[Health care usage by Moroccans and Turks compared to the indigenous Dutch population: no higher consumption of health care and lower medication costs]. / Zorggebruik door Marokkanen en Turken vergeleken met autochtone Nederlanders: geen hogere zorgconsumptie en lagere geneesmiddelkosten.

OBJECTIVE: Examination of whether health care consumption of Moroccan or Turkish insured under the Dutch national health system varies from that of the indigenous Dutch population. DESIGN: Retrospective, transverse. METHOD: Research was performed on the database of an insurance company concerning medication, referrals to a specialist, admissions to the hospital and use of physiotherapy. Data of 22,603 Moroccan and 15,190 Turkish persons from the records for 1999 were compared with a random sample of 17,976 other persons in the database and differences were tested after correction for differences in age and sex. RESULTS: Foreigners received 50% less physiotherapy, while hospital admissions did not differ from the control group. The number of referrals to a specialist and the number of prescriptions for Moroccans appeared to be higher, but the number of consumers appeared to be equal to the control group. Turks on the contrary showed an equal number of referrals, but fewer prescriptions. The differences concerned mostly long-term physiotherapy and also referrals to specialists in internal medicine and gynaecology. Differences in prescriptions were found for certain medication groups. Costs for medication for foreigners were lower per insured person. CONCLUSION: Foreigners did not have a higher consumption of health services than indigenous persons, whilst medication costs were lower.

All rights reserved, or can we just copy? Cost sharing arrangements and characteristics of health care systems.

In most European countries cost sharing has been introduced in order to reduce the demand for care. Different forms of cost sharing are available, but because of historically grown system characteristics and prevailing values countries differ in the application of specific forms. This review focuses on eighteen European countries, and on the combinations of health system characteristics and present forms of cost sharing. We found that some combinations are more present: different payment systems for primary care physicians go together with different forms of cost sharing, different services have different forms of cost sharing. In countries with a GP as gatekeeper no charges are in use for the GP. No distinct relationship could be found between the financing system (tax-based or insurance-based) and the form of cost sharing or the exclusion of vulnerable populations. It is concluded that there are two ways of filtering 'unnecessary' demand. One is by introducing cost sharing for directly accessible services such as GPs. The second way is by having GPs act as gatekeepers to more specialized, and more costly care.

Trends in HIV-related consultation in Dutch general practice.

New medicine against AIDS and a possible changing attitude towards AIDS will affect the role of the general practitioner (GP). We aim to explore and assess the changing role of the GP in preventing and detecting AIDS, which will be done by providing insight into the changing numbers and content of HIV-related consultations in the general practice. Since 1988 a representative sample of 63 Dutch GPs have participated in a network. They recorded all face-to-face consultations with non HIV-infected patients in which the subject of AIDS was brought up. Timetrend analysis is used to investigate variations over time in the number and content of the consultations, GPs' actions and patients' characteristics. The influence of a rural or urban setting and the characteristics of the patients who are involved are also taken into account. Until 1994 a significant increase was found in the number of consultations. In highly urban areas the number of consultations is higher and still growing, whereas physicians in rural areas see fewer patients every year. The most important topic of conversation was the request for an HIV test (74%). This figure grew over the years, as did the number of tests performed. GPs became less passive and restrictive in advising tests. The group of patients has also changed, e.g. patients do not mostly belong to traditional risk groups anymore, and are significantly younger. AIDS seems to have become more familiar to patients and doctors. A lot of general information is available from different sources. Because of this change in attitude and knowledge of patients, the GPs' role as it relates to AIDS is becoming more specific in tracing infected patients and giving customized information to individuals. Patients visit their physicians less often because of concerns about AIDS, but the GP continues to fulfil a very important role in the prevention and detection of AIDS.