[Do differences in referral rates threaten the goal of equity in health care?]. / Truar skilnadene i tilvisingsratar målet om likeverdige helsetenester?

BACKGROUND: In comparison with the national average, and particularly in comparison with the region Helse Vest, which it forms part of, Sogn og Fjordane county has a high level of specialist health care utilization. Apart from the fact that it has two small community hospitals, little is known that could explain this county's high expenditure, and especially whether contrasts exist between its municipalities. MATERIALS AND METHODS: Based on data from the National Patient Registry and the administrative hospital registry DIPS for the year 2009, age and sex-adjusted utilization rates are compared at municipality level and at the level of the primary health care doctor. RESULTS: Marked contrasts between the municipalities were observed, both with respect to contact and DRG point rates. A further comparison of three comparable municipalities with different utilization rates revealed high and concurrent differences in referral rates between primary health doctors in the three municipalities. INTERPRETATION: The high and diverse utilization rates of specialist health care between municipalities in Sogn og Fjordane seem to be associated with correspondingly high and even more pronounced differences in referral rates from primary health care doctors.

Self-rated health during adolescence: stability and predictors of change (Young-HUNT study, Norway).

BACKGROUND: Self-rated health (SRH) is an important single-item variable used in many health surveys. It is a predictor for later mortality, morbidity and health service attendance. Therefore, it is important to study how SRH is influenced during adolescence. The present study examined the stability of SRH over a 4-year period in adolescence, and the factors predicting change in it. METHODS: Analyses were based on 4-year longitudinal data from the Young-HUNT studies in Norway among adolescents aged 13-19 years. A total of 2800 students (81%) participated in the follow-up study, and 2399 of these were eligible for data analysis. Cross-tables for SRH at the start of the study (between 1995 and 1997) and 4 years later were used to estimate the stability over the period. Proportional odds logistic regression analyses of SRH during 2000-01 were carried out, controlling for initial SRH, independent variables at the start of the study and changes in the same independent variables over 4 years as covariates. RESULTS: In 59% of the respondents, SRH remained unchanged through the 4-year observation period during adolescence. Fewer than 4% changed their ratings of SRH by two steps or more on a four-level scale. The self-assessed general well-being, health behaviour variables, being disabled in any way, and body dissatisfaction at the start of the study and the change of these predictors influenced SRH significantly during the 4-year observation. Being diagnosed with a medical condition, or specific mental or somatic health symptoms was of less importance for later SRH. Adolescents with more health service contacts at the start of the study, or who increase their attendance rate during the 4 years, report deterioration of SRH. CONCLUSION: SRH is a relatively stable construct during adolescence, and deteriorates consistently with a lack of general well-being, disability, healthcare attendance and health-compromising behaviour.

Self-rated health in adolescence: a multifactorial composite.

BACKGROUND AND AIMS: Self-rated health is an important health predictor, and it has only rarely been studied in adolescents. This study examined the relationships between self-rated health and a broad spectrum of structural, medical, psychological, and social variables. The association between these variables and negative health rating through to good health rating versus good to very good health rating was also compared. METHODS: Analyses were based on cross-sectional data from the Young-HUNT II study in Norway. A total of 2,800 students aged 16 to 20 years participated, with a response rate of 81%. Separate logistic regression analyses for each gender were performed for a broad set of independent variables with self-rated health as the dependent variable. The effect of the variables at the negative (poor/not good) and positive (very good) ends of the scale were estimated and compared. RESULTS: Self-rated health in adolescence was significantly associated with a broad spectrum of independent variables reflecting medical, social, and personal factors. The associations were also present in multivariate analyses controlling for the interrelations between the independent variables. The negative and positive ends of the scale were affected in much the same way. The association with general well-being was especially strong. CONCLUSIONS: Adolescents conceptualize health as a construct related to medical, psychological, social, and lifestyle factors. Positive rating of health was affected in a similar manner to negative rating. However, the absolute importance of hampering positive health may be greater because of the higher prevalence of such health ratings.