The ecology of medical care: access points to the health care system in Austria and other developed countries

Figures & data

Table 1. Austrian participants’ characteristics.

Group	Subgroup	%	n
All		100	3508
Sex	Female	52	1824
	Male	48	1684
Age	15–24 years	13.9	486
	25–44 years	35	1228
	45–64 years	30.1	1057
	65+ years	21	736
Living condition	Urban	31.1	1093
	Rural	68.9	2415
Country of birth	Austria	91.8	3219
	Other	8.2	289
Highest educational level	Primary	37.4	1312
	Secondary	56	1964
	Tertiary	6.6	232
Working status	Full-time	43.8	1537
	Part-time	11.2	392
	Not working (retirement, student, seeking work)	45	1580
Self-rated overall health	Very good and good	75	2627
	Medium	19.4	679
	Bad and very bad	5.7	199
Health Service Utilization within the past 4 weeks	Any physician	46	1612
	GP	33.6	1180
	Specialist in the ambulatory sector	20.6	722
	Outpatient hospital department	7.8	273
	Hospital admission	3.5	124
	University hospital admission	0.3	11

Table 2. Number of people who encountered a health care service, per 1000 persons (95% CI), stratified by sociodemographic characteristics, who had at least one appointment with a physician within 4 weeks by the different health care settings in Austria.

Demographic characteristic		GP visits	Visits to specialist in the ambulatory sector	Visits to specialist in a hospital outpatient facility	Hospitalizations	Hospitalizations in an academic medical centre/ university hospital
Variable	Subvariable	n/N	n/N	n/N	n/N	n/N
		rate per 1000 (95% CI)	rate per 1000 (95% CI)	rate per 1000 (95% CI)	rate per 1000 (95% CI)	rate per 1000 (95% CI)
Age	15–24	71/433	69/432	30/432	10/433	2/433
		188 (136–241)	189 (132–246)	58 (27–89)	17 (4–30)	3 (<1–6)
	25–44	291/1304	257/1304	68/1304	25/1304	3/1304
		267 (228–306)	202 (168–236)	63 (41–85)	29 (12–46)	1 (<1–3
	45–64	329/1073	239/1071	80/1072	32/1073	2/1073
		351 (307–394)	182 (151–213)	94 (67–121)	43 (22–64)	5 (<1–11)
	65 and older	331/699	191/696	64/696	28/699	5/699
		529 (470-588)	259 (207-312)	94 (59-128)	47 (20-74)	4 (<1-9)
Sex	Female	606/1840	446/1837	128/1837	51/1840	5/1840
		370 (336–404)	237 (208–267)	75 (57–94)	39 (23–54)	4 (<1–8)
	Male	416/1669	310/1666	114/1667	44/1669	7/1669
		299 (264–335)	172 (145–200)	81 (60–102)	32 (17–46)	2 (<1–5)
Country of birth	Austria	919/3159	681/3154	219/3154	87/3159	10/3159
		340 (314–366)	203 (182–224	79 (65–94)	37 (26–48)	3 (<1–6)
	Other	103/350	75/349	23/350	8/350	2/350
		296 (216–377)	238 (161–314)	65 (21–109)	16 (3–29)	4 (<1–10)
Residence location	Urban	528/1936	437/1932	134/1933	46/1936	8/1936
		310 (273–347)	244 (210–279)	78 (59–98)	31 (17–46)	7 (<1–15)
	Rural	494/1573	319/1571	108/1571	49/1573	4/1573
		348 (317–380)	189 (163–214)	78 (60–96)	37 (23–51)	1 (<1–3)
Highest educational level	Primary	314/943	188/940	78/939	33/943	4/943
		376 (329–423)	212 (171–252)	92 (63–120)	44 (22–67)	2 (<1–5)
	Secondary	515/1739	384/1737	127/1739	50/1739	7/1739
		322 (292–352)	198 (174–222)	72 (57–88)	32 (21–44)	4 (<1–8)
	Tertiary	193/827	184/826	37/826	12/827	1/827
		235 (193–276)	239 (196–283)	48 (21–75)	10 (3–18)	1 (<1–2)
Working status	Full-time	340/1581	284/1579	84/1581	29/1581	3/1581
		244 (211–277)	181 (151–212)	60 (43–78)	23 (11–35)	4 (<1–8)
	Part-time	104/440	96/440	19/439	7/440	0/440
		280 (215–345)	184 (135–232)	40 (17–63)	11 (2–20)	0 (<1–8)
	None	578/1488	376/1484	139/1484	59/1488	9/1488
		440 (401–479)	236 (203–268)	105 (80–129)	53 (33–74)	3 (1–6)
Self-rated health status	Very good and good	639/2781	512/2777	131/2777	42/2781	4/2781
		256 (230–282)	173 (151–195)	51 (38–63)	18 (11–26)	1 (<1–2)
	Medium	274/567	176/565	72/566	33/567	3/567
		532 (472–592)	290 (236–344)	142 (96–187)	79 (38–120)	2 (<1–5)
	Bad and very bad	107/158	67/158	39/158	20/158	5/158
		726 (631–820)	361 (253–470)	223 (136–310)	109 (49–168)	32 (<1–71)

Figure 1. PRISMA 2009 flow diagram (adapted).

Table 3. Details of the publications of the seven countries listed in accordance with their publication date.

First author and year of publication	Country	Time of data sampling	Age of participants	Services assessed within the studies
White et al. 1961 [2]	U.K., U.S.	1928–1959	16 years and over	Visit to a physician Hospitalization Hospitalization in an academic medical center
Shao et al. 2011 (26)	Taiwan	2005	All age groups	Visit to any NHS service Visit to a Western medicine clinic Visit to a physician´s clinic Visit to a hospital outpatient clinic Visit to a dental clinic Visit to a Chinese medicine clinic Visit to an emergency department Admission to a ward in the hospital: the number of people who were admitted to a ward in any hospital and specific academic medical center Homecare
Ferro et al. 2011 (20)	Sweden	2006	All age groups	Home care Visit to primary health care center (treated by GPs) Visit to hospital outpatient departments Visit to hospital inpatient departments Visit to emergency departments Visit to university hospital outpatient departments Visit to university hospital inpatient departments
Hansen et al. 2012 (22)	Norway	2007/2008	30-87 years	Visit to GP Visit to physiotherapists Visit to dentist Visit to specialist outpatient clinic Visit to alternative care provider Visit to chiropractor Hospitalization
Stewart et al 2015 (27)	Canada	2007	15 years and older	Visit to family physicians Visit to other physicians than family physicians Visit to nurses Hospitalization
Kim et al. 2016 (25)	Korea	2012	18 years and older	Visit to ambulatory care clinics Visit to hospital outpatient departments Korean Oriental medical ambulatory care Hospitalization in clinics Hospitalization Hospitalization in tertiary hospitals Visit to emergency departments
Johansen 2017 (24)	U.S.	2011–2012	All age groups	Home health care Total visits to physicians Visit to primary care physicians Visit to outpatient specialty physician Visit to a complementary or alternative medical care provider Visit to an emergency department Hospitalization Hospitalization in an academic medical center
Fukui et al. 2017 (21)	Japan	2013	All age groups	Home health care Visit to CAM provider Visit to physician’s office Visit to a primary care physician Visit to a university medical center Hospitalization Emergency room visits
Recent Austrian study (16)	Austria	2011	15 years and older	Visit to any medical services Visit to GP Visit to specialist in an ambulatory care setting Visit to a specialist in an hospital outpatient facility Hospitalization Hospitalization in an academic medical center

The services relevant for this study are in bold.

Table 4. Comparison of the different ecology of medical care studies: result for 1000 persons within 4 weeks.

	U.K., U.S. (2)	U.S. (24)	Sweden (20)	Taiwan (26)	Norway (22)	Canada (27)	Korea (25)	Japan (23, 21)	Austria (16)
Visit to any physician office/clinic	250	290	–	329	–		333	265	460
Visit GP	–	103	87	–	214	238	–	206	336
Visit specialist in the ambulatory sector	–	102	–	–	–	70	–	–	206
Visit an outpatient clinic (outpatient clinic /hospital outpatient department)	–		44	152	91		136	60	78
Emergency department only	–	15	20	19	–	–	7	4
Hospitalized (sec. hospital care)	9	7	12	10	14	8	11	6	35
Hospitalized in an academic medical centre/ university hospital	1	–	<1	3	–	–	3	10	3

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Shao CC, Chang CP, Chou LF, et al. The ecology of medical care in Taiwan. J Chin Med Assoc. 2011;74(9):408–412.

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Ferro A, Kristiansson PM. Ecology of medical care in a publicly funded health care system: a registry study in Sweden. Scand J Prim Health Care. 2011;29(3):187–192.

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Fukui T, Rahman M, Ohde S, et al. Reassessing the ecology of medical care in Japan. J Community Health. 2017;42(5):935.

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Pichlhofer O, Maier M. Unregulated access to health-care services is associated with overutilization – lessons from Austria. Eur J Public Health. 2015;25(3):401–403.

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