Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Regional variation in health care utilization in Sweden – the importance of demand-side factors

Authors: Naimi Johansson, Niklas Jakobsson, Mikael Svensson

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources.

Methods

In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors.

Results

The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits.

Conclusion

50–67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.
Appendix
Available only for authorised users
Literature
1.
Skinner J. Causes and consequenses of regional variations in health care. In: Pauly MV, Barros PP, McGuire TG, editors. Handbook of health economics, vol. 2. London: Elsevier Science; 2012.
2.
Corallo AN, Croxford R, Goodman DC, Bryan EL, Srivastava D, Stukel TA. A systematic review of medical practice varition in OECD countries. Health Policy. 2014;114:5–14.CrossRefPubMed
3.
4.
Cutler D, Skinner J, Stern AD, Wennberg D. Physician beliefs and patient preferences: a new look at regional variation in health care spending, Harvard Business School Working Paper; 2015. p. 15–090.
5.
Finkelstein A, Gentzkow M, Williams H. Sources of geographical variation in health care: evidence from patient migration. Quart J Econ. 2016;131(4):1681–726.
6.
Skriabikova O, Pavlova M, Groot W. Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature. Int J Environ Res Public Health. 2010;7(6):2708–25.CrossRefPubMedPubMedCentral
7.
Cutler D, Sheiner L. The geography of Medicare. Am Econ Rev. 1999;89(2):228–33.CrossRef
8.
9.
10.
Reich O, Weins C, Schusterschitz C, Thoni M. Exploring the disparities of regional health care expenditures in Switzerland: some empirical evidence. Eur J Health Econ. 2012;13(2):193–202.CrossRefPubMed
11.
Baker LC, Bundorf MK, Kessler DP. Patients' preferences explain a small but significant share of regional variation in medicare spending. Health Aff (Millwood). 2014;33(6):957–63.CrossRef
12.
Sheiner L. Why geographic variation in health care spending cannot tell us much about the efficiency or quality of our health care system, Brookings paper on economic activity, Fall 2014, vol. 2014.
13.
Gopffarth D, Kopetsch T, Schmitz H. Determinants of regional variation in health expenditures in Germany. Health Econ. 2016;25(7):801–15.CrossRefPubMed
14.
Eibich P, Ziebarth NR. Analyzing regional variation in health care utilization using (rich) household microdata. Health Policy. 2014;114(1):41–53.CrossRefPubMed
15.
Bolin K, Lindgren A, Lindgren B, Lundborg P. Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries. Int J Health Care Finance Econ. 2009;9(1):83–112.CrossRefPubMed
16.
Baker LC, Fisher ES, Wennberg JE. Variations in hospital resource use for Medicare and privately insured populations in California. Health Aff (Millwood). 2008;27(2):123–34.CrossRef
17.
Chandra A, Staiger DO. Productivity spillovers in health care: evidence from the treatment of heart attacks. J Polit Economy. 2007;115(1):103–40.CrossRef
18.
19.
Kopetsch T, Schmitz H. Regional variation in the utilisation of ambulatory services in Germany. Health Econ. 2014;23(12):1481–92.CrossRefPubMed
20.
Eurostat European Commission. Regions in the European Union - Nomenclature of territorial units for statistics. In: Eurostat Methodologies & working papers. Luxembourg: Publications offices of the European Union; 2011.
21.
Jakobsson N, Svensson M. The effect of copayments on primary care utilization: results from a quasi-experiment. Appl Econ. 2016;48(39):3752–62.CrossRef
22.
Jakobsson N, Svensson M. Copayments and physicians visits: A panel data study of Swedish regions 2003-2012. Health Policy. 2016;120(9):1095–9.CrossRefPubMed
23.
OECD. Health at a glance 2015: OECD indicators. Paris: OECD Publishing; 2015.
24.
Wooldridge JM. Introduction to econometrics. Hampshire: Cengage Learning EMAE; 2014.
25.
Bell A, Jones K. Explaining fixed effects: random effects modeling of time-series cross-sectional and panel data. Political Science Research and Methods. 2015;3(1):133–53.CrossRef
26.
27.
28.
29.
Martinelle C, Ulriksson M. Utomlänsvård. 2016. Region Östergötland
30.
31.
Welch WP, Miller ME, Welch HG, Fisher ES, Wennberg JE. Geographic variation in expenditures for physicians' services in the United States. N Engl J Med. 1993;328(9):621–7.CrossRefPubMed
32.
Metadata
Title
Regional variation in health care utilization in Sweden – the importance of demand-side factors
Authors
Naimi Johansson
Niklas Jakobsson
Mikael Svensson
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3210-y

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Predictors of physicians’ stress related to information systems: a nine-year follow-up survey study

Research article

Challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia

Research article

Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations

Research article

Establishing Sexual Assault Care Centres in Belgium: health professionals’ role in the patient-centred care for victims of sexual violence

Research article

South African primary health care allied health clinical practice guidelines: the big picture

Research article

Transition to international classification of disease version 10, clinical modification: the impact on internal medicine and internal medicine subspecialties