The amount of health care services people use varies widely across the population and can change year to year. People may require a higher amount of care in one year and fewer services the next. Although "high utilizers" are often discussed, there are people who do not use any services throughout the year. Other than being in good physical health, people may not seek care for a variety of reasons including distance to care or lack of trust in providers. Among people with employer-sponsored insurance (ESI) in the Health Care Cost Institute's dataset, more than 20% did not use any services in 2022.

Figure 1 shows that the share of "non-utilizers," defined as enrolled individuals with no evidence of formal health care in a given calendar year, was fairly consistent from 2018 through 2022, averaging approximately 23% over the five-year period.

Lockdowns and periods of limited access to health care providers associated with the COVID-19 pandemic in 2020 did not seem to have a substantial effect on the portion of people with ESI who used health care services. As shown in Figure 1, in 2020, 23% of people with ESI did not use any health care services, the same proportion as 2019. In 2021, however, the share of non-utilizers is slightly lower than 2020 (suggesting more people used services), which may be due to care that had been deferred in 2020.

HCCI's data shows that older people tend to use more health care than their younger counterparts

As shown in Figure 2, for each 10-year age band for adults ages 18-64, rates of non-utilization decrease. This pattern held true for men and women. For example, 25% of women aged 18-24 did not seek any formal health care service in 2022. In contrast, only 12% of women aged 55 to 64 did not use any health care services. Similarly, 38% of men aged 18-24 did not seek formal health care services in 2022 compared to 17% of men aged 55-64.

Figure 2 also shows that, in 2022, nearly 20% of children under the age of 18 did not use any health care services. 

Women with ESI are more likely to use health care services than men

In 2022, men in every adult age group were less likely to use formal health care services than women in the same age group, as shown in Figure 2. For example, 37% of men aged 25-34 did not utilize services compared to 22% of women in the same age group in 2022.

Differences in utilization rates among age groups and between men and women remained consistent during our study period.

Rates of non-utilization among ESI enrollees varied by state, ranging from 13% and 31% in 2022

The map in Figure 3 illustrates that Rhode Island and Vermont had the highest proportion of ESI enrollees who used health care services. Their non-utilizer rate was 13%. Nevada and California, on the other hand, had the highest rates of non-utilizers among their ESI enrollees in 2022 (31% and 30%, respectively). State non-utilizer rates were consistent between 2018 and 2022, and we did not observe different non-utilizer rates within states.