Who Uses The Health Services More? A Descriptive Study of Excessive Users’ Profile and Causes

Abstract

Background: Identifying the causes of health services overutilization is an effective way of preventing misspending of insurance organizations' resources. Objectives: The present study was conducted to identifying demographic factors and the causes of health services overutilization among those insured by the Iran Health Insurance Organization (IHIO). Methods: The present cross-sectional study was conducted in 2017. The study population consisted of excessive users insured by IHIO in Isfahan province, of whom, 175 were randomly selected. Data obtained by the IHIO medical information system, insurance booklets and a data collection form was analyzed in SPSS-22 using descriptive statistics at a significant level of 0.05. Then, they were categorized based on their main referral cause. Results: About 1.2 percent of the people insured by the IHIO in Isfahan province are among the health service over users. Participants' mean age was 50.7 ± 15.8 years. Among them, 56.6 percent were female. Mean frequency of physicians’ visits were 16.3 ± 11.7 (more than 10 times greater than others) and the mean of paraclinical services usage was 19 ± 13.08 (more than 12 times greater than others) in the first 8 months of 2017. Mean of all physicians’ visits among females was 18.47 ± 14.7 and means of paraclinical services usage among them was 20.63 ± 14.83. The most common causes of health services over utilization among the insured included complicated medical problems (chronic disease 47.42 percent, being elderly 17.14 percent and pregnancy 6.28 percent), health anxiety disorder (HAD) (24 percent), and administrative causes (breaking or missing papers) 2.9 percent. Conclusions: According to the findings, people with complicated and chronic illness account for the majority of the over users. Others with health anxiety are in the next category. Then, identifying the over user group, their demographic characteristics, and their causative categorization can lead to a variety of solutions to suit each category. This study recommends insurance organizations to pay more attention to the service-seeking behaviors of different population groups and to consider utilization review studies as an important research approach.