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Health Serv Res. 1986 June; 21(2 Pt 1): 129–144.
PMCID: PMC1068940

Review of twenty years of research on medical care utilization.


A wide variety of issues in social distribution and system performance are approached through analysis of utilization, as shown by this review of twenty years of research. Utilization studies have been used to examine social norms with respect to dying and to geographical and class diffusion of access to the most useful diagnostic procedures. Prevention utilization is selected for special study but is difficult to analyze because both the boundary between prevention and treatment services and the unit of observation are ill defined. A series of studies of the class gradient in use of care under conditions of reduced barriers to care indicate that equity can be improved through program design even though deficits remain at this time. For health plans with social objectives, a stable low-user group presents a challenge to outreach rather than a source of financial comfort. Other work on utilization examines unnecessary care through study of interregional variation in surgical rates and the phenomenon of physician-induced demand; cost-sharing; the HMO model in its attempt theoretically to reconcile equity with cost-containment; the role of sex differences in utilization; and the influence of women's social roles and traditional/contemporary cultural relationships on access.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Steinmetz N, Hoey JR. Hospital emergency room utilization in Montreal before and after Medicare: the Quebec experience. Med Care. 1978 Feb;16(2):133–139. [PubMed]
  • Davidson SM. Understanding the growth of emergency department utilization. Med Care. 1978 Feb;16(2):122–132. [PubMed]
  • McCall N. Utilization and costs of Medicare services by beneficiaries in their last year of life. Med Care. 1984 Apr;22(4):329–342. [PubMed]
  • Singer DE, Carr PL, Mulley AG, Thibault GE. Rationing intensive care--physician responses to a resource shortage. N Engl J Med. 1983 Nov 10;309(19):1155–1160. [PubMed]
  • Ingman SR, Lawson IR. Utilization of specialized ambulatory care by the elderly. A study of a clinic. Med Care. 1982 Mar;20(3):331–338. [PubMed]
  • Diehr P, Williams SJ, Martin DP, Price K. Ambulatory mental health services utilization in three provider plans. Med Care. 1984 Jan;22(1):1–13. [PubMed]
  • Viseltear AJ. History of the medical care section-emergence of the medical care section of the american public health association, 1926-1948. Am J Public Health. 1973 Nov;63(11):986–1007. [PubMed]
  • Iglehart JK. Health Policy Report. Federal policies and the poor. N Engl J Med. 1982 Sep 23;307(13):836–840. [PubMed]
  • Broyles RW, Manga P, Binder DA, Angus DE, Charette A. The use of physician services under a national health insurance scheme. An examination of the Canada Health Survey. Med Care. 1983 Nov;21(11):1037–1054. [PubMed]
  • Kleinman JC, Gold M, Makuc D. Use of ambulatory medical care by the poor: another look at equity. Med Care. 1981 Oct;19(10):1011–1029. [PubMed]
  • Wolfe BL. Children's utilization of medical care. Med Care. 1980 Dec;18(12):1196–1207. [PubMed]
  • Orr ST, Miller CA. Utilization of health services by poor children since advent of medicaid. Med Care. 1981 Jun;19(6):583–590. [PubMed]
  • Greenlick MR, Freeborn DK, Colombo TJ, Prussin JA, Saward EW. Comparing the use of medical care services by a medically indigent and a general membership population in a comprehensive prepaid group practice program. Med Care. 1972 May-Jun;10(3):187–200. [PubMed]
  • Mullooly JP, Freeborn DK. The effect of length of membership upon the utilization of ambulatory care services. A comparison of disadvantaged and general membership populations in a prepaid group practice. Med Care. 1979 Sep;17(9):922–936. [PubMed]
  • Riessman CK. The use of health services by the poor: are there any promising models? Soc Policy. 1984 Spring;14(4):30–40. [PubMed]
  • Wennberg JE, McPherson K, Caper P. Will payment based on diagnosis-related groups control hospital costs? N Engl J Med. 1984 Aug 2;311(5):295–300. [PubMed]
  • Gornick M. Trends and regional variations in hospital use under Medicare. Health Care Financ Rev. 1982 Mar;3(3):41–73. [PubMed]
  • Hay J, Leahy MJ. Physician-induced demand: an empirical analysis of the consumer information gap. J Health Econ. 1982 Dec;1(3):231–244. [PubMed]
  • Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. [PubMed]
  • Enthoven AC. The Rand experiment and economical health care. N Engl J Med. 1984 Jun 7;310(23):1528–1530. [PubMed]
  • Verbrugge LM. Sex differentials in health. Public Health Rep. 1982 Sep-Oct;97(5):417–437. [PMC free article] [PubMed]
  • Haug MR. Age and medical care utilization patterns. J Gerontol. 1981 Jan;36(1):103–111. [PubMed]
  • Hibbard JH, Pope CR. Gender roles, illness orientation and use of medical services. Soc Sci Med. 1983;17(3):129–137. [PubMed]
  • Lerner M, Salkever DS, Newman JF. The decline in the Blue Cross Plan admission rate: four explanations. Inquiry. 1983 Summer;20(2):103–113. [PubMed]
  • Luft HS. Diverging trends in hospitalization: fact or artifact? Med Care. 1981 Oct;19(10):979–994. [PubMed]
  • Newacheck PW, Butler LH. Patterns of physician use among low-income, chronically ill persons. Med Care. 1983 Oct;21(10):981–989. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust