UNCONVENTIONAL MEDICINE IN THE UNITED-STATES - PREVALENCE, COSTS, AND PATTERNS OF USE
UNCONVENTIONAL MEDICINE IN THE UNITED-STATES - PREVALENCE, COSTS, AND PATTERNS OF USE
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DOI：
10.1056/nejm199301283280406
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发表时间：
1993-01-28
影响因子：
158.5
通讯作者：
DELBANCO, TL
中科院分区：
文献类型：
--
作者：
EISENBERG, DM;KESSLER, RC;DELBANCO, TL
背景资料。许多人使用非传统疗法来治疗健康问题，但这种使用的程度和成本尚不清楚。我们进行了一项全国性调查，以确定非传统疗法的流行率、费用和使用模式，如针灸和脊椎疗法。我们将研究的疗法限制在16种常用的干预措施上，这些干预措施既没有在美国的医学院广泛教授，也没有在美国的医院普遍提供。1990年，我们完成了对1539名成年人的电话采访(回应率为67%)，调查对象为18岁或以上的全国成年人。我们要求受访者报告任何严重或令人烦恼的医疗状况以及他们使用常规医疗服务的详细情况；然后我们询问他们使用非传统治疗的情况。三分之一的受访者(34%)报告在过去一年中至少使用了一种非常规疗法，其中三分之一的人看到了非常规疗法的提供者。后者在前一年平均访问了这类提供者19次，每次访问的平均费用为27.60美元。非传统疗法的使用频率在不同的社会人口学群体中略有不同，25岁至49岁的非黑人人群报告的使用率最高，他们拥有相对更多的教育和更高的收入。大多数人使用非传统疗法来治疗慢性疾病，而不是威胁生命的疾病。在那些使用非常规疗法治疗严重疾病的人中，绝大多数(83%)也寻求医生的治疗；然而，使用非常规疗法的受访者中，72%的人没有通知他们的医生他们已经这样做了。对美国人口的推断表明，1990年，美国人向非传统疗法提供者咨询的人数估计为4.25亿人次。这一数字超过了美国所有初级保健医生的就诊次数(3.88亿人次)。1990年与使用非常规治疗有关的支出约为137亿美元，其中四分之三(103亿美元)是自付的。这一数字与美国所有住院患者每年自掏腰包支付的128亿美元相当。在美国，非传统疗法的使用频率远远高于之前的报道。每当医生获得病史时，都应该询问他们的患者使用非传统治疗的情况。
Background. Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic.Methods. We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy.Results. One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among sociodemographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.Conclusions. The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.