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Self-referral and self-payment in Danish primary care
N D Olivarius1, F I Jensen, D Gannik
1Central Research Unit of General Practice, Panum Institute, Copenhagen, Denmark.
Health Policy (Amsterdam, Netherlands)
|February 7, 1994
Summary
A minority of Danes opt for direct specialist access with partial self-payment. This group, though older and wealthier, uses fewer primary care and hospital services, indicating a preference for choice over health needs.
Area of Science:
- Health Services Research
- Public Health Policy
- Healthcare Economics
Background:
- Danish healthcare system offers two models: restricted access with free services or free choice with partial self-payment.
- Understanding user preferences and characteristics is crucial for healthcare system design.
Purpose of the Study:
- To characterize individuals choosing direct specialist access with partial self-payment.
- To compare their demographics and healthcare utilization with those in the free, restricted-access system.
Main Methods:
- Cross-sectional study utilizing nationwide Danish registers.
- Inclusion of all adults or a 10% sample.
- Analysis of social, demographic factors, and healthcare utilization (primary, secondary, specialist care).
Main Results:
- 3% of the population chose free choice and partial self-payment.
- This group is older, has higher income, lower mortality, lower general practice/hospital use, and higher specialist use.
- Utilization patterns are driven by preference for choice and specialized care, not solely high morbidity.
Conclusions:
- A parallel system offering free choice of doctor with partial self-payment can address dissatisfaction with restricted specialist access.
- This model caters to a specific demographic and preference profile within the population.
- Policy implications for healthcare system design and patient choice are highlighted.