Health care: an international comparison of perceived morbidity, health services resources, and use

Selected summary findings from the World Health Organization/International Collaborative Study of Medical Care Utilization are presented, based on data collected during a twelve-month period in 1968-1969 in twelve study areas in seven countries in the Americas and Europe. A household interview survey of almost 48,000 persons, representing a total population of about 15 million, elicited information on demographic characteristics, on perceptions of illness, its severity and character, and on attitudes toward and use of major components of health services. Information was also collected on the prevailing health care systems and resources available to the study population, as well as on socioeconomic characteristics of the study areas. Standardized rates for those defined as "healthy" and "functionally healthy" are quite similar across the twelve study areas, as are the rates for persons who reported being sick within two weeks. Rates for the volume of sick days within two weeks vary widely, and levels of chronicity with disability are much higher in the four continental European study areas. Rates for volume of physician contacts within two weeks vary considerably across study areas, but rates for persons with contacts are more stable, although for persons with perceived morbidity of high severity, the corresponding rates are lower in the four continental European study areas. By contrast, the rates for persons with an administrative reason for their most recent physical examination within twelve months are substantially higher in the latter. Where unmet need for a physician contact is greatest, the volume of hospital nights used is also greatest; a direct relationship between these two measures is evident without regard to the ratio of hospital beds available to the population. Wide differences are observed between the extremes of the measures of need, resources, and use employed in the study, raising questions about the ways in which resources are organized to provide services and about the effectiveness and efficiency of these services.