Societal and individual determinants of medical care utilization in the United States. TheMilbank Memorial Fund Quarterly

A theoretical framework for viewing health services utilization is presented, emphasizing the importance of the (1) characteristics of the health services delivery system, (2) changes in medical technology and social norms relating to the definition and treatment of illness, and (3) individual determinants of utilization. These three factors are specified within the context of their impact on the health care system. Empirical findings are discussed which demonstrate how the framework might be employed to explain some key patterns and trends in utilization. In addition, a method is suggested for evaluating the utility of various individual determinants of health services utilization used in the framework for achieving a situation of equitable distribution of health services in the United States. Analyses of the determinants of medical careutilization in this country are receiving increasing attention.1This attention seems to result from the emergence of a number of related societal values and perceptions including: (1) a growing consensus that all people have a right to medical care regardless of their ability to pay for this care2; (2) the general belief that certain population groups suc