Understanding Healthcare Usage and Delays - A Psychological Perspective

1. Chapter Eight:Using Health Services

2. Healthcare Costs • 2.4 trillion dollars; 18% of economy • Medicare rising 2x rate of inflation • Therefore, control = Medicare cuts • ACA reduced 580 billion from Medicare – provider cuts mainly • Depressed: #1 users of medical system • Anxiety/Panic: #2 overuse • Low SES: ER overuse and belief about care

3. Who uses healthcare? • Not everybody who needs it uses it • Not everyone who uses it needs it • Not a rational system of use • - Misused • - Underused • - Overused

4. Who feels sick? Individual differences • Hypochondriacs believe normal bodily symptoms are indicators of illness • Neurotic people either exaggerate symptoms or are more attentive to real symptoms Attentional differences • People who are focused on themselves are quicker to notice symptoms • People with more distractions and who attend less to themselves experience fewer symptoms

5. Recognition of Symptoms Situational factors • Boring situations make people more attentive to symptoms • Medical students’ disease: Students believing they are ill with the same illness about which they are studying Stress • Stress-related physiological changes are misinterpreted as symptoms of illness Mood • Affects perception about symptoms and perceived vulnerability to illness

6. Irrational Judgement • Common disorders are regarded as less serious • Influenza/flu deaths? • Unexpected symptoms are ignored and expected symptoms are amplified • Delay treatment • Treatment is sought only when the symptom: • Affects a highly valued body part • Causes pain

7. Commonsense Model of Illness • Commonsense beliefs - Held by people about their symptoms and illnesses • Result in organized illness representations • Includes basic information about an illness • Identity - Name of the illness • Causes - Factors believed to have led to the illness

8. Cultural Expressions of Distress • Culturally bound expressions of illness • Examples: • Ataque de Nervious (Hispanic): intense distress, seizure like, stress triggered • Dhat Syndrome (S.Asian): impotence, fatigue,anx • Khyal Cap: (Cambodian) “A wind attack suffocation”

9. Who treats us first? • Family and friends who offer their own interpretations of symptoms way before the treatment is sought • Advice is offered regarding: • What the symptom means • Advisability of seeking medical treatment • Various home remedies

10. The Internet: knower of all things? • Two-thirds of Internet users have used it to find health information • Many physicians depend on it for the most up-to-date information on illnesses and treatments • Problem?

11. Who Uses Health Services? • Age - Infants and the elderly use it most frequently • Gender • Women use it more than men • Pregnancy and childbirth account for it • Women have better homeostatic mechanisms • Men are expected to ignore pain and not give in to illness

12. Who Uses Health Services? • Social class and culture - Lower social classes use it less than affluent ones • Social psychological factors • Individual’s attitudes and beliefs toward health services and symptoms • Children learn how to use health services from their parents

13. Using Health Services for Emotional Disturbances • Psychological complaints - Nonmedical complaints that stem from anxiety and depression • People use health services for psychological complaints as: • They are accompanied by physical symptoms • Medical disorders are perceived to be more legitimate than psychological ones

14. Misuse Health Services for Emotional Disturbances • Seeing Medical Doctor for Anxiety, Depressive, or Stress related symptoms • Suicidality addressed in emergency rooms not psychologist’s offices • They need to document their absence in order to collect wages at work

15. Delay Behavior Putting off seeking treatment for one or more potentially serious symptoms

16. Stages of Delay in Seeking Treatment for Symptoms Appraisal delay • Time taken to decide that a symptom is serious Illness delay • Time between the recognition that a symptom implies an illness and the decision to seek treatment Behavioral delay • Time between deciding to seek treatment and actually doing so Medical delay • Time that elapses between the person’s calling for an appointment and his or her receiving appropriate medical care

17. Causes of Delay • Common among people: • With no regular contact with a physician • Who are phobic about medical services • Symptoms that delay seeking treatment • Those similar to a previous one that turned out to be minor • Those that are easily accommodated

18. Causes of Delay • Typical symptoms of a disorder are more likely to be treated • Delay in taking recommended treatments • Patients no longer feel any urgency about their condition • Patients become alarmed by the symptoms and avoid thinking about them altogether

19. Causes of Delay • Delay in the part of the health care practitioner • Medical delay is likely when a patient deviates from the profile of the average person with a given disease