FREQUENT USERS OF AMBULATORY HEALTH-CARE IN QUEBEC - THE CASE OF DOCTOR SHOPPERS

Objective: To examine the patterns of use of ambulatory care in Quebec in 1991, with special emphasis on patients who received care from mor e than 20 physicians. Design: Retrospective study of population-based data. Setting: Province of Quebec. Participants: All 7 154 591 people eligible for coverage under the Regie de l'assurance-maladie du Quebec (RAMQ) (Quebec Health Insurance Plan) in 1991, including 3639 people who received ambulatory care from more than 20 physicians. Data extrac tion: The databanks of the RAMQ. Outcome measures: Mean number (and st andard deviation) of physician visits and services received, place of visit (clinic or private office), mean cost of services, patient's age , diagnosis, type or. specialist visited and social assistance status of frequent users. Results: The patients who obtained ambulatory care from more than 20 physicians received 10 times more medical services t han the overall patient population (59.6 v. 5.8), and the mean cost pe r patient for ambulatory care was also 10 times higher ($1379 v. $136) . Almost all of the frequent users visited at least one outpatient cli nic, as compared with 37.3% of the overall population. A higher propor tion of the frequent users than of the overall population obtained car e from specialists (98.9% v. 54.7%), mainly general surgeons and psych iatrists. The most frequent diagnoses among the frequent users were an xiety (36.0%), abdominal pain (24.3%), drug or alcohol dependence (22. 2%) and depression (16.4%). Conclusions: A small proportion of the pop ulation obtained ambulatory care from a high number of physicians duri ng the year, leading to high expenses. identifying and understanding t his type of frequent user may be useful in developing strategies to pr omote more effective health-care-seeking behaviours and reduce overuse .