Gender and health care utilization: the role of mental distress and help-seeking propensity. 
Many studies report higher levels of health care utilization among women.  Understanding how gender influences health care utilization is still unresolved.  We developed a model that could explain these gender-related differences.  The possible pathways assumed by this model that relate gender to utilization, can be summarized as follows: (1) utilization may be influenced by somatic morbidity, mental distress, perceived symptoms, poor subjective health and propensity to use services; (2) women have higher levels of these variables than men (mediating effect); and (3) the direct effects of some of these variables on utililization are moderated by gender, i.e. they are stronger for women than for men (moderating effect).  Data were drawn from a community-based sample of adult enrollees of a sickness fund in the Netherlands, who had responded to a mailed health survey (N = 8698).  This survey contained questions on somatic morbidity, mental distress and other mediating variables.  Health care utilization was measured prospectively, using data extracted from a claims database held by the sickness fund that covers all types of general health services except general practitioner consultations.  The model was tested using structural equation modelling.  Women reported more somatic morbidity and mental distress than men did, as well as elevated levels of other mediating variables, which might explain-at least partly-gender related differences in utilization.  Differences in propensity to use services were not found.  The expected moderating effect of gender could not be demonstrated.  That is, we did not find gender related differences in the strength of the relations between mental distress, other mediating variables and utilization.  Mental distress is related to utilization in a way that is not gender specific, however, because women report higher levels of mental distress (as well as somatic morbidity), this results in a greater utilization of somatic health care services.