Why do people go to the doctor? Sex differences in the correlates of GP consultation

doi:10.1016/0277-9536(87)90174-2

Social Science & Medicine

Volume 25, Issue 5, 1987, Pages 507-513

https://doi.org/10.1016/0277-9536(87)90174-2 Get rights and content

Abstract

This study explores the variables associated with consultation behaviour within the NHS of 256 men and women aged 16–45 and registered with one GP. The focus is on long term effects rather than on the immediate precipitants of a consultation and hence the dependent variable is the one year consultation rate. The predictor variables include predisposing, enabling and need factors. It is found that not only do women consult more often than men but also the correlates of primary care utilisation differ between the sexes. Health status (need) and social role factors (including parenthood and marital status) are found to be more important for men, while psychological predisposition is of greater significance among women in this setting. The implications of the findings are discussed.

References (24)

D. Mechanic
The concept of illness behaviour
J. chron. Dis.
(1962)
I. Waldron
Sex differences in illness incidence, prognosis and mortality: issues and evidence
Soc. Sci. Med.
(1983)
J.H. Hibbard et al.
Gender roles, illness orientation and use of medical services
Soc. Sci. Med.
(1983)
D. Mechanic
Correlates of physician utilization; why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects?
J. Hlth soc. Behav.
(1979)
L.M. Verbrugge
Sex differentials in health
Publ. Hlth Rep.
(1982)
R. Anderson et al.
Medical Care Use in Sweden and the United States A Comparative Analysis of Systems and Behaviour
A.S. Andersen et al.
A causal model for physician utilization: analysis of Norwegian data
Med. Care
(1983)
N.M. Bradburn
The Structure of Psychological Well-Being
(1969)
M.E. Briscoe
Sex differences in psychological well-being
Psychol. Med.
(1982)
R. Gove et al.
Possible causes of the apparent sex differences in psychological health: an empirical investigation
Am. Sociol. Rev.
(1979)

J. Ormel

Neuroticism and well-being inventories: measuring traits or states

Psychol. Med.

(1983)

M.E. Briscoe

Proxy responses in health surveys: a methodological issue

Sociol. Hlth Illness

(1984)

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Why do people go to the doctor? Sex differences in the correlates of GP consultation

Abstract

J. chron. Dis.

Soc. Sci. Med.

Soc. Sci. Med.

Correlates of physician utilization; why do major multivariate studies of physician utilization find trivial psychosocial and organizational effects?

J. Hlth soc. Behav.

Sex differentials in health

Publ. Hlth Rep.

Medical Care Use in Sweden and the United States A Comparative Analysis of Systems and Behaviour

A causal model for physician utilization: analysis of Norwegian data

Med. Care

The Structure of Psychological Well-Being

Sex differences in psychological well-being

Psychol. Med.

Possible causes of the apparent sex differences in psychological health: an empirical investigation

Am. Sociol. Rev.

Neuroticism and well-being inventories: measuring traits or states

Psychol. Med.

Proxy responses in health surveys: a methodological issue

Sociol. Hlth Illness