Article1998

Skepticism Toward Medical Care and Health Care Utilization

Kevin A Fiscella · Peter John Franks · Carolyn M. Clancy

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Healthcare Policy and Management Patient-Provider Communication in Healthcare Health Literacy and Information Accessibility

Abstract

OBJECTIVES: As health care moves toward systems that assume accountability for defined populations, there has been increasing emphasis on developing performance measures for those systems and their providers, with little attention given to patient demand or attitudinal factors. The impact of skepticism toward health care providers on health behavior and health care utilization was assessed using a cross-sectional analysis of data from the 1987 National Medical Expenditure Survey (NMES). METHODS: A nationally representative sample from the United States comprising 18,240 persons 25 years and older was surveyed. Skepticism, defined as doubts about the ability of conventional medical care to appreciably alter one's health status, was assessed through a 4-item scale. Outcome measures included health behavior, access (health care insurance, having a regular source of care, and physician type), utilization (annual number of physician or emergency department visits and hospitalizations), total annual health care expenditures, and preventive health care behavior (having had a Pap smear within 3 years or ever having had a mammogram). RESULTS: In multivariate analyses, skepticism was associated with younger age, white race, lower income, less education, and higher health perceptions. After adjusting for these variables, skepticism was associated with less healthy behavior, with not having health insurance, not having one's own physician, choice of a physician, fewer physician and emergency department visits, less frequent hospitalizations, lower annual health care expenditures, and less prevention compliance. CONCLUSIONS: Medical skepticism represents a relevant patient demand factor that demonstrates significant associations with a variety of health care access and utilization measures with important policy implications.

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References

1995Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?1988The MOS Short-form General Health Survey 1979Correlates of Physician Utilization: Why Do Major Multivariate Studies of Physician Utilization Find Trivial Psychosocial and Organizational Effects?1976The Effect of Psychological Distress on Physician Utilization: A Prospective Study 1984Life Events, Social Network, Life-Style, and Health: An Analysis of the 1979 National Survey of Personal Health Practices and Consequences 1975A Re-Examination of Suchman's Views on Social Factors in Health Care Utilization 1995How white and African Americans view their health and social problems. Different experiences, different expectations.

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