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Submitted by Emre Ozaltin on

Dear Adam,

A very interesting look at the links between utilization and HHR and health infrastructure.

In addition to availability of services, some thoughts on further layers readily available from WHS and other sources that could be added to the analysis of utilization:

Health status – while endogenous, the links between aggregate levels of health (self-rated, based on coverage indicators, or based on other aggregate indicators at country level) and utilization may yield interesting insights.

Met/unmet need – beyond levels of utilization, the WHS allows us to measure the proportion of those who needed care who sought care (or the converse). We have this overall and for a number of conditions. The unmet need may be more strongly correlated with service availability than utilization overall.

Levels of social spending - as much of the determinants of health lie outside the health sector, this variable may account for a substantial portion of the variance in utilization, for example the relatively low utilization in Europe. Elisabeth Bradley at Yale is doing interesting work on this in developed countries, with potential implications for the developing world.

Prevention – similar to the previous variable, indicators at country level on prevention activities at the population level, such as legislation related to smoking, drinking, diet and road safety as well as health promotion activities may account for some of the variance in utilization beyond service availability.

Inpatient/outpatient – the WHS allows us to disaggregate utilization by inpatient/outpatient (unfortunately we cannot do so by level of care). There may be interesting differences at this level of disaggregation that yield insights and patterns by country.