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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a&#44; el grado y las caracter&#237;sticas de la utilizaci&#243;n de los servicios sanitarios de atenci&#243;n primaria est&#225; siendo objeto de an&#225;lisis desde&#44; por lo menos&#44; los a&#241;os ochenta&#46; Uno de los motivos principales es averiguar hasta qu&#233; punto dicha utilizaci&#243;n se corresponde con unas necesidades de atenci&#243;n sanitaria&#46; De hecho&#44; se ha establecido como prioridad generalmente aceptada un servicio de salud adecuado para los pacientes que m&#225;s lo necesitan&#46;</p> <span class="elsevierStyleSectionTitle">Factores condicionantes de la utilizaci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La evidencia muestra que las caracter&#237;sticas del individuo&#44; sobre todo su estado de salud&#44; son las que se relacionan principalmente con la utilizaci&#243;n de servicios de atenci&#243;n primaria&#46; Otras caracter&#237;sticas personales&#44; como el sexo y la edad&#44; podr&#237;an actuar como moduladores de la necesidad de atenci&#243;n&#46; Algunas variables familiares y&#47;o culturales&#44; as&#237; como las variables relacionadas con el profesional sanitario y otras institucionales&#44; podr&#237;an explicar tambi&#233;n parte de la variabilidad observada en la utilizaci&#243;n de los servicios de atenci&#243;n primaria&#46; Respecto a las variables socioecon&#243;micas&#44; como la renta&#44; se produce una situaci&#243;n parad&#243;jica&#46; De forma a&#241;adida&#44; existe una evidencia emp&#237;rica que demuestra que la renta constituye el principal determinante&#44; tanto de la utilizaci&#243;n como del gasto sanitario&#46; Cuando se analizan los datos individuales&#44; sin embargo&#44; dicha variable no est&#225; relacionada con la utilizaci&#243;n de servicios de atenci&#243;n primaria&#46;</p> <span class="elsevierStyleSectionTitle">Inconsistencias metodol&#243;gicas</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La situaci&#243;n es controvertida&#44; con implicaciones no simplemente metodol&#243;gicas sino&#44; sobre todo&#44; respecto al an&#225;lisis de la eficiencia en la utilizaci&#243;n de los servicios sanitarios de atenci&#243;n primaria&#46; El problema es que&#44; revisando la bibliograf&#237;a&#44; se pueden apreciar ciertas inconsistencias metodol&#243;gicas que podr&#237;an explicar&#44; al menos en parte&#44; la disparidad de los resultados obtenidos&#46; Entre otras&#44; cabe citar las siguientes&#58; problemas de dise&#241;o&#44; errores de medida&#44; errores de especificaci&#243;n y m&#233;todos estad&#237;sticos inadecuados&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Como v&#237;as de soluci&#243;n citar&#237;amos el dise&#241;o de cuasi experimentos&#44; la utilizaci&#243;n de grandes bases de datos administrativos&#44; as&#237; como de fuentes de datos primarios &#40;dise&#241;o&#41;&#59; la distinci&#243;n entre distintos tipos de utilizaci&#243;n y entre unidades de an&#225;lisis alternativas a la visita&#44; y la correcci&#243;n de errores de medida en las variables explicativas &#40;errores de medida&#41;&#59; la consideraci&#243;n de variables explicativas relevantes &#40;errores de especificaci&#243;n&#41;&#44; y la utilizaci&#243;n de modelos multinivel &#40;m&#233;todos estad&#237;sticos inadecuados&#41;&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In Spain&#44; the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s&#46; One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs&#46; In fact&#44; the provision of an adequate health service for those who most need it is a generally accepted priority&#46;</p> <span class="elsevierStyleSectionTitle">Factors conditioning use</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The evidence shows that individual characteristics&#44; mainly health status&#44; are the factors most closely related to primary care utilization&#46; Other personal characteristics&#44; such as gender and age&#44; could act as modulators of health care need&#46; Some family and&#47;or cultural variables&#44; as well as factors related to the health care professional and institutions&#44; could explain some of the observed variability in primary care services utilization&#46; Socioeconomic variables&#44; such as income&#44; reveal a paradox&#46; From an aggregate perspective&#44; income is the main determinant of utilization as well as of health care expenditure&#46; When data are analyzed for individuals&#44; however&#44; income is not related to primary health utilization&#46;</p> <span class="elsevierStyleSectionTitle">Methodological inconsistencies</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The situation is controversial&#44; with methodological implications and&#44; above all&#44; consequences for the assessment of the efficiency in primary care utilization&#46; Review of the literature reveals certain methodological inconsistencies that could at least partly explain the disparity of the empirical results&#46; Among others&#44; the following flaws can be highlighted&#58; design problems&#44; measurement errors&#44; misspecification&#44; and misleading statistical methods&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Some solutions&#44; among others&#44; are quasi-experiments&#44; the use of large administrative databases and of primary data sources &#40;design problems&#41;&#59; differentiation between types of utilization and between units of analysis other than consultations&#44; and correction of measurement errors in the explanatory variables &#40;measurement errors&#41;&#59; consideration of relevant explanatory variables &#40;misspecification&#41;&#59; and the use of multilevel models &#40;statistical methods&#41;&#46;</p>"
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