The University of Toledo The University of Toledo Digital Repository Theses and Dissertations 2013 Is complementary and alternative medicine (CAM) used to combat medical costs? : a study of consumers, medical professionals, and a CAM practitioner Keri A Kovacsiss The University of Toledo Follow this and additional works at: http://utdr.utoledo.edu/theses-dissertations Recommended Citation Kovacsiss, Keri A., "Is complementary and alternative medicine (CAM) used to combat medical costs? : a study of consumers, medical professionals, and a CAM practitioner" (2013) Theses and Dissertations Paper 120 This Thesis is brought to you for free and open access by The University of Toledo Digital Repository It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of The University of Toledo Digital Repository For more information, please see the repository's About page A Thesis entitled Is Complementary and Alternative Medicine (CAM) Used to Combat Medical Costs?: A Study of Consumers, Medical Professionals, and a CAM Practitioner by Keri A Kovacsiss Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Masters of the Arts Degree in Sociology Dr Barbara Chesney, Committee Chair Dr Patricia Case, Committee Member Dr Lea McChesney, Committee Member Dr Patricia R Komuniecki, Dean College of Graduate Studies The University of Toledo August 2013 Copyright 2013, Keri A Kovacsiss This document is copyrighted material Under copyright law, no parts of this document may be reproduced without the expressed permission of the author An Abstract of Is Complementary and Alternative Medicine Being Used to Combat Medical Costs?: A Study of Consumers, Medical Professionals, and a CAM Practitioner by Keri A Kovacsiss Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Masters of Arts Degree in Sociology The University of Toledo August 2013 Rising medical costs have become a national issue in the U.S (Hulme and Long 2005, Seifert and Rukavina 2006, Wright and Rogers 2011) and medical debt and medical bankruptcy have become more common (Seifert and Rukavina 2006, Wright and Rogers 2011) Meanwhile, CAM use has increased in the U.S (Ben-Ary et al 2011, Ditte et al 2011, Dolder et al 2003, and Wetzel et al 2003) This study used qualitative methods to identify how rising medical costs and the rise in complementary and alternative medicine (CAM) use were affecting participants Particularly, data were collected in order to identify whether participants were utilizing CAM to combat rising medical costs This study also explored how participant interactions and attitudes influenced their health and healing behaviors These topics were explored from the perspective of participants with various social roles within and outside of the health care industry: consumers, physicians, nurses, and a CAM practitioner Despite the fact that CAM is typically outside of the health care industry, which is considered the norm, most of the participants recognized the legitimacy and effectiveness of CAM Even medical professionals, who are educated iii in the dominance of the health care industry and traditional Western medicine, had positive views of CAM use Participants also described that they, or others, were utilizing CAM as tool in order to combat negative aspects of the health care industry The negative aspects that were described by participants were medical expenses, overmedication, somatic therapies, and difficulties in communicating Although not every one of these issues was overtly related to costs, many responses reflected a cost component Thus, CAM is utilized by participants as a tool to combat negative aspects of the health care industry -especially medical costs Despite the fact that CAM can be utilized in this way, CAM is not fully integrated into the health care industry The exclusion, or rarity, of CAM use within the industry is most likely a business decision by corporate elites in the industry to maintain control and profitability -decisions which profoundly influence the health of the population iv This thesis is dedicated to my family I want to dedicate this to my parents, grandparents, and great-grandparents for always supporting and encouraging my education Thank you Mom, Dad, Grandma Smith, Grandpa Smith, Grandma K, Grandpa K, Grandma Simon, and Grandpa Simon I could not have done this without any of you Also, a big thank you to the rest of my family for supporting me on this journey! Thank you to my best friend and partner Shawn Alkenbrack for putting up with my craziness every single day I not think I could have made it through without you To the rest of my wonderful family: Thank you for putting up with my missing events, phone calls, and canceling plans due to my crazy schedule, especially my two beautiful sisters Chea and Mamie Hopefully, you can all forgive me This thesis is dedicated to you! Acknowledgements First, I would like to acknowledge my committee for all of their time, insight, and encouragement Thank you so much to Dr Barbara Chesney, Dr Patricia Case, and Dr Lea McChesney for putting up with and answering all my questions, emails, and craziness! I am so grateful to all of you for helping me on this journey I not believe I could have selected better committee members, and I am truly blessed for having the privilege to get to know all of you better You are all an inspiration to me as an academic and as a woman Thank you! I would also like to acknowledge my crazy cohort for all their time and support All four of you are intelligent, hard-working, silly, beautiful, crazy, and wonderful! Thank you all for your moral support! I have had the best time getting to know, working with, laughing, and crying with the four of you I love you Aleiah, Richard, Christopher Walter-Thompson, and Lisa! Last, I want to acknowledge my wonderful family again: Shawn, my parents Bob and Tami, my grandparents, great grand-parents, Mamie, and Chea Thank you again for everything you have done for me throughout this program and every day of my life A big thanks for the love and support of my extended family, also: Corin, Riley, Cody, Aleiah, Mel, Rachael, Jena, Emma, Kryssie, and Kaleigh! I love you all! vi Table of Contents Abstract iii Acknowledgements vi Table of Contents vii List of Abbreviations xii Introduction 1.1 Aim of this research 1.2 Rational for this study 1.3 What this study adds to health and healing research Literature Review………… 2.1 Health as a result of societal, cultural, and environmental factors……………5 2.2 Health challenges in U.S society and culture.…………………….………… 2.3 Sociocultural values and healing……… ……………………………………8 2.4 A brief history of capitalism in the U.S and the formal health care industry.11 2.5 Culture’s effect on health and healing .14 2.6 Traditional Western medicine 15 2.7 Rising medical costs 15 2.8 Medical debt 17 2.9 Complementary and alternative medicine .18 2.10 Occupational roles 20 vii 2.10.1 CAM practitioners 21 2.10.2 Physicians .21 2.10.3 Nurses .22 2.10.4 Consumers .23 2.11 How this study adds to research on health and healing 26 2.11.1 Interactions in Cohn’s research .27 2.11.2 Qualitative studies on traditional Western medicine and CAM use 27 Theory .28 3.1 Individuality in behaviors 29 3.2 Social roles, attitudes, interactions and behaviors 30 3.2.1 Social roles and authority 31 3.2.2 Health care consumers and social roles 32 3.2.3 Medical professionals and social roles .33 3.3 Performances 34 3.3.1 Physician performances 34 3.3.2 Nurse performances 35 3.4 Interactions and behaviors .35 3.5 Attitudes and behaviors 37 3.6 The I, the Me, and the Generalized Other and behaviors 37 3.7 Marxist theory and the health care industry .37 3.8 Goff man’s discussions of teams and the health care industry 40 3.9 Goff man’s discrepant roles and the health care industry 44 viii Methodology and Data 48 4.1 Research design .48 4.2 Qualitative data collection .48 4.3 Sampling Methods 49 4.4 Procedure 49 4.5 Field Site Access 50 4.6 Coding 51 Findings 52 5.1 Rising medical costs 52 5.1.2 Nurse participants and medical costs 54 5.1.3 Physicians and medical costs 56 5.1.4 CAM practitioner and medical costs .57 5.2 Rise in complementary and alternative medicine use 57 5.2.1 Consumer participants and CAM use .58 5.2.2 Nurses and CAM use 59 5.2.3 Physicians ad CAM use 61 5.2.4 CAM practitioner and CAM use .62 5.3 Interactions with the health care industry 62 5.3.1 Consumer participants and interacting with the health care industry 63 5.3.2 Nurse participants and interacting with the health care industry .64 5.3.3 Physicians and interacting with the health care industry 65 5.3.4 CAM practitioner and interactions with the health care industry 66 ix Hollenberg, Daniel and Ivy Lynn Bourgeault 2011 “Linking Integrative Medicine with Interprofessional Education and Creative Initiatives: Challenges and Opportunities for Interprofessional Collaboration.” Journal of Interprofessional Care 25(3):182-188 Hood, Leroy, James Health, Michael Phelps, and Biaoyang Lin 2004 “Systems Biology and New Technologies Enable Predictive and Preventative Medicine.” Science 306(5696) Hulme, Claire and Andrew Long 2005 “Square Pegs and Round Holes? 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What measures you take to stay healthy? Where does your information about health come from? You are a _ (depending on participant which is pre-selected for their occupation) How does your occupation affect your health? Can I ask your age? How have your attitudes on health changed throughout your life? a Prompt: Did they change because of your education? How your attitudes on health effect how you treat your patients? How your attitudes on health effect how you treat your own illnesses/health conditions? What makes one treatment superior to another? 10 What motivates your decision to choose one medical treatment over another? 11 What is your experience in treating patients in the health care industry? a Prompt: What have been some of the positives? b Prompt: What are some of the challenges? 12 Medical care in the U.S has become increasingly more expensive and medical debt more common Do you think these factors have had an effect on treatments that an individual uses? Please explain 13 Do medical expenses affect the treatments that you “prescribe” patients? 14 Are you familiar with alternative medicine? 15 Where has your information on the topic come from? 16 Have you used an “alternative method” of treatment? Why? 17 I have read that alternative medicine use is increasing What is your opinion on that? 108 Appendix B Interview questions for consumer participants What does healthy mean to you? What measures you take to stay healthy? Where does your information about health come from? Can I ask your occupation? How does your occupation affect your health? Can I ask your age? How have your attitudes on health changed throughout your life? What has been your experience with treating illness/health condition? Please describe your experience with treating a health condition, using a specific example if you have one Did this include consulting a medical professional or using a health care facility? a Prompt: What were some of the challenges of navigating through the health care industry? b Prompt: What were some of the positives of treating illness within the health care industry? 10 How you regard the health care industry based on this experience? 11 What you think makes one method of treatment more effective than another? 12 Medical care in the U.S has become increasingly more expensive and medical debt more common, you think these factors have an effect on treatments that an individual uses? Please explain 13 Are you familiar with alternative medicine? 14 Have you ever used an “alternative method” of treatment? Why? This can be on your own, or you could have consulted an alternative health provider 15 I have been reading that the use of alternative medicine is increasing What is your opinion on that? Why? 109 Appendix C Informed Consent Documentation Informed Consent Documentation 110 111 112