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Visits to physicians: a critical review of the literature on ambulatory utilization in Israel.

Data on health services utilization contribute to the monitoring and appraisal of the performance of health services and the extent of usage by patients. Past utilization and morbidity patterns provide useful inputs for making projections of probable future needs and demands on the health service, as well as for mapping out appropriate strategies to meet the anticipated changes. However, there are often competing rationales inherent in the use of information in processes of policy and planning decisions. Information is, in fact, data to which meaning and significance are attached depending on who is interpreting it. Since the founding of the State of Israel in 1948 and possibly even before, until at least the 1970s, the consensus perception based on the available data was that the rate of utilization of ambulatory health services was (too) high. The usual point of reference was that rates of visits to physicians were much lower in western countries than in Israel. In the last decade or so however, data began to emerge suggesting that this measure of ambulatory utilization in Israel was on the decline. This paper first briefly reviews the data and literature that provided the early evidence that utilization of ambulatory health services in Israel was (too) high. It then looks at the available evidence for declining rates of utilization, including comparisons with data and trends abroad. Factors that could explain this decline are then considered, as are the underlying factors, which in fact should be driving an increased rate of visits. This paper looks at how the data have been interpreted and used by the health service community including policy makers. It is proposed here that recognition of this changing reality has not yet been addressed and internalized in the public debate on the Israeli health care system.