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Such practices contributed to high medicine utilisation; for example, in China, almost 50% of the revenues of medical doctors and pharmacists came from pharmaceuticals.
However, that kind of reverse effect is not likely for socioeconomic differences in health care utilisation; for example, primary prevention measures such as cancer screening are unlikely to affect a person's socioeconomic status.
They include factors such as disability, poor health literacy and cultural differences in attitudes to health that shape the ways people access services and their lower health service utilisation, for example, in rural and Aboriginal communities [ 14, 15].
Limitations of this study include the use of a BMI value recorded at a single time point, challenges presented when quantifying health service utilisation, for example, inability to account for community services, and the disregard of indirect and intangible health service costs.
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A short-term increase in healthcare utilisation may, for example, lead to lower utilisation in the long term.
Our review identified that domestic abuse can create or exacerbate an immediate health need which makes health service utilisation unavoidable, for example a physical injury requiring medical attention [ 43].
To illustrate this in terms of bed utilisation, if for example we assume an average LOS for elective patients on a surgical ward is 7 days, then the 266 days lost due to avoidable non-surgical delays equates to admitting and discharging a further 38 patients during this 4 month period, or greater than 100 patients over a year.
This method also allows the isopleths containing any percentiles of the data points to be identified, providing us with the ability to determine utilisation distributions for various percentiles of use, for example the 50% isopleth, which corresponds to the 'core utilisation distribution' and the 90% isopleth, corresponding to the true 'home range' [ 41].
Direct medical costs are costs associated directly with the utilisation of healthcare services, for example physician contacts, medication, hospitalisation, rehabilitation, remedies, aids and also over-the-counter medication.
For example, utilisation of services was not necessarily influenced by user fees when patients were accustomed to paying informal fees [ 30], whereas utilisation of certain services dropped in urban areas in Uganda and in rural Nigeria after introduction of user fees [ 29, 31].
It is assumed that providing patients with self-management support will either lead to indirect utilisation benefits (where self-management leads to better health and thus reduces utilisation) or more direct effects (for example, where self-management enables more effective response to exacerbations and crises, avoiding high cost use such as hospital admission).
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