Healthcare Service Utilization Patterns and Patient Experience in Persons With High Healthcare Needs: A Comparison Across 22 Countries

Background: Persons with complex health conditions, e.g. spinal cord injury (SCI), frequently visit numerous clinical settings. Their service utilization and patient experience is a comprehensive indicator of how a system is functioning overall. This study compared the patient experience of persons with chronic SCI in relation to healthcare service utilization patterns in 22 countries, hypothesizing that primary-care oriented patterns would offer better experience. Methods: This study was based on International Spinal Cord Injury Survey with 12 588 participants from 22 countries worldwide. Utilization clusters were identified by cluster analysis, experience score was attained by partial credit model. The association between the two was explored by regression analysis. Results: Highest share of visits was to primary care physician (18%) and rehabilitation physician (16%). Utilization patterns had diverse orientation: from primary care to specialized and from inpatient to outpatient. The experience was reported as very good and good across different dimensions: 78% reported respectful treatment; 75% – clear explanations; 71% – involvement in decision making; 63% – satisfaction with care. Average experience score on 0-100-point scale was 64, highest – 74 (Brazil) and lowest – 52 (Japan, South Korea). Service utilization patterns were associated with patient experience, but no uniformly better patient experience was found for neither primary or specialized care-oriented systems. Conclusion: While there are distinct utilization patterns between countries of how persons with chronic SCI use the healthcare system, neither the more primary care oriented nor the specialized care system leads to a uniformly better patient experience.