Whose interests are represented in the concept of healthcare utilisation?

Problem

Many studies in the field of self-management for chronic musculoskeletal pain measure health care utilisation to gauge behaviour change and or resource costs. What is meant with "healthcare utilisation"? If healthcare utilisation is used as outcome for a healthcare intervention there must be an underlying concept of what constitutes worse or better healthcare utilisation. Are there criteria to quantify and qualitatively evaluate healthcare utilisation? How do these data inform us about quality of care? What do they mean? Whose interests are represented? How it is used in various contexts? I undertook this work as a spin-off from a large randomised controlled trial investigating the effectiveness of a community-based intervention for chronic musculoskeletal pain. "Healthcare utilisation" was a secondary outcome and we felt that the discourse of "healthcare utilisation" needs further exploration.

Approach

We conducted an exploratory conceptual literature review using a systematic review approach. We used a qualitative framework methodology to organise and analyse our data. All relevant medical databases were searched for studies that defined, explored and /or measured health care utilisation for chronic musculoskeletal pain patients in primary care. We organised the narrative data into themes and subthemes. In a second phase we then conducted an interpretative analysis to identify models and principles about health care resource use. Using satellite-tracking of references we investigated the ideological underpinnings of the discourse of healthcare utilisation.

Findings

There was no definition of what would be “better” or even “optimal” health care resource use. There were wide variations in the components and data sources used to measure healthcare utilisation. There were various methodologies for data acquisitions and only rarely limitations of these methodologies were mentioned. Definitions were influenced by government, social and health care policy and whether the defining agent was the purchaser, the provider, the patient or even ‘society’.

Consequences

The concept of better health care resource use as an outcome is arbitrary and any definition needs to be qualified and made transparent. The interests of the defining or commissioning party need to be stated and considered when interpreting data.