Economic depression and the use of physician services in Finland

At the start of the 1990s, the economic situation in Finland deteriorated radically. During the depression (1991-93), health care expenditure decreased by about 10%, and was associated with considerable changes in Finnish health care. This paper reports studies of the determinants of use of physician services in Finland in the 1990s. The particular aim was to evaluate how utilization altered during the economic depression and during the changes in the health care system. Using econometric methods, an attempt was made to describe the changes in structure and level of utilization. The study was based on annual computer-assisted telephone interviews made during 1991-94. Visits to a doctor were analysed using a two-part model (logit and truncated negative binomial regression). Structural changes were tested by Chow-type tests and changes in the level of utilization by chronologically defined dummy variables for each year. The most significant changes (both in structure and level) occurred in the model explaining the number of visits (negative binomial regression) of chronically ill persons. Variables describing the continuity of care seem to be more important determinants of visits to a doctor than certain other availability and socioeconomic variables.