely related to distance to hospital because of the lower shadow prices for access, as proven in a number of studies (Blais 1993;Gregory et al 2000;Groenewegen 1991;Lin et al 2002;Linnala et al 2006;Mooney et al 2000;Pedersen 2005;Ricketts et al 2001;Roemer 1961;Shwartz et al 1994;Thomsen 1985;Thomsen and Barner-Rasmussen 1992). The question is whether this relationship stands when spatial patterns are taken into account.…”

Exploring spatial patterns in general practice expenditure

“…Municipalities with a hospital are expected to have lower GP expenditure because hospital services to some degree act as a substituting service. Studies have shown that higher use of GP services is not associated with the number of inpatient admissions but may be associated with outpatient hospital visits [32][33][34][35][36], meaning that outpatient visits to some degree substitute for GP services. A higher number of outpatient hospital visits is therefore expected to decrease GP expenditure.…”

“…A higher number of outpatient hospital visits is therefore expected to decrease GP expenditure. For inpatient admissions, the opposite is expected because GP services and inpatient admissions are considered to be complementary so that more admissions also require more visits to the GP [36][37][38]. Another supply factor influencing GP utilisation may be the GP/population ratio [39][40][41][42][43], which may influence access to GP services by influencing waiting time, travel costs and possibly rationing of the health care services [41][42][43][44][45][46].…”