Table 4 Impact of physician density on satisfaction in lowrhigh physician density municipalities. Ordered
probit regression. Only coefficients for physician density are displayed. Wald x
2
test statistics Ž
. absolute values below the regression coefficient. High physician density area: Physician density
7.56
2
Low physician High physician
Wald x
a
density density
test statistics municipalities
municipalities Dependent Õariables
Waiting time 0.084
0.084 0.20
52.34 125.8
Distance 0.060
0.012 12.03
22.39 2.14
Communication 0.054
0.013 6.30
11.20 2.09
Friendliness 0.052
0.028 1.25
17.20 12.09
Professional skills 0.039
0.025 0.67
10.86 11.04
Outcome 0.036
0.009 1.70
7.76 1.17
General satisfaction 0.072
0.036 7.19
38.58 22.93
a 2
Ž .
Wald x test statistics absolute values refer to the interaction term between physician density
and a dummy variable for high physician density municipalities in pooled regressions. p- 0.05.
p- 0.01.
Second, the control variables measured demographic characteristics of the municipalities which may affect accessibility to primary physician services. The
following variables were included: population size, dummies for town and North- ern Norway, and the mean travelling time to the municipality centre. Third, the
control variables measured the health status of the population. The following variables were included: mortality rate, proportion of welfare clients and average
education level. All variables at the level of the municipality were obtained from the Norwegian Social Science Data Service.
4. Results and discussion
As is evident from Table 1, the respondents were relatively satisfied with the physicians’ professional skills but dissatisfied with the waiting time to get an
appointment. These results are consistent with international studies, which mainly
F. Carlsen,
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745
Table 5
2
Ž .
Impact of physician density on satisfaction for two income categories. Ordered probit regression. Wald x test statistics
absolute values below the regression
Ž .
coefficient. High income respondents: Family income G NOK300,000 £25,000 All municipalities
Low physician density municipalities High physician density municipalities
Low income High income
Low income High income
Low income High income
Waiting time Physician density
0.060 0.058
0.100 0.070
0.079 0.089
98.38 111.7
31.92 21.01
51.69 75.02
Distance Physician density
0.025 0.027
0.079 0.046
0.007 0.017
14.84 20.57
16.44 7.49
0.35 2.57
Communication Physician density
0.015 0.027
0.058 0.052
0.006 0.019
3.85 15.81
5.31 6.06
0.25 2.62
Friendliness Physician density
0.027 0.032
0.051 0.052
0.038 0.022
16.98 29.75
6.94 9.55
9.98 4.15
Professional skills Physician density
0.027 0.026
0.037 0.039
0.035 0.019
18.43 20.75
4.17 6.16
9.81 3.39
Outcome Physician density
0.017 0.017
0.021 0.045
0.018 0.0009
7.05 8.34
1.13 6.94
2.28 0.006
General satisfaction Physician density
0.023 0.046
0.049 0.088
0.030 0.044
13.94 69.95
7.35 33.55
7.44 18.46
p - 0.05. p - 0.01.
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J. Grytten
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of Health
Economics 19
2000 731
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746
Table 6 Ž
. Determinants of satisfaction with primary physician services. Ordered probit regression with and without random effects. Standard error absolute values
below the regression coefficient Dependent variables
Waiting time Distance
Communication Without
With Without
With Without
With random
random random
random random
random effect
effect effect
effect effect
effect Variables at the leÕel of the indiÕidual
Constant 0.70
0.75 2.47
2.49 1.85
1.88 0.1271
0.1737 0.1366
0.1441 0.1609
0.1833 Respondent’s age 1
0.24 0.25
0.16 0.16
0.28 0.29
0.0288 0.0302
0.0298 0.0305
0.0365 0.0383
Respondent’s age 2 0.59
0.62 0.39
0.39 0.69
0.70 0.0354
0.0379 0.0362
0.0379 0.0447
0.0460 Respondent’s gender
y0.020 y0.018
y0.060 y0.061
y0.076 y0.077
0.0202 0.0214
0.0215 0.0228
0.0261 0.0276
Respondent’s marital status y0.049
y0.044 y0.014
y0.015 0.002
0.001 0.0247
0.0249 0.0262
0.0266 0.0311
0.0321 Respondent’s level of education 1
y0.024 y0.029
y0.033 y0.033
y0.16 y0.16
0.0247 0.0257
0.0265 0.0264
0.0318 0.0325
Respondent’s level of education 2 0.029
0.032 0.004
0.003 y0.14
y0.14 0.0300
0.0311 0.0322
0.0327 0.0381
0.0396 Respondent’s family income
0.007 0.014
0.024 0.025
y0.023 y0.021
0.0224 0.0238
0.0234 0.0246
0.0278 0.0294
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2000 731
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747 Variables at the leÕel of the municipality
Physician density 0.059
0.061 0.022
0.022 0.024
0.024 0.0057
0.0078 0.0058
0.0062 0.0070
0.0080 Other personnel
y0.003 y0.003
0.002 0.002
y0.0001 y0.0001
0.0014 0.0021
0.0015 0.0014
0.0019 0.0029
Care for the elderly 0.58
0.67 0.28
0.29 0.30
0.27 0.4219
0.5891 0.4451
0.4593 0.5230
0.5980 Dummy for hospital
0.078 0.077
0.074 0.074
0.12 0.12
0.0281 0.0433
0.0297 0.0332
0.0380 0.0416
Proportion of employed physicians y0.20
y0.21 y0.055
y0.055 y0.13
y0.13 0.0404
0.0554 0.0424
0.0435 0.0515
0.0602
y5 y5
y7 y7
y6 y6
Population 0.10=10
0.11=10 y0.11=10
y0.10=10 y0.41=10
y0.42=10
y6 y6
y6 y6
y6 y6
0.30=10 0.56=10
0.35=10 0.37=10
0.45=10 0.46=10
Dummy for town 0.033
0.030 0.077
0.78 0.053
0.054 0.0267
0.0433 0.0278
0.0290 0.0340
0.0376 Dummy for Northern Norway
y0.29 y0.30
0.037 0.037
y0.060 y0.060
0.0324 0.0475
0.0346 0.0391
0.0412 0.0469
Travelling time y0.001
y0.001 y0.011
y0.011 y0.003
y0.003 0.0013
0.0018 0.0013
0.0012 0.0015
0.0019 Mortality
y0.0002 y0.0002
y0.0003 y0.0003
y0.0004 y0.0004
0.0001 0.0001
0.0001 0.0001
0.0001 0.0002
Welfare clients y1.99
y2.14 y2.65
y2.68 1.25
1.24 0.8693
1.2255 0.9168
0.9722 1.1243
1.2530 Education
y0.18 y0.25
y0.10 y0.097
1.06 1.07
0.3809 0.5734
0.4036 0.4242
0.4895 0.5231
p- 0.05. p- 0.01.
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Friendliness Professional skills
Outcome General satisfaction
Without With
Without With
Without With
Without With
random random
random random
random random
random random
effect effect
effect effect
effect effect
effect effect
1.88 1.89
2.37 2.41
2.28 2.30
2.16 2.20
0.1346 0.1501
0.1444 0.1672
0.1341 0.1461
0.1300 0.1438
0.23 0.24
0.22 0.23
0.17 0.17
0.25 0.26
0.0293 0.0290
0.0308 0.0324
0.0298 0.0318
0.0284 0.0289
0.70 0.71
0.67 0.70
0.57 0.57
0.77 0.78
0.0363 0.0369
0.0394 0.0411
0.0366 0.0383
0.0357 0.0358
y0.096 y0.097
y0.17 y0.18
y0.16 y0.16
y0.21 y0.21
0.0214 0.0217
0.0228 0.0236
0.0214 0.0220
0.0206 0.0213
0.009 0.009
0.010 0.010
0.022 0.023
0.016 0.019
0.0256 0.0257
0.0277 0.0284
0.0255 0.0257
0.0253 0.0258
y0.11 y0.11
y0.12 y0.13
y0.067 y0.066
y0.18 y0.19
0.0261 0.0260
0.0280 0.0282
0.0258 0.0259
0.0255 0.0256
y0.15 y0.15
y0.18 y0.18
y0.11 y0.11
y0.21 y0.22
0.0320 0.0324
0.0341 0.0341
0.0320 0.0321
0.0309 0.0316
y0.007 y0.007
y0.036 y0.032
0.001 0.001
y0.068 y0.071
0.0232 0.0230
0.0249 0.0256
0.0232 0.0239
0.0226 0.0227
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749 0.028
0.028 0.030
0.030 0.012
0.012 0.028
0.029 0.0060
0.0065 0.0061
0.0067 0.0059
0.0060 0.0056
0.0061 0.0004
0.0005 0.002
0.002 0.001
0.001 0.0001
0.0001 0.0016
0.0017 0.0016
0.0022 0.0016
0.0022 0.0015
0.0016 0.058
0.038 0.25
0.23 y0.71
y0.72 0.54
0.52 0.4446
0.4808 0.4678
0.5221 0.4422
0.4928 0.4288
0.4593 0.062
0.063 0.071
0.072 0.10
0.10 0.12
0.12 0.0291
0.0313 0.0326
0.0393 0.0293
0.0314 0.0287
0.0351 y0.13
y0.13 y0.17
y0.17 y0.068
y0.068 y0.17
y0.17 0.0432
0.0474 0.0452
0.0539 0.0430
0.0469 0.0408
0.0459
y6 y6
y6 y6
y7 y7
y6 y6
y0.10=10 y0.11=10
0.11=10 0.10=10
y0.34=10 y0.36=10
y0.28=10 y0.29=10
y6 y6
y6 y6
y6 y6
y6 y6
0.31=10 0.52=10
0.35=10 0.41=10
0.34=10 0.41=10
0.32=10 0.39=10
0.058 0.058
0.087 0.087
0.056 0.057
0.066 0.067
0.0278 0.0307
0.0301 0.0355
0.0278 0.0296
0.0265 0.0303
y0.049 y0.049
y0.026 y0.028
y0.061 y0.061
y0.075 y0.077
0.0342 0.0358
0.0372 0.0427
0.0345 0.0350
0.0329 0.0354
y0.004 y0.004
y0.004 y0.005
y0.003 y0.003
y0.003 y0.003
0.0013 0.0015
0.0015 0.0017
0.0014 0.0016
0.0013 0.0014
y0.0002 y0.0002
y0.0004 y0.0004
y0.0002 y0.0002
y0.0002 y0.0002
0.0002 0.0001
0.0001 0.0001
0.0001 0.0001
0.0001 0.0001
0.37 0.36
y2.29 y2.31
y0.53 y0.57
y1.62 y1.70
0.9314 0.9929
0.9834 1.1186
0.9318 1.0298
0.8913 1.0149
0.32 0.34
0.70 0.74
y0.078 y0.071
y0.14 y0.12
0.3944 0.4132
0.4461 0.5057
0.3916 0.3780
0.3867 0.4750
find that consumers are most satisfied with physician competence and the outcome Ž
of care, and least satisfied with access to care for a review see: Hall and Dornan, .
1988 . Table 3 presents regressions based on the full data set. Two regressions are
presented for each dependent variable. In the first column, all explanatory Ž
. variables are included, whereas only statistically significant variables
p - 0.05 are included in the second column. The two specifications produced virtually
identical coefficients. Ž
. Consistent with US surveys Pascoe, 1983; Cleary and McNeil, 1988 , we
found that older people, women, and less educated people were more satisfied than younger people, men and people with higher education. There was also some
indication that married people and people with high income were relatively dissatisfied with primary physician services.
Physician density was positively associated with all aspects of satisfaction, and the coefficient was always statistically significant at conventional levels of signifi-
Ž .
cance p - 0.05 . The impact of physician density on reported satisfaction was
strongest for waiting time and weakest for outcome of care and communication. The results thus indicate that physician density is more important for access to
care than for quality of care. In general, the coefficients of the other municipal variables are plausible: people were more satisfied with primary physician services
in towns, municipalities with a hospital, densely populated municipalities and municipalities with low mortality.
To examine whether the relationship between reported satisfaction and physi- cian density is non-linear, we split the sample into low density and high density
municipalities and replicated the parsimonious regressions reported in Table 3 for each subsample.
2
The results reported in Table 4 suggest that the impact of physician density on satisfaction is a decreasing function of physician density. For
six of the dependent variables, the coefficient of physician density was higher in the low density sample than in the high density sample, and the difference between
the subsamples was statistically significant for three of these six variables. The coefficient of physician density was always significant in the low density sample
but only significant for four out of seven dependent variables in the high density sample.
Satisfaction with waiting time to get an appointment was the exception; the coefficient of physician density was equal in the two subsamples. This result
suggests that diminishing return to physician density sets in at a higher level of physician density for waiting time than for the other dependent variables. One
possible reason is that people on average are less satisfied with waiting time than
Ž .
with the other aspects of primary physician services Table 1 .
2
For brevity, Tables 4 and 5 display the coefficients of physician density only.
We expect policy-makers to be particularly interested in the relationship between supply of primary physician services, and access to and quality of care for
low income groups. Table 5 presents separate analyses for high and low income respondents using family income as split criterion.
3
The results suggest that there are no systematic differences between the two groups.
Finally, we constructed a small subsample by drawing five respondents from each municipality and year. We estimated the ordered probit model on this
subsample both with and without the municipal error term to check whether the results presented in Tables 3–5 were biased when the municipal error term was
excluded. The results reported in Table 6 suggest that this is not the case; inclusion of the municipal error term has only a modest impact on the coefficients and the
estimated standard deviations of the coefficients.
5. Conclusion
