Demand for primary healthcare services in Greece based on general practice prescribing model.

Pantelidis, Pantelis and Vozikis, Athanassios and Meggouli, Eirini (2019): Demand for primary healthcare services in Greece based on general practice prescribing model.

Abstract

Analyze the demand for general practitioners and estimate trends in the demand for health care services, mostly based on demographic and epidemiological development. We sought to project the cost and volume of prescribing in primary care. We used the data from the National Organization for the Provision of Primary Healthcare Services (EOPYY) to design a model based on the number of prescriptions issued to a patient visit. The prescriptions are grouped by patients' age, sex, place of residence and their diagnostic evaluation. We selected eleven conditions, which are identified by the codes from the International Classification of Diseases. The forecasting model is based on the negative binomial regression. Projections are made for drug expenditure based on data taken from the World Bank and analysis of current utilization trends. We project an increase in drug expenditure in 2021, although it is expected population decline. Older adults use more health services than younger people. It is noted that female have higher medical care service utilization than male. Greeks living in rural areas have less healthcare utilization rates than their urban counterparts.

• Item Type: MPRA Paper
• Language: English
• Keywords: Primary Health Care, Health Demand model, Prescribing Indicators, Negative Binomial.
• Subjects: C - Mathematical and Quantitative Methods > C2 - Single Equation Models ; Single Variables > C25 - Discrete Regression and Qualitative Choice Models ; Discrete Regressors ; Proportions ; Probabilities; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior

References

Access Economics. An analysis of the widening gap between community need and the availability of GP services. Australian Medical Association. Canberra;2002. Available at:https://ama.com.au/sites/default/files/documents/210202_Access_Ec_GP_Workforce_Report.pdf .

Anell A, Glenngård AH, Merkur S. Sweden: Health system review. Health Systems in Transition. Copenhagen: The European Observatory on Health Systems and Policies. 2012;14(5):1-159.ISSN 1817-6119.

Barber P, Lopez-Valcarcel B. Forecasting the need for medical specialists in Spain: application of a systems dynamics model, Human Resources for Health. 2010;28:24. DOI:10.1186/1478-4491-8-24.

Begashaw B, Tesfaye T. Healthcare Utilization among Urban and Rural Households in Esera District: Comparative Cross-sectional Study, American Journal of Public Health Research.2016;4(2):55-61. DOI: 10.12691/ajphr-4-2-3.

Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49(2):147-152.

Britt H, Miller GC, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O’Halloran J, Fahridin S. General practice activity in Australia 2009–10. General practice series no. 27,Cat. no. GEP 27. Canberra: AIHW;2010. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442472722.

Basu K, Gupta A. A physician demand and supply forecast model for Nova Scotia, Cahiers de sociologie et de demographie medicales. 2005;45(2-3):255-85.

Canadian Institute for Health Information. National Physician Database - Utilization Data 2014-2015;2015. Available at: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC3268&lang=en.

Carretero MT, Calderón-Larrañaga A, Poblador-Plou B., Prados-Torres A. Primary health care use from the perspective of gender and morbidity burden, BMC Female's Health. 2014;14:145. DOI:10.1186/s12905-014-0145-2.

Carr-Hill R, Hardman G, Martin S, et al. A Formula for Distributing NHS Revenues Based on Small Area Use of Hospital Beds. Occasional Paper, Centre for Health Economics, University of York;1994.

CfWI - Center for Workforce Intelligence. A strategic review of the future healthcare workforce: informing medical and dental student intakes. London;2012. Available at: http://www.cfwi.org.uk/publications/a-strategicreview-of-the-future-healthcare-workforce-informing-medical-and-dental-student-intakes1/at_download/attachment1.

Cornwall J, Davey J. Impact of Population Ageing in New Zealand on the Demand for Health and Disability Support Service and Workforce Implications. Background Paper. Wellington: Ministry of Health New Zealand;2004. Available at:https://www.health.govt.nz/system/files/documents/publications/cornwallanddavey.pdf.

Deb P, Holmes A.M. Estimates of use and costs of behavioural health care: a comparison of standard and finite mixture models. Health Econ. 2000;9(6):475–489.

Deb P, Trivedi P. The Structure of Demand for Health Care: Latent Class Variables Versus Two Part Models, Journal of Health Economics. 2002;21(4):601-25. DOI:10.1016/S0167-629 02)00008-5.

Dussault G, Buchan J, Sermeus W, Padaiga Z. Assessing future health workforce needs. Policy Summary 2. WHO, on behalf of European Observatory on Health Systems and Policies;2010.

Fernández-Olano C, Hidalgo JD, Cerdá-Díaz R, Requena-Gallego M, Sánchez-Castaño C, Urbistondo-Cascales L, et al. Factors associated with health care utilization by the elderly in a public health care system. Health Policy. 2006;75(2):131–9. DOI:10.1016/j.healthpol.2005.02.005.

García Rodríguez LA, Pérez Gutthann S. Use of the UK General Practice Research Database for pharmacoepidemiology, British Journal of Clinical Pharmacology. 1998;45:419–425. DOI:10.1046/j.1365-2125.1998.00701.x.

Goulding MR, Rogers ME. Public Health and Aging: Trends in Aging—United States and Worldwide. JAMA. 2003;289(11):1371-1373. DOI:10.1001/jama.289.11.1371.

Gravelle H, Sutton M, Morris S, Windmeijer F, Leyland A, Dibben C, Muirhead M. Modelling supply and demand influences on the use of health care: implications for deriving a needs-based capitation formula. Health Econ. 2003;12: 985–1004. DOI:10.1002/hec.830.

Greene W. Functional forms for the negative binomial model for count data, Economics Letters. 2008;99:585-590. DOI:10.1016/j.econlet.2007.10.015.

Harrison C, Britt H, Henderson J. Prevalence of Chronic Conditions in Australia, PLoS ONE. 2013;8(7):e67494. DOI:10.1371/journal.pone.0067494.

Health Workforce Australia. Health Workforce 2025 -Volume 3 - Medical Specialties. 2012. Available at: https://submissions.education.gov.au/forms/archive/2015_16_sol/documents/Attachments/Royal%20Australasian%20College%20of%20Surgeons.pdf.

Hippisley-Cox J, Vinogradova Y. Trends in Consultation Rates in General Practice 1995/1996 to 2008/2009: Analysis of the QResearch database. Final report to the NHS Information Centre and Department of health. Leeds: The NHS Information Centre for health and social care; 2009. Available at: https://catalogue.ic.nhs.uk/publications/primary-care/general-practice/tren-cons-rate-gene-prac-95-09/tren-cons-rate-gene-prac-95-09-95-09-rep.pdf.

IHS Inc. The Complexities of Physician Supply and Demand: Projections from 2013 to 2025. Prepared for the Association of American Medical Colleges. Washington DC;2015. Available at:https://www.aamc.org/download/426242/data/ihsreportdownload.pdf?cm_mmc=AAMC-_-ScientificAffairs-_-PDF-_-ihsreport.

Kephart G, Asada Y. Need-based resource allocation: different need indicators, different results?, BMC Health Services Research. 2008;9:122. DOI:10.1186/1472-6963-9-122.

Laurence C, Karnon J. Improving the planning of the GP workforce in Australia: a simulation model incorporating work transitions, health need and service usage, Human Resources for Health. 2016; V.14:13. DOI:10.1186/s12960-016-0110-2.

Lopes A, Almeida A, Almada-Lobbo B. Handling healthcare workforce planning with care: where do we stand?, Human Resources for Health. 2015;13(1):38. DOI:10.1186/s12960-015-0028-0.

Maleec V, Lix L, Nowicki S, Ekuma O. Health care use at the end of life among older adults: does it vary by age?, J Gerontol A Biol Sci Med Sci. 2007;62(4):400-407. DOI:10.1093/gerona/62.4.400.

McGovern E, Morris R. Medical Workforce Planning: Future Demand for General Practitioners 2015-2025. Health Service Executive, Health Service Executive - National Doctors Training and Planning, Dublin;2015. Available at: http://www.hse.ie/eng/staff/leadership_education_development/met/plan/reports/medical_workforce_planning_future_demand_for_general_practitioners_2015-2025.pdf.

Moineddin R, Meaney C, Agha M, Zagorski B, Glazier RH. Modeling factors influencing the demand for emergency department services in ontario: a comparison of methods. BMC Emergency Medicine. 2011;11:13. DOI:10.1186/1471-227X-11-13.

NZIER. Ageing New Zealand and Health and Disability Services: Demand projections and workforce implications, 2001–2021. Discussion document. Dec 2004. Wellington: NZ Ministry of Health,2004. Available at: http://www.moh.govt.nz/moh.nsf/0/E6EE108D0901CAD8CC256F73000F1F9A/$File/nzierreport-ageingnzandhealthanddisabilityservices.pdf.

Nolan B. Economic incentives, health status and health services utilisation. J. Health Econ. 1993;12:151–169. DOI:10.1016/0167-6296(93)90025-A.

O' Brien-Pallas L, Baumann A, Donner G, Murphy GT, Lochhaas-Gerlach J, Luba M. Forecasting models for human resources in health care, Journal of Advanced Nursing. 2001;33(1):120-9. DOI:10.1046/j.1365-2648.2001.01645.x.

Oladipo JA. Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems. African Health Sciences. 2014;14(2):322-333. DOI:10.4314/ahs.v14i2.6.

Omar RZ, O’Sullivan C, Petersen I, Islam A, Majeed A. A model based on age, sex, and morbidity to explain variation in UK general practice prescribing: cohort study, BM. 2008;337:a238. DOI:10.1136/bmj.a238.

Ono T, Lafortune G, Schoenstein M. Health workforce planning in OECD countries: a review of 26 projection models from 18 countries. OECD Health Working Papers, No. 62. France: OECD Publishing. 2013;8-11. DOI:10.1787/5k44t787zcwb-en.

Østbye T, Yarnall KSH, Krause KM, Pollak KI, Gradison M, Michener JL. Is There Time for Management of Patients With Chronic Diseases in Primary Care? Annals of Family Medicine. 2005;3(3):209-214. DOI:10.1370/afm.310.

Phuc Hong Le. An Empirical model to Estimate the Demand for Primary Care in Urban Settings, The University of Texas School of Public Health. Policy & Community Health, ProQuest;2009.

Redondo-Sendino Á, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain, BMC Public Health. 2006;6:155. DOI:10.1186/1471-2458-6-155.

Ringel JS, Hosek SD, Vollaard BA.Mahnovski S. The Elasticity of Demand for Health Care: A Review of the Literature and Its Application to the Military Health System; Santa Monica, CA:RAND Health;2002.

Roberts A, Charlesworth A. Future demand for health care: a modelling study. Lancet. 2012;380(S20). DOI:10.1016/S0140-6736(13)60306-2.

Roksvaag K,Texmon I. Arbeidsmarkedet for helse- og sosialpersonell fram mot år 2035 [Helsemod- the labor market for healthcare personel towards 2035], Report 14/2012.

Royal College of General Practitioners. A Vision for General Practice in the future NHS. London;2013. Available at: http://www.rcgp.org.uk/policy/rcgp-policy-areas/general-practice-2022.aspx.

Salinas J, Al Snih S, Markides K, Ray LA, Angel RJ. The rural-urban divide: health services utilization among older Mexicans in Mexico, Journal of rural health. 2010;26(4):333-341. DOI: 10.1111/j.1748-0361.2010.00297.x.

Statistics Norway, Oslo;2012. Available at: https://www.ssb.no/a/publikasjoner/pdf/rapp_201214/rapp_201214.pdf.

Schulz E. et al., Impact of ageing on curative health care workforce in selected EU countries, NEUJOBS working paper D12.1. Berlin;2013. Available at: http://www.neujobs.eu/sites/default/files/NEUJOBS%20Working%20Paper-D12.1-091213_new.pdf.

Seematter-Bagnoud L, Junod J, Jaccard Ruedin H, Roth M, Foletti C, Santos-Eggiman B. Offre et recours aux soins médicaux ambulatoires en Suisse - Projections a l'horizon 2030, Document de travail 33. Observatoire suisse de la santé (OBSAN), Neuchatel;2008. Available at: http://www.obsan.admin.ch/sites/default/files/publications/2015/arbeitsdokument-33.pdf.

Singh D, Lalani H, Kralj B, Newman E, Goodyear J, Hellyer D, et al. Ontario population needs-based physician simulation model. Toronto: Ontario Ministry of Health and Long-Term Care; 2010. Available at: https://www.healthforceontario.ca/UserFiles/file/PolicymakersResearchers/needs-based-model-report-oct-2010-en.pdf.

SPF Santé publique, Sécurité de la Chaîne alimentaire et Environnement, Direction générale Soins de Santé primaires et Gestion de crises, Cellule Planification des professionnels de santé. Perspectives d’avenir de la Commission de Planification, Offre médicale: Rapport scénario de base Médecins. 2009;43. Available at: http://organesdeconcertation.sante.belgique.be/sites/default/files/documents/planningscommissie_-_medisch_aanbod-fr/19069354_fr.pdf.

Statistics Canada. Health Care Professionals and Official-Language Minorities in Canada. Catalogue No. 91-550X. Available at:http://www.statcan.gc.ca/pub/91-550-x/2008001/part-partie1-eng.htm.

Stevens A, Gillam S. Needs assessment: from theory to practice. BMJ : British Medical Journal. 1998;31(7142):1448-1452.

Stevens A, Raftery J. Health Care Needs Assessment. Radcliffe Medical Press, Oxford;1997.

Trivedi PK. Introduction: econometric models of event counts events. J. Appl. Econom. 1997;12:199–201. DOI: 10.1002/(SICI)1099-1255(199705)12:3<199::AID-JAE442>3.0.CO;2-R.

Van Greuningen M, Batenburg R, Van der Velden L. Ten years of health workforce planning in the Netherlands: a tentative evaluation of GP planning as an example, Human Resources for Health. 2012;10(1):21. DOI:10.1186/1478-4491-10-21.

Vegda K, Nie J, Wang L, Tracy S, Moineddin R, Upshur R. Trends in health services utilization, medication use, and health conditions among older adults: a 2-year retrospective chart review in a primary care practice. BMC Health Services Research. 2009;9(1):217. DOI:10.1186/1472-6963-9-217.

Williams R, Wright J. Epidemiological issues in health needs assessment, British Medical Journal. 1998;316:1379-82. DOI:10.1136/bmj.316.7141.1379.

Wilkinson J, Murray S. Assessment in primary care: practical issues and possible approaches, British Medical Journal.1998;316(7143),1524:1528. DOI:10.1136/bmj.316.7143.1524.

Wright J, Williams R. Development and importance of health needs assessment, BMJ. 1998;316:1310. DOI:10.1136/bmj.316.7140.1310.

Zurn P, Dal Poz M, Stilwell B, Adams O. Imbalances in the health workforce. Geneva: World Health Organization; 2002. Available at: http://www.who.int/hrh/documents/en/imbalances_briefing.pdf.