Health Care Utilization: More Than a Numbers Game

by Cathy Miller on May 6, 2014

in Health Insurance

vector illustration of red diceHealth care utilization seems to be all about numbers.

  • We measure utilization
  • Make utilization projections
  • And analyze the heck out of utilization

For all our numbers-crunching, health care utilization is much more than a numbers game.

Health Care Utilization Defined

There are various definitions. Because I prefer simple, let’s use the following.

The type and frequency of health care services we access.

So we have two categories.

  1. The type of services we use − office visits, prescriptions, surgery, etc.
  2. The frequency of those services − X number of doctor visits per year

Analysts gone wild dissect those two categories a million different ways. Oops, there’s that numbers game again.

In the battle of health care costs, the rallying cry is often, How can we reduce utilization?

As a favorite wellness mentor of mine counters −

Our focus shouldn’t be on reducing utilization.
Our focus should be on creating the right kind of utilization.

Is This Right?

Health reform promotes the concept of a better health care consumer. Employer sponsors of health benefits, burdened by decades of rising costs, push employees into taking responsibility for their own health.

All that is good. Some would say it’s working.

My concern comes with the celebration of reduced utilization in those of us with high-deductible, health savings account-type plans.

  • Reduced health care utilization
  • But is it better utilization?

Promoting the right kind of utilization takes many forms.

  • The individual with high blood pressure who regularly takes his or her medication
  • The person who consistently receives recommended preventive services
  • Follow-up visits to our doctor’s office to review test results and plan treatment

Or are we skipping those because we haven’t met our deductible or don’t know preventive care incurs no out-of-pocket cost?

So before we jump for joy at lower health care utilization, ask if it means eliminating the right kind of utilization.

To quote one of my dad’s favorite southernism −

Everything’s relative.

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Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.

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{ 2 comments… read them below or add one }

Roy A. Ackerman, Ph.D., E.A. May 7, 2014 at 7:09 am

Almost every one of these wonks considers utilization to be “emergency room visits that never should have happened”. (It’s too long- and too direct- to be used in political circles.)
Whether it’s because the patient was not treated properly or fully in the first place, the patient lacked insurance to visit a doctor (which then became an emergency or the ER was used in lieu of less intensity services), the patient failed to follow (or receive) proper maintenance care, etc- the end result is that the costs for service are higher than desired.
That’s why Medicare is now requiring hospitals to follow-up, to insure they don’t dump patients before they are ready, to work with the patient to develop regimens of maintenance care, etc.
It’s why we need every person to have insurance so they can be treated BEFORE it’s an emergency.
But, then, again, I have never been a fan of political correctness. Because it’s simply a game of wordsmanship, or worse yet-chicanery.
Roy A. Ackerman, Ph.D., E.A.´s last blog post ..Rates on the rise?My Profile

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Cathy Miller May 7, 2014 at 8:03 am

Thanks, Roy, for your thoughtful comments – politically correct or otherwise. ;-)

Certainly care before a condition becomes an emergency would be the ideal world. Did you know (not you you, as you know everything) ;-) that ER visits for dental-related problems have risen dramatically?

But on top of lack of insurance, those that do have it are often being directed by their physician to go to the ER due to scheduling difficulties.

Your sterling illustration shows that it really is a bigger problem than the number of visits. Thanks, Roy.
Cathy Miller´s last blog post ..Health Care Utilization: More Than a Numbers GameMy Profile

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