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Health Care Utilization
Measures of health care utilization complement patient reports of barriers to care and permit a fuller understanding of access to care. Barriers to care that are associated with differences in health care utilization may be more significant than barriers that do not affect utilization. Many landmark reports on disparities have relied on measures of heath care utilization,22,23,24 and these data demonstrate some of the largest differences in care among diverse groups. More recent efforts to inform health care delivery continue to include measures of health care utilization.25,26
Interpreting health care utilization data is more complex than analyzing data on patient perceptions of access to care. Besides access to care, health care utilization is strongly affected by health care need and patient preferences and values. In addition, greater use of services does not necessarily indicate better care. In fact, high use of some inpatient services may reflect impaired access to outpatient services. Therefore, the key to symbols used in Tables 3.2a and 3.2b, which summarize findings on all core report measures related to health care utilization, is different from that used for Tables 3.1a and 3.1b. Rather than indicating better or worse access compared with the comparison group, symbols on the utilization tables simply identify the amount of care received by racial, ethnic, and socioeconomic groups relative to their comparison groups.
Each year, the Nation's 12 million health services workers provide about 820 million office visits and 590 million hospital outpatient visits and treat 35 million hospitalized patients, 2.5 million nursing home residents, 1.4 million home health care patients, and 100,000 persons in hospice settings.27 Each year, about 70% of the civilian noninstitutionalized population visit a medical provider's office or outpatient department, about 60% receive a prescription medicine, and about 40% visit a dental provider.28
National health expenditures totaled over $1.5 trillion in fiscal year 2002, about 14.9% of the gross domestic product.29 Governments account for 46% of the U.S. total—over 32% from the Federal Government in the form of Medicare and Medicaid payments and grants to States and over 13% from State and local governments. Health care spending per capita rose 9.3% from 2001 to 200230; premiums for private health insurance increased 12.7% in 2002.31
Health expenditures among the civilian noninstitutionalized population in America are extremely concentrated, with 5% of the population accounting for 55% of outlays.32 In addition, it has been estimated that as much as $390 billion a year—almost a third of all health care expenditures—are the result of poor quality care, including overuse, misuse, and waste.33
The 2003 NHDR and the 2004 NHDR reported that different racial, ethnic, and SES groups had different patterns of health care utilization. Asians and Hispanics tended to have lower use of most health care services including routine care, emergency department visits, avoidable admissions, and mental health care. Blacks tended to have lower use of routine care, outpatient mental health care, and outpatient HIV care but higher use of emergency departments and hospitals, including higher rates of avoidable admissions, inpatient mental health care, and inpatient HIV care. Lower SES individuals tended to have lower use of routine care and outpatient mental health care and higher use of emergency departments, hospitals, and home heath care. This year, findings related to dental care, emergency department visits, potentially avoidable admissions, and mental health care and substance abuse treatment are highlighted.