Programme no. 224-OP
Health Economics
Towards a sequential model of health care utilization
Wolfram Herrmann*1, Uwe Flick2, Anders Bærheim3, Alexander Haarmann4
1Institute of General Practice and Family Medicine,Otto-von-Guericke-University of Magdeburg,Magdeburg,Germany;Institute of General Practice and Family Medicine,Charité-Universitätsmedizin Berlin,Berlin,Germany, 2Freie Universität Berlin,Berlin,Germany, 3Department of Global Public Health and Primary Care,University of Bergen,Bergen,Norway, 4Institute of General Practice and Family Medicine,Otto-von-Guericke-University of Magdeburg,Magdeburg,Germany
* = Presenting author
Objectives: To develop a new model of health care utilization more adequate to explain such differences.
Background:

There are substantial differences in health care utilization between different countries. Classic models of health care utilization such as Andersen's Behavioral Model set up factors and their influence on rates of health care utilization. However, these models cannot explain differences in health care utilization between different countries.

Results:

From our empirical findings, we could deduce two theoretical aspects for model building:

A single event of health care utilization can be seen as the result of a complex process which was initiated by some problem experienced by the patient. The occurrence of problems is influenced by factors, such as age and sex. Likewise, the process of assessing these problems and deciding whether to utilize health care is influenced by factors such as the social network and prior experiences. However, during participant observation we could observe that most encounters are not due to a single problem which led to this encounter. Instead, they were often realizations of a longer sequence of encounters. Most consultations are not comprehensible in its’ own, but can only be seen in the context of this sequence. Hence, an important part of health care utilization is not due to one problem each, but applies to a blending of problems and follow-ups.

Thus, we developed a sequential model of health care utilization to describe these sequences. In this temporal model, singularities of of health care utilization are nodes, connected by the flow of information as edges. By this model, the health care utilization patterns of individual patients can be visualized and analyzed qualitatively and quantitatively.

Material/Methods: A qualitative study. We conducted 40 episodic interviews with patients in Germany and Norway and conducted participant observations in eight primary care practices. The German participants were matched with the Norwegian participants, urban and rural areas were covered. In addition, we conducted a context analysis of the health care systems. Data was analyzed by thematic coding in the framework of grounded theory.
Conclusion:

This sequential model of health care utilization highlights aspects which have been so far neglected in health care utilization research such as the frequency of follow-up visits and the blending of reasons for encounter. Thus, we hope this new model can explain differences in health care utilization between countries. It could be used to model prediction of health care utilization in relation to structural aspects of health care.

Points for discussion:

Does this new model give advantages for research and practice?

Do we have evidence for the frequency of follow-up visits in chronically ill patients?