A framework for evaluating underutilization of health care services

Underutilization is becoming increasingly recognized as an area of importance in managed care, where aggressive measures to control overutilization are creating concern among the general public. The author sought solid definition of underutilization and methods for its evaluation in the medical literature but was impressed at the small number of peer reviewed articles on the subject. A review of key issues is discussed, including a number of methods a health plan may use to approach the identification of underutilization within its domain. Methods include the use of "gold standard" population health requirements; statistically defined underutilization; second-order, combined variables; and socially defined underutilization. Sample statistics identified within the author's plan are identified, and recommendations for their implementation and use are made.