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

在德国，与其他国家相比，门诊医疗服务的使用率很高：一项基于德国一家大型公共医疗保险公司流程数据的研究显示，每年平均有17.9名医患接触者，而挪威的可比数字下降到约5人。常用的医疗保健利用模型，如Rosenstock的健康信念模型和Andersen的行为模型不能充分解释这些差异。卫生保健系统的组织因素，如门卫，并不能解释差异的大小。我们的假设是，患者对初级卫生保健利用的主观观念在解释不同国家不同的卫生保健利用行为中起主要作用。因此，本研究的目的是对这些主观概念进行比较探讨，以德国和挪威为例。为此，我们选择了比较定性研究设计。在挪威和德国，我们将用定性情景访谈的方式采访20名患者。此外，我们将在四个德国和四个挪威的初级保健实践中进行参与性观察。数据将通过主题编码进行分析。通过选定的类别，我们将进行比较案例和群体分析。因此，我们将对德国和挪威关于初级卫生保健利用的主观概念之间的异同形成一个概念和理解。

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.