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 Attentional differences
Hypochondriacs believe normal bodily symptoms are indicators of illness
Neurotic people either exaggerate symptoms or are more attentive to real symptoms
Individual 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
Attentional differences

5. Recognition of Symptoms
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
Situational factors
Stress-related physiological changes are misinterpreted as symptoms of illness
Stress
Affects perception about symptoms and perceived vulnerability to illness
Mood

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
Gender
Women use it more than men
Pregnancy and childbirth account for it
Women have better homeostatic mechanisms
Women’s medical care is more fragmented
Men are expected to 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
Time taken to decide that a symptom is serious
Appraisal delay
Time between the recognition that a symptom implies an illness and the decision to seek treatment
Illness delay
Time between deciding to seek treatment and actually doing so
Behavioral delay
Time that elapses between the person’s calling for an appointment and his or her receiving appropriate medical care
Medical delay

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