title: Frequent users of ambulatory health care in Quebec: the case of doctor-shoppers.
abstract: OBJECTIVE
  To examine the patterns of use of ambulatory care in Quebec in 1991, with special emphasis on patients who received care from more than 20 physicians.
  
  
  METHODS
  Retrospective study of population-based data.
  
  
  METHODS
  Province of Quebec.
  
  
  METHODS
  All 7,154,591 people eligible for coverage under the Régie de l'assurance-maladie du Québec (RAMQ) (Quebec Health Insurance Plan) in 1991, including 3639 people who received ambulatory care from more than 20 physicians.
  
  
  METHODS
  The databanks of the RAMQ.
  
  
  METHODS
  Mean number (and standard deviation) of physician visits and services received, place of visit (clinic or private office), mean cost of services, patient's age, diagnosis, type of specialist visited and social assistance status of frequent users.
  
  
  RESULTS
  The patients who obtained ambulatory care from more than 20 physicians received 10 times more medical services than the overall patient population (59.6 v. 5.8), and the mean cost per patient for ambulatory care was also 10 times higher ($1379 v. $136). Almost all of the frequent users visited at least one outpatient clinic, as compared with 37.3% of the overall population. A higher proportion of the frequent users than of the overall population obtained care from specialists (98.9% v. 54.7%), mainly general surgeons and psychiatrists. The most frequent diagnoses among the frequent users were anxiety (36.0%), abdominal pain (24.3%), drug or alcohol dependence (22.2%) and depression (16.4%).
  
  
  CONCLUSIONS
  A small proportion of the population obtained ambulatory care from a high number of physicians during the year, leading to high expenses. Identifying and understanding this type of frequent user may be useful in developing strategies to promote more effective health-care-seeking behaviours and reduce overuse.
authors.affiliation: Direction des affaires médicales et de l'évaluation des programmes, Régie de l'assurance-maladie du Québec, Sillery.
authors.forename: M
authors.initials: M
authors.lastname: Demers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011792:Quebec; D012189:Retrospective Studies