A global approach to evaluation of health services utilization: concepts and measures

Health services utilization has been the object of many books and articles in the literature. Measures associated with utilization are often a function of volume of services. The objective of this article is to present a comprehensive approach to the evaluation of health services utilization and of associated measures, using databases. Based on the theoretical framework of Starfield, we propose to analyze health services utilization with the help of indicators that are not directly linked to volume but that indirectly provide an estimate, while also documenting the qualitative aspects of utilization. The indicators mark out accessibility, continuity, comprehensiveness, and productivity of care. Once the concepts have been defined, we propose their operationalization using the databases. We then present the advantages of multidimensional conceptualization of health services utilization through a simultaneous analysis of these indicators. Researchers and decision-makers in public health and health planning have much to gain with this type of innovative multidimensional approach, which presents a dynamic conceptualization of health services utilization while using health administrative data. Prat Organ Soins. 2011;42(1):11-18