Concerning High and Low Utilizers of Service in a Medical Care Plan, and the Persistence of Utilization Levels over a Three Year Period

Abstract

HE unequal distribution of episodes of illness and physical and social disability in various population groups has been the subject of intensive investigation for years. These studies have demonstrated repeatedly that small groups account for disproportionately large shares of the adverse events experienced by the population and that there is a tendency for high incidence groups to remain high for extended periods of time. A distinguishing characteristic of inquiries in more recent years has been the application made of this type of observation to specific medical care, industrial, health and welfare problems. Thus, the uneven distribution of medical costs in the population (1) has spurred much of the interest in the extension of health insurance to all types of physician services. The concentration of the bulk of industrial absenteeism and illnesses in a minority of employees has led to questions of direct concern to management as well as to more general questions regarding the role of the social and interpersonal environment in the occurrence of these episodes. (2) In the public welfare field, the receipt by a relatively few disabled indigent families of most of the expenditures for community health and dependency services has resulted in concerted efforts to find better methods of prevention or control. (3) Two observations of the utilization experience of members of the Health Insurance Plan of Greater New York (HIP)