such as the NHIS and the BRFSS. If reliable statistical risk models can be developed, using variables from these two sources but based on data sets like the NHEFS, current mortality rates and current risk factor data can be combined into annual estimates of excess mortality.

OBJECTIVE 5: REDUCING MORBIDITY AND PAIN THROUGH TIMELY AND APPROPRIATE TREATMENT

Utilization Indicator: Percentage of Healthy Individuals Who Do Not Contact a Physician During an Acute Episode of Illness

People who perceive themselves to be in good to excellent health occasionally have an acute illness or a flare-up of a chronic condition that causes them to temporarily limit their normal activities. This could mean staying home from work or school, being restricted to bed, or reducing one's normal activities for more than half a day. During these episodes, a person may believe that his or her symptoms warrant medical attention. Differences among subpopulations in the frequency with which they contact a physician during such episodes could reflect differences in access. Physician contacts refer to consultation either in person or by telephone with a physician or someone (e.g., nurse, physician's assistant) who is supervised by a physician. Data on physician contacts, perceived health status, and restricted activity days are available from the NHIS.

Roughly 800 million physician contacts are made each year by people believing themselves to be in good or excellent health. In addition to requiring treatment for acute care conditions and low-impact chronic conditions, many of these people have undetected chronic diseases that might be aided by prompt medical attention. For example, a 1987 NCHS study estimated that nearly 50 percent of diabetes cases in the United States from 1976 through 1980 went undiagnosed. This indicator contrasts with that for continuing care for chronic disease in that those individuals, perceiving themselves to be in poor health, are more likely to know that they require continuous medical monitoring and care.

Someone who feels ill enough to restrict his or her activities may not necessarily need to seek assistance from a health care provider. For example, many colds and cases of back pain are self-limiting, and the individual can resume normal activities after rest. Thus, choosing not to visit a physician for these conditions may be appropriate utilization. The point of the indicator, however, is that over a broad range of many people and providers, average utilization should not differ among groups by, for example, insurance status. Individual variation in under- and overutilization should be canceled out. In other words, differences among population groups can reflect the presence of access barriers or overuse by groups with high-incomes



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