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Health Care Use and Delivery

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Skepticism about the value of conventional medical care may be a risk factor for early death

Research has shown that individual patient attitudes toward health and health care are independently predictive of health care use and outcomes. Likewise, an individual's rating of his or her own overall health has been shown to be one of the best predictors of future use of health care and mortality. A recent study has found that doubts about the value of health care are associated with a higher risk for early death. The study was conducted by researchers from the University of Rochester School of Medicine and Dentistry (supported by AHCPR grant HS09522) and the University of Washington, Seattle, along with Carolyn M. Clancy, M.D., and Jessica S. Banthin, Ph.D., of the Agency for Health Care Policy and Research.

The researchers used data from the 1987 National Medical Expenditure Survey of 18,240 people, a nationally representative sample of the noninstitutionalized U.S. population. They measured skepticism via an eight-item scale and ascertained death 5 years later through the National Death Index. Medical skepticism was defined through statements about doubts of the ability of conventional medical care to appreciably alter health status. For instance, a skeptic would agree with statements in the skepticism scale that a person can overcome most illness without the help of a medically trained professional, or that home remedies are often better than drugs prescribed by a doctor.

An increase of 1 point in the 5-point skepticism scale was associated with an 11 percent increase in mortality 5 years later (Adjusted Hazard Ratio, AHR 1.11), comparable to the effect of an 18-month increase in age. The mortality risk associated with medical skepticism was lessened by additional adjustment for unhealthy behaviors (AHR 1.07). Further adjustment for smoking status alone weakened the AHR to 1.08. Additional adjustment for physician visits or medical insurance status had little impact on AHR for medical skepticism (AHR 1.12 and 1.11, respectively).

These findings suggest that the effect of skepticism on mortality may be largely explained by higher rates of risky behavior, such as smoking, rather than lower rates of health care use. Although these findings do not prove that skepticism causes higher mortality, they do raise concerns about the trend in the United States towards increasing health care cost shifting to patients. Because skepticism toward health care is associated with both lower rates of health care insurance and lower health care use, such a trend has the potential to further increase long-term mortality rates among the medically skeptical, conclude the authors.

See "Does skepticism towards medical care predict mortality?" by Kevin Fiscella, M.D., M.P.H., Peter Franks, M.D., Dr. Clancy, Mark P. Doescher, M.D., and Dr. Banthin, in Medical Care 37(4), pp. 409-414, 1999. Reprints (AHCPR Publication No. 99-R059) are available from the AHCPR Clearinghouse.

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