ECONOMIC DEPRESSION AND THE USE OF PHYSICIAN SERVICES IN FINLAND

At the start of the 1990s, the economic situation in Finland deteriora ted radically. During the depression (1991-93), health care expenditur e 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 depres sion and during the changes in the health care system. Using econometr ic methods, an attempt was made to describe the changes in structure a nd level of utilization. The study was based on annual computer-assist ed telephone interviews made during 1991-94. Visits to a doctor were a nalysed using a two-part model (logit and truncated negative binomial regression). Structural changes were tested by Chow-type tests and cha nges in the level of utilization by chronologically defined dummy vari ables for each year. The most significant changes (both in structure a nd level) occurred in the model explaining the number of visits (negat ive binomial regression) of chronically ill persons. Variables describ ing the continuity of care seem to be more important determinants of v isits to a doctor than certain other availability and socioeconomic va riables.