The Worried-Well Revisited

Abstract

To determine if an undifferentiated entry mix impedes the effective and efficient delivery of health care services, the relative impact of nonsick patients on a health care system is empirically examined. The distribution of new presenting morbidities in a 5 per cent sample of Kaiser Health Plan members seen by all physicians in the ambulatory care system for 1970 and the distribution of all presenting morbidities in the sample seen by primary physicians in the department of internal medicine for the same year are assessed. The nonemergent contacts made by patients without a regular doctor are isolated on the assumption that this group contains the worried-well visits. The number of visits in this special group accounts for only 18.8 per cent of total presenting visits to the department of internal medicine. The large number of new morbidities revealed by physical examinations necessitates reclassifying the patients who made visits for this purpose from the well to the asymptomatic sick. It can be concluded that the relative impact of the group of patients described as the worried-well is much smaller than has been previously postulated.