Health Care Services Utilization

Health care services utilization refers to how much health care people use, the types of health care they use, and the timing of that care. People use health care services for many reasons: to cure illnesses and health conditions, to mend breaks and tears, to prevent or delay future health care problems, to reduce pain and increase quality of life, and sometimes merely to obtain information about their health status and prognosis. Health care utilization can be appropriate or inappropriate, of high or low quality, expensive or inexpensive. It is an evolving process as the population's need for care has changed over time. Factors that influence health care needs include aging, sociodemographic population shifts, and changes in the prevalence and incidence of different diseases. This entry reviews factors that influence health care utilization and reviews the impact of overall trends found in the United States, as reported by the Centers for Disease Control and Prevention (CDC). The study of trends in health care utilization provides important information on health care delivery phenomena and can spotlight areas that may warrant future in-depth studies because of potential disparities in access to, or quality of, care. Trends in utilization may also be used as the basis for projecting future health care needs, forecasting future health care expenditures, or projecting increased personnel training or supply initiatives.

Multiple forces determine the utilization of health services. Some forces encourage more utilization; others deter it. Factors that may decrease health services utilization include decreased supply (e.g., hospital closures, physicians retiring), public health/sanitation advances (e.g., quality standards for food and water distribution), better understanding of the risk factors of diseases and prevention initiatives (e.g., smoking prevention programs), discovery/implementation of treatments that cure or eliminate diseases (e.g., polio vaccine), payer pressure to reduce costs, consensus documents or guidelines that recommend decreases in utilization, changes in practice patterns (e.g., encouraging self-care and healthy lifestyles), and changes in consumer preferences (e.g., home birthing, alternative medicine), to name a few.

Factors that may increase health services utilization include increased supply (e.g., ambulatory surgery centers, assisted-living residences), a growing population, aging (e.g., prevalence of more chronic illnesses and functional limitations), new procedures and technologies (e.g., hip replacement, MRI), consensus documents or guidelines that recommend increases in utilization (e.g., annual mammograms), new disease entities (e.g., HIV/AIDS, bioterrorism), increased health insurance coverage, changes in practice patterns (e.g., more aggressive treatment of the elderly), and changes in consumer preferences and demand (e.g., cosmetic surgery, direct marketing of drugs), to name a few.

The relationship between any one correlate of utilization and overall health care utilization is not a direct one. For example, the increased length of the aging process can be a result of the postponement of disease onset or a steady rate of functional loss. The increase in the use of some drugs may reduce the prevalence of some other conditions and their associated utilization. Another example would be the increased use of glucose-lowering and blood-pressure-lowering drugs that may reduce complications of diabetes but may also be associated with increased utilization of physicians’ services. Therefore, the independent effect of any one factor on health services utilization is not immediately apparent.

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