Main Outcomes Measures.-Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Results.-Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (PՅ.001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P = .36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Conclusions.-Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.

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Although many conditions contribute to socioeconomic and racial disparities in potential life-years lost, a few conditions account for most of these disparities - smoking-related diseases in the case of mortality among persons with fewer years of education, and hypertension, HIV, diabetes mellitus, and trauma in the case of mortality among black persons. These findings have important implications for targeting efforts to reduce existing disparities in mortality rates.

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There are substantial disparities in the characteristics of patients receiving care at high-volume hospitals. The interest in selective referral to high-volume hospitals should include explicit efforts to identify the patient and system factors required to reduce current inequities regarding their use.

This study examines the interconnections among education--as a proxy for socioeconomic status--stress, and physical and mental healthy by specifying differential exposure and vulnerability models using data from The National Study of Daily Experiences (N = 1,031). These daily diary data allowed assessment of the social distribution of a qualitatively different type of stressor than has previously been examined in sociological stress research--daily stressors, or hassles. Moreover, these data allowed a less biased assessment of stress exposure and a more micro-level examination of the connections between stress and healthy by socioeconomic status. Consistent with the broad literature describing socioeconomic inequalities in physical and mental health, the results of this study indicated that, on any given day, better-educated adults reported fewer physical symptoms and less psychological distress. Although better educated individuals reported more daily stressors, stressors reported by those with less education were more severe. Finally, neither exposure nor vulnerability explained socioeconomic differentials in daily health, but the results clearly indicate that the stressor-health association cannot be considered independent of socioeconomic status.

Data from the 1986-1988 Survey of Income and Program Participation panels were used to analyze how informal caregiving of disabled elderly parents affected female labor supply. Instrumental variables analyses suggested that coresidence with a disabled parent leads to a large, significant reduction in work hours, due primarily to withdrawal from the labor force. Although the impact of nonhousehold member caregiving was insignificant, evidence of an effect was stronger when commitment of caregiving time was greater. Projections of female labor force participation rates should account for potential increases in caregiving demand due to the aging of the U.S. population.

This study provides substantial evidence that efforts to reduce postoperative readmissions should begin by focusing on postoperative complications that can be reliably and validly measured. Such an approach will not eliminate all postoperative readmissions but will likely have a major effect on readmission rates.