High utilizers of medical care: a crucial subgroup among somatizing patients.
OBJECTIVE
Patients with somatoform disorders (SFD) are likely to overutilize healthcare services. This study investigates (a) whether extraordinarily high medical costs can be predicted from patient characteristics or psychopathology, and (b) whether high-utilizing patients respond differently to cognitive-behavioral treatment.


METHODS
We compared 42 SFD high utilizers with 53 SFD average utilizers and 29 patients suffering from other than SFD mental disorders. High utilization was defined by healthcare expenditures of > or = 2500 euros during the past 2 years. Costs were computed from medical and billing records of health insurance companies. Somatization distress, hypochondriasis, depression, dysfunctional cognitions related to bodily symptoms, general psychopathology, personality profiles, and psychosocial disabilities were assessed before treatment.


RESULTS
High utilizers had higher levels of self- and observer-rated illness behavior, self-perceived bodily weakness, and psychosocial disabilities. Although they did not report more somatization symptoms, their subjective symptom distress was higher. There were no differences between high and average utilizers concerning general psychopathology, DSM-IV comorbidity, and personality profiles. Treatment improvements were similar.


CONCLUSIONS
High- and average-utilizing somatizers represent distinguishable subgroups. The results emphasize the importance of mechanisms specifically related to SFD and may enhance the early detection of patients who are likely to develop overutilization.
Hiller
Wolfgang
W
Department of Clinical Psychology, University of Mainz, Germany. hiller@mail.uni-mainz.de
Fichter
Manfred M
MM
D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003863:Depression / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005102:Health Expenditures; D006801:Humans; D006998:Hypochondriasis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010554:Personality Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D012803:Sick Role; D013001:Somatoform Disorders / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*