RISING USE OF PHYSICIAN SERVICES BY THE ELDERLY - THE CONTRIBUTION OFMORBIDITY

Use of medical services by the elderly population is increasing. While rising numbers of elderly persons account for much of the overall inc rease, per capita increases in use of medical services within this gro up have been substantial. This phenomenon is commonly attributed to gr eater need due to the ''aging'' of the elderly population (i.e. an inc reased proportion of those 85 years of age and over) and to changing p atterns of morbidity or to changing patterns of servicing the old and sick. Research to date suggests that the impact of the aging of the el derly population has been small. However, because the relationship bet ween morbidity and rising utilization has not yet been studied, there is considerable debate about the extent to which increased ''need'' fo r care contributes to patterns of rising utilization. This research st udied the impact of changes in numbers, demographics, and morbidity pa tterns of the elderly on per capita and aggregate consumption of ambul atory physician services at two points in time. Linked survey and phys ician claims data for representative samples of the elderly in 1971 an d 1983 were used to study patterns of utilization of total ambulatory, consultative and non-consultative care by age and health status. The research found that per capita utilization of both consult and non-con sult visits rose across all categories, with older individuals and tho se in poor health experiencing greater increases in utilization than y ounger and healthier individuals. At the aggregate level, a large perc entage of the increase in utilization of medical services was related to increased numbers of elderly. Changes in 'need' attributable to agi ng of the elderly population and increased morbidity had only minor ef fects. At least 35 per cent of the increase in non-consult visits and 50 per cent of the increase in consult visits were not specifically re lated to changes in need of the elderly population and remain as unexp lained changes in patterns of servicing individuals. While some of thi s increase was directed to individuals in poor health, the majority of increased servicing (32% of the increase in non-consultative visits a nd 58% of the increase in consultation visits) was directed to individ uals in good health. Policy implications are discussed.