Patients' Subjective Concepts about Primary Health Care Utilization: a Qualitative Comparative Study Between Norway and Germany

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In Germany, utilization of ambulatory health care services is high compared to other countries: Whereas a study based on the process data of a large German public health care insurance show in an average 17.9 physician-patient-contacts per year, the comparable figure for Norway is down at about 5. The usual models of health care utilization, such as Rosenstock's Health Belief Model and Andersen's Behavioral Model cannot explain these differences adequately. Organizational factors of the health care system, such as gatekeeping, do not explain the magnitude of the differences.Our hypothesis is that patients' subjective concepts about primary health care utilization play a major role in explaining different health care utilization behavior in different countries. Hence, the aim of this study is to explore these subjective concepts comparatively, exemplary between Germany and Norway.To that aim, we opted for a comparative qualitative study design. In Norway and Germany, we are going to interview 20 patients each with qualitative episodic interviews. In addition, we are going to conduct participant observation in four German and four Norwegian primary care practices. The data is going to be analyzed by thematic coding. By selected categories, we are going to conduct comparative case and group analyses. Thus, we are going to develop a concept and understanding of similarities and differences between the subjective concepts regarding primary health care utilization in Germany and Norway.