Introduction
Materials and methods
Study design
Data
Study population
Group classification
Inclusion and exclusion criteria
Variables
Covariates
Outcome variables
Health problems
Medical care utilization
Statistical analyses
Ethics statement
Results
The ecology of medical care in 2018
Demographics of study subjects by type and location of a regular doctor, according to sex
Men | Women | |||||||
---|---|---|---|---|---|---|---|---|
No regular doctor | Regular doctor-Clinic physician | Regular doctor-Hospital physician | P value | No regular doctor | Regular doctor-Clinic physician | Regular doctor-Hospital physician | P value | |
4900 (80.08) | 802 (13.11) | 417 (6.81) | 5386 (74.96) | 1304 (18.15) | 495 (6.89) | |||
Age | ||||||||
19–44 | 1875 (92.41) | 102 (5.03) | 52 (2.56) | < .0001 | 1926 (87.78) | 193 (8.80) | 75 (3.42) | < .0001 |
45–64 | 1888 (80.00) | 310 (13.14) | 162 (6.86) | 1959 (75.55) | 443 (17.08) | 191 (7.37) | ||
65 and more | 1137 (65.72) | 390 (22.54) | 203 (11.73) | 1501 (62.59) | 668 (27.86) | 229 (9.55) | ||
Area | ||||||||
Urban | 3825 (80.65) | 604 (12.73) | 314 (6.62) | 0.12 | 4106 (75.23) | 963 (17.64) | 389 (7.13) | 0.07 |
Rural | 1075 (78.13) | 198 (14.39) | 103 (7.49) | 1280 (74.12) | 341 (19.75) | 106 (6.14) | ||
Household income | ||||||||
1st | 494 (72.43) | 122 (17.89) | 66 (9.68) | < .0001 | 784 (66.61) | 302 (25.66) | 91 (7.73) | < .0001 |
2nd | 794 (74.76) | 168 (15.82) | 100 (9.42) | 938 (69.07) | 299 (22.02) | 121 (8.91) | ||
3rd | 1046 (80.52) | 180 (13.86) | 73 (5.62) | 1114 (75.27) | 272 (18.38) | 94 (6.35) | ||
4th | 1251 (84.02) | 160 (10.75) | 78 (5.24) | 1286 (80.27) | 229 (14.29) | 87 (5.43) | ||
5th | 1315 (82.86) | 172 (10.84) | 100 (6.3) | 1264 (80.61) | 202 (12.88) | 102 (6.51) | ||
Charlson Comorbidity Index | ||||||||
0 | 3933 (85.59) | 514 (11.19) | 148 (3.22) | < .0001 | 4421 (79.70) | 888 (16.01) | 238 (4.29) | < .0001 |
1 | 627 (65.79) | 193 (20.25) | 133 (13.96) | 618 (59.83) | 286 (27.69) | 129 (12.49) | ||
2 and more | 340 (59.54) | 95 (16.64) | 136 (23.82) | 347 (57.36) | 130 (21.49) | 128 (21.16) | ||
Chronic disease | ||||||||
No | 2886 (87.53) | 298 (9.04) | 113 (3.43) | < .0001 | 2556 (82.99) | 404 (13.12) | 120 (3.90) | < .0001 |
Yes | 2014 (71.37) | 504 (17.86) | 304 (10.78) | 2830 (68.94) | 900 (21.92) | 375 (9.14) | ||
Self-rated health | ||||||||
Good | 2154 (84.6) | 286 (11.23) | 106 (4.16) | < .0001 | 1996 (81.77) | 337 (13.81) | 108 (4.42) | < .0001 |
Fair | 1974 (77.41) | 377 (14.78) | 199 (7.80) | 2359 (72.94) | 659 (20.38) | 216 (6.68) | ||
Bad | 772 (75.46) | 139 (13.59) | 112 (10.95) | 1031 (68.28) | 308 (20.40) | 171 (11.32) |
Ecology of medical care by having a regular doctor and type of the doctor, according to sex
Men | Women | ||||||
---|---|---|---|---|---|---|---|
No regular doctor | Regular doctor-Clinic physician | Regular doctor-Hospital physician | No regular doctor | Regular doctor-Clinic physician | Regular doctor-Hospital physician | ||
Health problems | 692.5 (676.7, 708.3) | 918.1 (893.3, 942.8) | 938.9 (906.7, 971.2) | 754.3 (740.0, 768.6) | 904.0 (881.9, 926.1) | 937.0 (905.2, 968.7) | |
Ambulatory Care or outpatient department visit | Clinic | 239.9 (231.0, 248.8) | 604.8 (576.6, 632.9) | 288.1 (253.81, 322.41) | 356.3 (346.8, 365.8) | 615.2 (593.9, 636.5) | 389.4 (360.1, 418.8) |
Secondary Hospital | 37.7 (34.1, 41.4) | 52.2 (42.4, 61.9) | 106.4 (83.0, 129.9) | 62.0 (57.7, 66.2) | 66.4 (56.7, 76.1) | 132.8 (107.8, 157.8) | |
Tertiary Hospital | 68.5 (63.8, 73.2) | 100.6 (84.8, 116.4) | 372.2 (337.1, 407.2) | 83.5 (78.7, 88.4) | 82.2 (73.0, 91.4) | 350.3 (317.9, 382.6) | |
Hospitalization | Secondary Hospital | 3.0 (2.5, 3.6) | 3.4 (2.0, 4.8) | 5.4 (2.9, 7.9) | 4.8 (4.1, 5.4) | 5.4 (3.8, 6.9) | 9.9 (5.4, 14.4) |
Tertiary Hospital | 6.0 (5.1, 6.9) | 9.4 (6.2, 12.5) | 23.5 (16.8, 30.3) | 5.9 (5.1, 6.7) | 6.3 (4.6, 8.0) | 21.1 (14.9, 27.2) | |
Emergency Department Visit | 7.20 (6.4, 8.0) | 10.8 (8.0, 13.5) | 17.4 (12.8, 22.0) | 8.2 (7.3, 9.1) | 8.5 (6.8, 10.2) | 16.4 (12.0, 20.8) |
Adjusted odds ratio of medical care utilization in the different care setting in 2018 according to sex
Ambulatory Care | Inpatient Care | Emergency Department Visit | ||||
---|---|---|---|---|---|---|
Clinic | Hospital | General, Tertiary Hospital | Hospital | General, Tertiary Hospital | ||
Age group | ||||||
19–44 | 0.31 (0.27, 0.35) | 0.53 (0.41, 0.70) | 0.45 (0.35, 0.57) | 0.37 (0.21, 0.64) | 0.60 (0.38, 0.97) | 0.83 (0.61, 1.14) |
45–64 | 0.54 (0.48, 0.61) | 0.93 (0.76, 1.15) | 0.58 (0.50, 0.69) | 0.61 (0.43, 0.88) | 0.63 (0.45, 0.88) | 0.79 (0.63, 1.01) |
65 and more | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Household income | ||||||
1st | 0.97 (0.82, 1.16) | 1.15 (0.82, 1.62) | 1.09 (0.84, 1.41) | 1.09 (0.65, 1.83) | 1.42 (0.91, 2.20) | 1.26 (0.89, 1.78) |
2nd | 1.04 (0.91, 1.19) | 0.98 (0.76, 1.27) | 1.00 (0.82, 1.23) | 0.85 (0.51, 1.39) | 1.63 (1.12, 2.39) | 1.41 (1.05, 1.89) |
3rd | 1.04 (0.92, 1.18) | 0.95 (0.72, 1.24) | 1.01 (0.84, 1.22) | 0.80 (0.48, 1.31) | 1.67 (1.15, 2.44) | 1.10 (0.81, 1.48) |
4th | 1.08 (0.96, 1.22) | 1.02 (0.79, 1.30) | 0.92 (0.76, 1.11) | 0.90 (0.56, 1.47) | 1.27 (0.85, 1.91) | 1.18 (0.88, 1.58) |
5th | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Area | ||||||
Urban | 0.99 (0.90, 1.07) | 0.87 (0.73, 1.03) | 0.96 (0.85, 1.09) | 0.90 (0.65, 1.23) | 0.89 (0.69, 1.14) | 0.81 (0.67, 0.99) |
Rural | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Charlson Comorbidity Index | ||||||
0 | 0.76 (0.64, 0.92) | 0.90 (0.67, 1.22) | 0.27 (0.22, 0.34) | 0.84 (0.54, 1.32) | 0.25 (0.16, 0.37) | 0.56 (0.41, 0.76) |
1 | 1.28 (1.05, 1.55) | 1.37 (1.03, 1.83) | 0.57 (0.46, 0.70) | 1.20 (0.74, 1.94) | 0.41 (0.29, 0.59) | 0.57 (0.41, 0.78) |
2 = < | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Chronic diseases | ||||||
No | 0.52 (0.47, 0.57) | 0.59 (0.48, 0.74) | 0.50 (0.43, 0.58) | 0.75 (0.51, 1.10) | 0.63 (0.47, 0.86) | 0.71 (0.57, 0.89) |
Yes | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Self-rated health | ||||||
Good | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Fair | 1.26 (1.14, 1.39) | 1.19 (0.98, 1.45) | 1.37 (1.18, 1.59) | 1.36 (0.90, 2.05) | 1.20 (0.88, 1.64) | 1.29 (1.02, 1.65) |
Bad | 1.12 (0.97, 1.29) | 1.67 (1.29, 2.16) | 1.95 (1.62, 2.35) | 2.52 (1.66, 3.82) | 2.37 (1.73, 3.25) | 1.92 (1.50, 2.47) |
Regular doctor | ||||||
No regular doctor | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Regular doctor-Clinic physician | 3.39 (2.98, 3.86) | 1.01 (0.81, 1.26) | 0.91 (0.75, 1.12) | 0.77 (0.49, 1.21) | 1.04 (0.72, 1.52) | 1.23 (0.91, 1.65) |
Regular doctor-Hospital physician | 0.65 (0.54, 0.79) | 1.89 (1.40, 2.56) | 3.86 (3.16, 4.71) | 1.04 (0.63, 1.71) | 1.59 (1.10, 2.28) | 1.56 (1.11, 2.19) |
Ambulatory Care | Inpatient Care | Emergency Department Visit | ||||
---|---|---|---|---|---|---|
Clinic | Hospital | General, Tertiary Hospital | Hospital | General, Tertiary Hospital | ||
Age group | ||||||
19–44 | 0.36 (0.32, 0.40) | 0.80 (0.64, 0.99) | 0.53 (0.44, 0.65) | 1.10 (0.69, 1.75) | 0.56 (0.37, 0.85) | 0.75 (0.56, 0.99) |
45–64 | 0.57 (0.52, 0.64) | 1.03 (0.86, 1.23) | 0.81 (0.70, 0.93) | 1.18 (0.81, 1.71) | 0.96 (0.72, 1.28) | 0.76 (0.60, 0.96) |
65 and more | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Household income | ||||||
1st | 1.28 (1.11, 1.49) | 1.34 (1.06, 1.70) | 0.95 (0.77, 1.16) | 1.75 (1.08, 2.85) | 0.97 (0.68, 1.39) | 0.90 (0.66, 1.22) |
2nd | 1.09 (0.97, 1.22) | 1.18 (0.96, 1.45) | 1.01 (0.86, 1.20) | 1.22 (0.81, 1.83) | 0.96 (0.68, 1.36) | 1.00 (0.76, 1.32) |
3rd | 1.11 (1.00, 1.24) | 1.12 (0.91, 1.37) | 0.91 (0.77, 1.07) | 1.05 (0.71, 1.56) | 0.93 (0.65, 1.32) | 0.92 (0.69, 1.24) |
4th | 1.04 (0.94, 1.16) | 1.05 (0.86, 1.28) | 0.87 (0.74, 1.02) | 0.99 (0.66, 1.51) | 0.90 (0.59, 1.37) | 1.00 (0.74, 1.34) |
5th | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Area | ||||||
Urban | 0.99 (0.92, 1.06) | 0.91 (0.80, 1.04) | 0.96 (0.86, 1.06) | 0.86 (0.67, 1.10) | 1.02 (0.81, 1.27) | 0.86 (0.72, 1.04) |
Rural | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Charlson Comorbidity Index | ||||||
0 | 1.12 (0.96, 1.31) | 1.21 (0.96, 1.54) | 0.29 (0.25, 0.34) | 0.89 (0.59, 1.35) | 0.30 (0.22, 0.41) | 0.75 (0.58, 0.97) |
1 | 1.76 (1.47, 2.09) | 1.38 (1.06, 1.80) | 0.56 (0.48, 0.67) | 0.99 (0.62, 1.57) | 0.51 (0.36, 0.74) | 0.76 (0.56, 1.05) |
2 = < | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Chronic diseases | ||||||
No | 0.59 (0.55, 0.64) | 0.69 (0.59, 0.80) | 0.54 (0.48, 0.62) | 0.63 (0.47, 0.83) | 0.76 (0.58, 1.01) | 0.80 (0.64, 1.00) |
Yes | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Self-rated health | ||||||
Good | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Fair | 1.33 (1.23, 1.44) | 1.32 (1.13, 1.53) | 1.26 (1.11, 1.44) | 1.29 (0.95, 1.75) | 1.34 (0.98, 1.82) | 1.17 (0.92, 1.50) |
Bad | 1.41 (1.25, 1.59) | 1.90 (1.57, 2.29) | 1.79 (1.54, 2.08) | 2.78 (2.02, 3.84) | 2.88 (2.08, 3.99) | 2.34 (1.80, 3.05) |
Regular doctor | ||||||
No regular doctor | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) | 1.00 (REF) |
Regular doctor-Clinic physician | 2.16 (1.96, 2.37) | 0.90 (0.75, 1.08) | 0.67 (0.59, 0.77) | 0.94 (0.68, 1.31) | 0.77 (0.58, 1.03) | 0.90 (0.71, 1.13) |
Regular doctor-Hospital physician | 0.72 (0.62, 0.85) | 1.83 (1.41, 2.36) | 3.22 (2.76, 3.76) | 1.48 (0.89, 2.49) | 1.72 (1.22, 2.43) | 1.46 (1.06, 2.01) |