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Use of U.S. Health Services Stays Fairly Constant Over Forty Years

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Press Release Date: June 27, 2001

Despite substantial changes in the organization and financing of health care in the United States, the estimated monthly use of health care services by Americans has remained remarkably consistent over the past four decades, according to a new study supported by the Agency for Healthcare Research and Quality (AHRQ).

In updating a landmark 1961 study by Kerr White, M.D., researchers led by Larry A. Green, M.D., of the Robert Graham Center in Washington, D.C., found that in an average month, 800 of every 1,000 American men, women and children experience health-related symptoms; 217 visit a physician and 8 are hospitalized. Fewer than one per 1,000 is admitted in a month to a teaching hospital. These figures are similar to Dr. White's earlier estimates that in an average month, 750 of 1,000 adults experienced an illness, 250 sought care from a physician, 9 were hospitalized, and 1 was referred to a teaching hospital.

The research team, which included David Lanier, M.D., of AHRQ's Center for Primary Care Research, based its estimates primarily on data from AHRQ's 1996 Medical Expenditure Panel Survey, which tracks the health care use of a nationally representative sample of noninstitutionalized Americans. Other data sources, including a Gallup Survey conducted in April-May, 2000, were used to estimate the number of people who considered seeking health care and those who received care from a provider of complementary or alternative medicine.

According to the researchers, these findings reconfirm that the majority of medical care experienced by most Americans occurs outside hospitals. The findings suggest that those involved in medical education, research and clinical practice should strive for a balanced view of the "ecology" of health care by considering the health and health care of the entire population, regardless of care setting.

For details, see "The Ecology of Medical Care Revisited" in the June 28, 2001, issue of the New England Journal of Medicine.

Note to Editors: The Robert Graham Center is supported by the American Academy of Family Physicians. For interviews with Dr. Green, contact Maureen Maxwell of the Robert Graham Center at (202) 232-9033.

For more information, please contact Karen Migdail (301) 427-1855 (


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