title: Another way to look at high service utilization: the contribution of disability.
abstract: OBJECTIVE
  High users of health services are usually identified in terms of their health complications stemming from the coincidence of a number of chronic conditions. Instead, this analysis attempts to characterize high users in terms of disability, based on the belief that disability provides a more detailed and accurate representation of functional needs and health consequences. The study compares the characteristics of high users of health services among Canadian adults (aged 20-65) with those of low to moderate users and non-users.
  
  
  METHODS
  Secondary analysis of data collected for the National Population Health Survey, a cross-sectional public-use population-based national survey, conducted in 1998-99.
  
  
  RESULTS
  No matter how disability is conceptualized and measured, it has the strongest association of all the variables considered with health service utilization. Whether looking at the simple presence of a disability or at specific impairments or activity restrictions, there is at least a two-fold increase in the risk of high use over the non-disabled.
  
  
  CONCLUSIONS
  The present study challenges the clinical wisdom that high users should be the target for efforts to reduce the overall consumption of health services. Many high users consume on the basis, not of choice, but of need rooted in disability. Moreover, when compared with low or moderate service users, their clinical condition is exacerbated by social factors, including lower income, less education and less immediate family support. Equity cannot be achieved by focusing on reducing consumption by this clinically and socially vulnerable group.
authors.affiliation: Centre for Health Services & Policy Research, Queen's University, Kingston, ON, Canada. mccollm@post.queensu.ca
authors.forename: Mary
authors.initials: M
authors.lastname: McColl
authors.forename: Sam
authors.initials: S
authors.lastname: Shortt
mesh_terms: D000328:Adult; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs