Factors influencing general practitioner choice among working-age population in Serbia
Keywords:
General practitioners, sick leave, healthcare disparities, access to primary healthcare, Serbia
Abstract
This study investigates how sick leave and socio-demographic and occupational factors affect the choice of general practitioners in Serbia. The objective was to identify the factors influencing the choice of a general practitioner among employees in Serbia, considering incidences of sick leave. The study analyzed data from the 2019 Serbian National Health Survey, including 4,652 participants aged 18 to 65 years, using descriptive statistics and binary logistic regression. Overall, 92.4% of participants, mostly employees in the public sector (85.2%), chose a general practitioner, with a higher prevalence among episodes of prolonged sick leave (92.8%). The choice of a general practitioner is influenced by socio-demographic and health-related factors. Being employed by an employer increases the likelihood of choosing a general practitioner (OR = 2.277), while blue-collar workers (OR = 0.757) and employees of middle and poor wealth status have a lower likelihood among participants without sick leave (middle OR = 0.709, poor OR = 0.701). Employees in Vojvodina with sick leave have a lower likelihood of choosing a general practitioner (OR = 0.111). The last visit to a general practitioner is a significant predictor for both groups. Socio-demographic, work-related factors, and health status significantly influence the choice of general practitioner among employees in Serbia, indicating the importance of accessible primary healthcare during periods of sick leave.
References
1. Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D, et al. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health 2022; 10(5): e715–72. https://doi.org/10.1016/S2214-109X(22)00005-5
2. Liao R, Liu Y, Peng S, Feng XL. Factors affecting health care users’ first contact with primary health care facilities in north eastern China, 2008–2018. BMJ Global Health 2021; 6(2): e003907. https://doi.org/10.1136/bmjgh-2020-003907
3. Bjegovic-Mikanovic V, Vasic M, Vukovic D, Jankovic J, Jovic-Vranes A, Santric-Milicevic M, et al. Serbia: Health System Review. Health Syst Transit 2019; 21(3): 1–211. https://doi.org/10.1371/journal.pgph.0002563
4. Zakon o zdravstvenoj zaštiti [Internet]. [cited 2024 May 21]. Available from: https://www.paragraf.rs/propisi/zakon_o_zdravstvenoj_zastiti.html
5. Health statistical yearbook of the Republic of Serbia 2019 [Internet]. 2019 [cited 2024 May 21]. Available from: https://www.batut.org.rs/index.php?category_id=9
6. The 2019 Serbian National Health Survey | Statistical Office of the Republic of Serbia [Internet]. [cited 2024 May 21]. Available from: https://www.stat.gov.rs/en-us/vesti/20210429-istrazivanje-zdravlja-stan/
7. Lakiša S, Matisāne L, Gobiņa I, Vanadziņš I, Akūlova L, Eglīte M, et al. Impact of Workplace Conflicts on Self-Reported Medically Certified Sickness Absence in Latvia. Int J Environ Res Public Health 2021; 18(3): 1193. https://doi.org/10.3390/ijerph18031193
8. Antczak E, Miszczyńska KM. Causes of Sickness Absenteeism in Europe-Analysis from an Intercountry and Gender Perspective. Int J Environ Res Public Health 2021; 18(22): 11823. https://doi.org/10.3390/ijerph182211823
9. Ubalde-Lopez M, Hernando-Rodriguez JC, Benavides FG, Serra L. Trajectories of sickness absence among salaried workers: evidence from the WORKss cohort in Catalonia (Spain), 2012-2014. BMJ Open 2019; 9(7): e029092. https://doi.org/10.1136/bmjopen-2019-029092
10. Lork K, Holmgren K, Hultqvist J. Does the Number of Reasons for Seeking Care and Self-Rated Health Predict Sick Leave during the Following 12 Months? A Prospective, Longitudinal Study in Swedish Primary Health Care. International Journal of Environmental Research and Public Health 2022; 19(1): 354. https://doi.org/10.3390/ijerph19010354
11. Nordling P, Alexanderson K, Hensing G, Lytsy P. Factors associated with general practitioners’ contacts with sick-listed patients’ employers: A Swedish nationwide questionnaire study. Scand J Public Health 2023; 51(4): 602–10. https://doi.org/10.1177/14034948211053141
12. Söderman M, Wennman-Larsen A, Hoving L, Alexanderson K, Friberg E. Interventions regarding physicians’ sickness certification practice - a systematic literature review with meta-analyses. Scand J Prim Health Care 2022; 40(1): 104–14. https://doi.org/10.1080/02813432.2022.2036420
13. Duchemin T, Bar-Hen A, Lounissi R, Dab W, Hocine MN. Hierarchizing Determinants of Sick Leave: Insights from a Survey on Health and Well-being at the Workplace. J Occup Environ Med 2019; 61(8): e340–7. https://doi.org/10.1097/JOM.0000000000001643
14. Nielsen MB, Indregard AMR, Øverland S. Workplace bullying and sickness absence: a systematic review and meta-analysis of the research literature. Scand J Work Environ Health 2016; 42(5): 359–70. https://doi.org/10.5271/sjweh.3579
15. Marchildon GP, Brammli-Greenberg S, Dayan M, De Belvis AG, Gandré C, Isaksson D, et al. Achieving higher performing primary care through patient registration: A review of twelve high-income countries. Health Policy 2021; 125(12): 1507–16. https://doi.org/10.1016/j.healthpol.2021.09.001
16. Fernández-Pérez Á, Jiménez-Rubio D, Robone S. Freedom of choice and health services’ performance: Evidence from a national health system. Health Policy 2022; 126(12): 1283–90. https://doi.org/10.1016/j.healthpol.2022.11.001
17. Kozikowski A, Morton-Rias D, Mauldin S, Jeffery C, Kavanaugh K, Barnhill G. Choosing a Provider: What Factors Matter Most to Consumers and Patients? J Patient Exp 2022; 9: 23743735221074176. https://doi.org/10.1177/23743735221074175
18. Kuruoglu E, Guldal D, Mevsim V, Gunvar T. Which family physician should I choose? The analytic hierarchy process approach for ranking of criteria in the selection of a family physician. BMC Med Inform Decis Mak 2015; 15: 63. https://doi.org/10.1186/s12911-015-0183-1
19. Bazyar M, Yazdi-Feyzabadi V, Bahmani M, Sadeghifar J, Momeni K, Shaabani Z. Preferences of people in choosing a family physician in rural areas: a qualitative inquiry from Iran. Prim Health Care Res Dev 2022; 23: e57. https://doi.org/10.1017/S1463423622000317
20. Al-Ateeq M. Factors that Influence Patients in Choosing Their Treating Physicians in the Private Sector in Saudi Arabia. American Journal of Public Health Research 2018; 6. https://doi.org/10.12691/ajphr-6-4-1
21. Dahlgren C, Dackehag M, Wändell P, Rehnberg C. Simply the best? The impact of quality on choice of primary healthcare provider in Sweden. Health Policy 2021; 125(11): 1448–54. https://doi.org/10.1016/j.healthpol.2021.09.009
22. Dumontet M, Buchmueller T, Dourgnon P, Jusot F, Wittwer J. Gatekeeping and the utilization of physician services in France: Evidence on the Médecin traitant reform. Health Policy 2017; 121(6): 675–82. https://doi.org/10.1016/j.healthpol.2017.04.006
23. Zhang A, Nikoloski Z, Albala SA, Yip W, Xu J, Mossialos E. Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals. Health Systems & Reform 2020; 6(1): e1846844. https://doi.org/10.1080/23288604.2020.1846844
24. Empel G, Gravelle H, Santos R. Does quality affect choice of family physician? Evidence from patients changing general practice without changing address. Economic Modelling 2023; 126: 106395. https://doi.org/10.1016/j.econmod.2023.106395
25. Victoor A, Delnoij DMJ, Friele RD, Rademakers JJDJM. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Serv Res 2012; 12: 272. https://doi.org/10.1186/1472-6963-12-272
26. Blomgren J, Jäppinen S, Perhoniemi R. Identifying user profiles of healthcare, social and employment services in a working-age population: A cluster analysis with linked individual-level register data from Finland. PLOS ONE 2023; 18(11): e0293622. https://doi.org/10.1371/journal.pone.0293622
27. Blomgren J, Virta LJ. Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland. PLoS One 2020; 15(4): e0231792. https://doi.org/10.1371/journal.pone.0231792
28. Jovanovic D, Jankovic J, Mirilovic N. Socio-demographic inequalities in satisfaction with primary health care and utilization of chosen doctors’ services: a cross-sectional study. South Eastern European Journal of Public Health (SEEJPH). [cited 2024 May 22]; Available from: https://www.biejournals.de/index.php/seejph/article/view/3311
29. Janković J, Šiljak S, Marinković J, Kovač B, Janković S. Patterns of Health Care Utilization for Noncommunicable Diseases in a Transitional European Country: Results from the National Health Survey. Int J Health Serv 2019; 49(1): 37–50. https://doi.org/10.1177/0020731418762717
30. Govender K, Girdwood S, Letswalo D, Long L, Meyer-Rath G, Miot J. Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa. BMC Public Health 2021; 21(1): 1649. https://doi.org/10.1186/s12889-021-11678-9
31. Žvinakis P, Kalibataitė R, Kalibatas V. Patients’ Shift from Public to Private Primary Health Care Providers in Lithuania: Analysis of the Main Reasons. Inquiry 2021; 58: 469580211060304. https://doi.org/10.1177/00469580211060304
32. Khatami F, Shariati M, Khedmat L, Bahmani M. Patients’ preferences in selecting family physician in primary health centers: a qualitative-quantitative approach. BMC Fam Pract 2020; 11; 21:107. https://doi.org/10.1186/s12875-020-01181-2
2. Liao R, Liu Y, Peng S, Feng XL. Factors affecting health care users’ first contact with primary health care facilities in north eastern China, 2008–2018. BMJ Global Health 2021; 6(2): e003907. https://doi.org/10.1136/bmjgh-2020-003907
3. Bjegovic-Mikanovic V, Vasic M, Vukovic D, Jankovic J, Jovic-Vranes A, Santric-Milicevic M, et al. Serbia: Health System Review. Health Syst Transit 2019; 21(3): 1–211. https://doi.org/10.1371/journal.pgph.0002563
4. Zakon o zdravstvenoj zaštiti [Internet]. [cited 2024 May 21]. Available from: https://www.paragraf.rs/propisi/zakon_o_zdravstvenoj_zastiti.html
5. Health statistical yearbook of the Republic of Serbia 2019 [Internet]. 2019 [cited 2024 May 21]. Available from: https://www.batut.org.rs/index.php?category_id=9
6. The 2019 Serbian National Health Survey | Statistical Office of the Republic of Serbia [Internet]. [cited 2024 May 21]. Available from: https://www.stat.gov.rs/en-us/vesti/20210429-istrazivanje-zdravlja-stan/
7. Lakiša S, Matisāne L, Gobiņa I, Vanadziņš I, Akūlova L, Eglīte M, et al. Impact of Workplace Conflicts on Self-Reported Medically Certified Sickness Absence in Latvia. Int J Environ Res Public Health 2021; 18(3): 1193. https://doi.org/10.3390/ijerph18031193
8. Antczak E, Miszczyńska KM. Causes of Sickness Absenteeism in Europe-Analysis from an Intercountry and Gender Perspective. Int J Environ Res Public Health 2021; 18(22): 11823. https://doi.org/10.3390/ijerph182211823
9. Ubalde-Lopez M, Hernando-Rodriguez JC, Benavides FG, Serra L. Trajectories of sickness absence among salaried workers: evidence from the WORKss cohort in Catalonia (Spain), 2012-2014. BMJ Open 2019; 9(7): e029092. https://doi.org/10.1136/bmjopen-2019-029092
10. Lork K, Holmgren K, Hultqvist J. Does the Number of Reasons for Seeking Care and Self-Rated Health Predict Sick Leave during the Following 12 Months? A Prospective, Longitudinal Study in Swedish Primary Health Care. International Journal of Environmental Research and Public Health 2022; 19(1): 354. https://doi.org/10.3390/ijerph19010354
11. Nordling P, Alexanderson K, Hensing G, Lytsy P. Factors associated with general practitioners’ contacts with sick-listed patients’ employers: A Swedish nationwide questionnaire study. Scand J Public Health 2023; 51(4): 602–10. https://doi.org/10.1177/14034948211053141
12. Söderman M, Wennman-Larsen A, Hoving L, Alexanderson K, Friberg E. Interventions regarding physicians’ sickness certification practice - a systematic literature review with meta-analyses. Scand J Prim Health Care 2022; 40(1): 104–14. https://doi.org/10.1080/02813432.2022.2036420
13. Duchemin T, Bar-Hen A, Lounissi R, Dab W, Hocine MN. Hierarchizing Determinants of Sick Leave: Insights from a Survey on Health and Well-being at the Workplace. J Occup Environ Med 2019; 61(8): e340–7. https://doi.org/10.1097/JOM.0000000000001643
14. Nielsen MB, Indregard AMR, Øverland S. Workplace bullying and sickness absence: a systematic review and meta-analysis of the research literature. Scand J Work Environ Health 2016; 42(5): 359–70. https://doi.org/10.5271/sjweh.3579
15. Marchildon GP, Brammli-Greenberg S, Dayan M, De Belvis AG, Gandré C, Isaksson D, et al. Achieving higher performing primary care through patient registration: A review of twelve high-income countries. Health Policy 2021; 125(12): 1507–16. https://doi.org/10.1016/j.healthpol.2021.09.001
16. Fernández-Pérez Á, Jiménez-Rubio D, Robone S. Freedom of choice and health services’ performance: Evidence from a national health system. Health Policy 2022; 126(12): 1283–90. https://doi.org/10.1016/j.healthpol.2022.11.001
17. Kozikowski A, Morton-Rias D, Mauldin S, Jeffery C, Kavanaugh K, Barnhill G. Choosing a Provider: What Factors Matter Most to Consumers and Patients? J Patient Exp 2022; 9: 23743735221074176. https://doi.org/10.1177/23743735221074175
18. Kuruoglu E, Guldal D, Mevsim V, Gunvar T. Which family physician should I choose? The analytic hierarchy process approach for ranking of criteria in the selection of a family physician. BMC Med Inform Decis Mak 2015; 15: 63. https://doi.org/10.1186/s12911-015-0183-1
19. Bazyar M, Yazdi-Feyzabadi V, Bahmani M, Sadeghifar J, Momeni K, Shaabani Z. Preferences of people in choosing a family physician in rural areas: a qualitative inquiry from Iran. Prim Health Care Res Dev 2022; 23: e57. https://doi.org/10.1017/S1463423622000317
20. Al-Ateeq M. Factors that Influence Patients in Choosing Their Treating Physicians in the Private Sector in Saudi Arabia. American Journal of Public Health Research 2018; 6. https://doi.org/10.12691/ajphr-6-4-1
21. Dahlgren C, Dackehag M, Wändell P, Rehnberg C. Simply the best? The impact of quality on choice of primary healthcare provider in Sweden. Health Policy 2021; 125(11): 1448–54. https://doi.org/10.1016/j.healthpol.2021.09.009
22. Dumontet M, Buchmueller T, Dourgnon P, Jusot F, Wittwer J. Gatekeeping and the utilization of physician services in France: Evidence on the Médecin traitant reform. Health Policy 2017; 121(6): 675–82. https://doi.org/10.1016/j.healthpol.2017.04.006
23. Zhang A, Nikoloski Z, Albala SA, Yip W, Xu J, Mossialos E. Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals. Health Systems & Reform 2020; 6(1): e1846844. https://doi.org/10.1080/23288604.2020.1846844
24. Empel G, Gravelle H, Santos R. Does quality affect choice of family physician? Evidence from patients changing general practice without changing address. Economic Modelling 2023; 126: 106395. https://doi.org/10.1016/j.econmod.2023.106395
25. Victoor A, Delnoij DMJ, Friele RD, Rademakers JJDJM. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Serv Res 2012; 12: 272. https://doi.org/10.1186/1472-6963-12-272
26. Blomgren J, Jäppinen S, Perhoniemi R. Identifying user profiles of healthcare, social and employment services in a working-age population: A cluster analysis with linked individual-level register data from Finland. PLOS ONE 2023; 18(11): e0293622. https://doi.org/10.1371/journal.pone.0293622
27. Blomgren J, Virta LJ. Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland. PLoS One 2020; 15(4): e0231792. https://doi.org/10.1371/journal.pone.0231792
28. Jovanovic D, Jankovic J, Mirilovic N. Socio-demographic inequalities in satisfaction with primary health care and utilization of chosen doctors’ services: a cross-sectional study. South Eastern European Journal of Public Health (SEEJPH). [cited 2024 May 22]; Available from: https://www.biejournals.de/index.php/seejph/article/view/3311
29. Janković J, Šiljak S, Marinković J, Kovač B, Janković S. Patterns of Health Care Utilization for Noncommunicable Diseases in a Transitional European Country: Results from the National Health Survey. Int J Health Serv 2019; 49(1): 37–50. https://doi.org/10.1177/0020731418762717
30. Govender K, Girdwood S, Letswalo D, Long L, Meyer-Rath G, Miot J. Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa. BMC Public Health 2021; 21(1): 1649. https://doi.org/10.1186/s12889-021-11678-9
31. Žvinakis P, Kalibataitė R, Kalibatas V. Patients’ Shift from Public to Private Primary Health Care Providers in Lithuania: Analysis of the Main Reasons. Inquiry 2021; 58: 469580211060304. https://doi.org/10.1177/00469580211060304
32. Khatami F, Shariati M, Khedmat L, Bahmani M. Patients’ preferences in selecting family physician in primary health centers: a qualitative-quantitative approach. BMC Fam Pract 2020; 11; 21:107. https://doi.org/10.1186/s12875-020-01181-2