Development of a healthcare utilisation index to compare patients worldwide: a cross-sectional study

There is no simple tool for synthesising the total volume of different healthcare services a patient utilizes into a single meaningful measure. We aimed to develop such an instrument and explore its associations with two broad health indicators: mortality and life expectancy.

We constructed the Healthcare Utilisation (HUTIL) index to sum the weighted volume of healthcare services used over a given period. Each healthcare service's weighting was calculated using worldwide median ratios between that service's costs and those of a consultation with a primary care physician (PCP). Data were obtained from the literature and internet searches. Next, we calculated the annual average HUTIL index per capita for European countries by collecting data available from their statistical offices and the European Union. Life expectancy at birth and mortality rates per 100,000 inhabitants were used to compare countries with HUTIL index scores above and below the continental median.

In 63 countries worldwide, ratios of healthcare costs to PCP costs were 2 (IQR: 2-3) for a consultation with a specialist, 4 (IQR: 2-6) for an emergency department consultation, 0.5 (IQR: 0.4-0.8) for a home visit by a nurse and 8 (IQR: 4-17) for a day spent in hospital. Using these weigthing factors, an annual average HUTIL index per capita was calculated for 26 European countries. Countries with HUTIL index scores above the continental median had higher mortality rates (1047 deaths per 100,000 inhabitants [IQR: 979-1321] vs. 889 [IQR: 778-930]; p < 0.01) and lower life expectancy (78.2 years [IQR: 76.1-81.3] vs. 82.0 [IQR: 81.5-82.6]; p = 0.01) than countries with lower HUTIL index scores.

Healthcare cost ratios were remarkably constant around the world. Based on these ratios, the HUTIL index could become a new, globally applicable tool to facilitate future research into healthcare services utilisation.