Health Care Utilization Paper: Option B

The number of health care services people use determines health care utilization. John Q is facing a situation that is far too common these days. He is in need of health care services; however, factors beyond his control are preventing him from getting the help he needs. There are many factors that can affect health care utilization, including demographics, social structure, and insurance status. Barsukiewicz, Raffel, and Raffel state that these factors are either mutable and can be changed or immutable and therefore cannot be changed (2010).

For instance, age, gender, and ethnicity are immutable factors, whereas income, insurance status, and transportation are mutable factors. Both immutable and mutable factors influence health care utilization, so as a country with a very large and diverse population the U. S. needs to consider change where it is necessary (Barsukiewicz et al. , 2010). As the U. S. population and life expectancy continue to increase, age will have a strong influence on health care utilization. People while living longer are not necessarily healthier; consequently this affects the use of health care services.

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As the use of health care services increase so does health care utilization, which leads to an increase in costs. Gender is another influential factor. Trends show that as a whole, women seek more treatment than men and according to Bertakis, Rahman, Helms, Callahan, and Robbins (2000): Several explanations have been offered. These differences may be associated with reproductive biology and conditions specific to gender, higher rates of morbidity in women than in men, differences in health perceptions and the reporting of symptoms and illnesses, or a greater likelihood that women seek help for prevention and illness. para. 1)

Ethnicity is also a factor that should be considered when discussing health care utilization. An individual’s ethnicity determines his or her cultural traditions as well as his or her genetics, lifestyle, and diet. Language barriers between health care providers and patients can be an issue as well. These factors may influence quality of care, mortality, and morbidity (Barsukiewicz et al. , 2010). Social structure, such as education, job, and location along with insurance status also influence health care utilization.

These factors almost always have an impact on each other. An individual with an education is more likely to get a good job, and therefore have insurance benefits. Availability of health care services correlates with location. Those who live in certain areas are more likely to have health care services readily available. On the other hand, there are areas with plenty of well educated individuals who have good jobs and insurance benefits, but because of their location access to health care services is limited. Changes in insurance have also impacted health care utilization.

Cuts in payments combined with an increase in paperwork have been met with unwillingness by health care providers to participate with government programs, such as Medicare and Medicaid. Unfortunately, this also affects health care utilization for those who are poor or living with disabilities (Barsukiewicz et al. , 2010). Demographics such as age, gender, and ethnicity are considered immutable or predisposing factors. They cannot be changed. Unfortunately, age and gender are also considered the primary risk factors for health.

A personal element, such as insurance status can be changed; therefore it is a mutable factor. Income and job status may affect one’s ability to purchase private insurance, but social welfare programs do offer insurance for qualifying individuals. Some communities also provide health care resources, such as transportation and free clinics to those who do not have the means to get to their doctor or cannot afford it. Other mutable risk factors may include excessive alcohol use, smoking tobacco, poor eating habits, lack of physical activity, and obesity.

Each of these factors can increase risk for chronic illnesses, such as cardiovascular disease, diabetes, or cancer. Obesity, on its own is a risk factor for some of the leading causes of preventable death. According to “Centers For Disease Control And Prevention” (2012), ” Between 1988–1994 and 2007–2008 the prevalence of obesity increased in adults at all income and education levels” (Obesity and socioeconomic status). Fortunately, these mutable factors are within each individual’s control.

Committing to a ealthy diet, exercise plan, avoiding tobacco products, and excessive alcohol use are all ways that one can change these mutable factors, therefore minimizing the need for increased health care utilization and costs. John Q is enrolled in Medicaid, he lives 40 minutes from the nearest participating health care provider, has no means of transportation, a history of high blood pressure, and a father who has had a recent heart attack. These are a combination of both mutable and immutable factors, which will affect his health care utilization.

Without the help of his community he may not be able to see a health care provider, which will lower his health care utilization but only for a brief time. Proper education about his disease and the preventive measures he can take may help him stay healthy, but left untreated his disease may lead to more complicated problems. Health care utilization is dependent on many things; each of which affects not only the ability to pay for health care services but also the ability to access those services.

According to Barsukiewicz et al. 2010), “Health beliefs, access to care, transportation, education, and other factors play a part in determining an individual’s decision to seek care. As a diverse nation, we may have to devise diverse methods of providing care and motivating preventive behavior” (chapter 4). John Q’s situation is an issue that is becoming more common for people all over the country. There are government programs in place to assist those in need; however, these programs are in desperate need of change if they are going to continue to do the job they were created to do.

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