Societal and Individual Determinants of Medical Care Utilization in the United States

Abstract

A theoretical framework for viewing health services utilization is presented, emphasizing the importance of the (1) characteristics of the health services delivery system, (2) changes in medical technology and social norms relating to the definition and treatment of illness, and (3) individual determinants of utilization. These three factors are specified within the context of their impact on the health care system. Empirical findings are discussed which demonstrate how the framework might be employed to explain some key patterns and trends in utilization. In addition, a method is suggested for evaluating the utility of various individual determinants of health services utilization used in the framework for achieving a situation of equitable distribution of health services in the United States.

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

“…The structural element concerns "the characteristics of the system that determine what happens to the patient following entry" [34,36]. While the PARiHS framework more explicitly considers provider and organizational behavior, the ABM does as well integrating provider-related variables within the more germane terminology of "environment" which we have more explicitly included as "healthcare system" [30]. Later iterations of the ABM included "feedback loops" to depict the reciprocal relationship between provider and patient behavior.…”

“…Determining the influence of geography and transportation on a patient's healthcare utilization patterns may influence a healthcare agency's decisions to, as in the case example described below, bridge gaps in care using telemedicine modalities. The ABM suggests that population characteristics, specifically the burden of a disease within a community, and patient predisposing characteristics, including enabling resources and risk perception, are the determinants of care utilization [30]. The predisposing characteristics component includes variables that describe the likelihood a patient will seek care such as their demographics, quality of life, and health status.…”

“…The ABM suggests that population characteristics, specifically the burden of a disease within a community as well as patient predisposing characteristics, patient enabling resources, and patient risk perception, are the determinants of care utilization [30]. The predisposing characteristics component includes variables that describe the likelihood a patient will seek care such as their demographics, quality of life, and health status.…”

“…Both urban and rural poor experience unique access to care difficulties, including geographic barriers or financial limitations, that may influence health outcomes even when integrated behavioral medicine and specialty care are successfully implemented to others [29]. A number of frameworks, such as the Andersen behavioral model (ABM) and its revisions, have been developed to organize thinking and research on patient factors hypothesized to influence healthcare access in underserved populations [30][31][32]. Compared to implementation theories, however, these access-to-care models provide less clear direction for the translation of novel healthcare delivery models to clinical practice settings.…”

Effect of daily migraine prevention on health care utilisation in an insured patient population

“…Aspects of the design were based on the Economic, Clinical, and Humanistic Outcomes (ECHO) model [22], originally developed to assist researchers in the examination of causal relationships between pharmaceutical treatments and health outcomes. The Behavioural Model of Health Care Utilisation [23] was incorporated to help identify the determinants of health care utilisation. The model characterises health care utilisation as a function of three categories: (1) predisposing characteristics (e.g., age or gender); (2) enabling characteristics (e.g., insurance status); or (3) need characteristics (e.g., headache frequency or severity).…”