The use of pediatric medical care: a critical review.

The problems of who uses medical services and why, are important ones for investigators interested in studying chronic diseases, particularly if they wish to avoid systematic error when assembling a study population. These issues are important when studying pediatric diseases due to the uneven use of medical services by children and the tendency of lower socioeconomic groups to use hospital facilities rather than private practitioners. In order to address these problems, we must understand why families seek medical care for young children. Utilization research shows that a number of descriptive factors such as child's age, birth order, parental education, financial resources and perceived symptoms are related to service use. Additionally, psychosocial variables, such as distress, also predict utilization. Neither the descriptive nor psychosocial variables explain much of the variance in utilization. While some of this lack of explanatory power can be attributed to problems in measurement or study design, there are also conceptual and methodological issues that are not addressed in pediatric utilization research. This paper discusses four of these issues. It is our conclusion that two of these problems, the need for a new utilization taxonomy and the ambiguity of cause and effect, can be remedied. While more difficult to address, the inadequate conceptualization of social stress, psychological distress, and social support can be improved. However, measuring health status independently of utilization represents a major methodologic problem for which we currently have no ideal solution.