The impact of accessibility on the use of specialist health care in Norway

What factors contribute to the utilization of specialist health care in Norway, and to what extent is the policy goal of allocating health care according to peoples medical need fulfilled? With this scope the authors analyse the impact of a person's health relative to the impact of access to specialist care. It is distinguished between services provided by public hospitals and services provided by private specialists financed by the National Insurance Scheme. The data allow to consider individual patient characteristics since Survey of Living Conditions data are merged with data on capacity and access to general practice and specialist care. <p> The estimation of logit models and negative binomial models show significant differences between the factors that influence contacts with private specialists and contacts with hospitals. While a person's self-assessed health plays a major role in the utilization of hospitals, there is no significant effect of this variable on the utilization of private specialists. The supply-side variables measured by GP density and the accessibility indices for specialist care have significant effects on the utilization of private specialists, but not on hospital visits and inpatient stays. <p> A preliminary conclusion is that the utilization of hospital services is rationed according to patients' health status, and not influenced by patients' access. Hence, the utilization of hospital services seems to be in accordance with officially stated health policy. On the other hand, private specialists seem to function as an alternative to general practice. Moreover, the significant effect of chronic conditions on the utilization of private specialists suggests that regular check-ups of chronic patients are an important part of the services provided by private specialists. The challenge to policy makers is to consider measures that bring the utilization of publicly funded private specialists in accordance with national health policy.