Publication date

Urban-rural differences in access to GP services.

Verheij, R.A., Uiters, E.H., Westert, G.P., Devillé, W. Urban-rural differences in access to GP services. European Journal of Public Health: 2002, 12(suppl. 4), 107 Abstract. 10th Annual Eupha Meeting 'Bridging the Gap between research and policy in public health: information, promotion and training', Dresden, Germany 28 - 30 November 2002.
Background: Urban health care seems to be in a crisis in the Netherlands. There are too few GPs; their workload is too high; many are burnt-out; and within a few years a large part of the population will have to do without a GP. At least, this is the picture we get from the media and from GPs themselves. Our question is, whether this has yet led to under-utilization of GP services in urban areas. Given one's health status, is an urban resident as likely to receive GP services as residents elsewhere in the Netherlands? In other words: is the accessibility of GP services in large cities worse than elsewhere? Aim: Assess whether urban residents are less likely to receive GP services. Methods: Health interview survey in Nivel's Dutch National Survey of General Practice (2001/2); representative sample aged 18+, N= 9684; response rate 65%, with control variables age, gender, education, perceived general health. The explanatory variable is use of GP services in past two months. Utilization was analyzed by means of logistic regression for higher and lower educated groups separately. Results: Preliminary results show that - after controlling for need factors - urban residents generally are more likely to have used GP services than residents of other areas. This suggests overutilization rather than under utilization in urban areas. However, specific analyses on the two subgroups indicates that overutilization occurs mainly in the lower educated subgroup. Conclusions: These preliminary results suggest that access to GP services is not worse in our large cities as compared to elsewhere. On the contrary, taking differences in health into account, lower socioeconomic groups receive more GP care than their higher educated counterparts. However, these preliminary analyses include only the non-migrant population. Further analyses will include the migrant population as well. (aut. ref.)