Psychosocial and Psychodynamic Factors Influencing Health Care Utilisation

Abstract

This paper aims to elucidate some dysfunctional aspects of health care utilisation by combining concepts from modern systems theory and from psychoanalysis. Contemporary health care in industrialised countries can be conceived as a social system in terms of modern systems theory. According to this theory, social systems are operating on the basis of a 'guiding difference,' which in the case of health care is the distinction between 'healthy' and 'ill.' Its rigidity in adhering to the healthy-ill dichotomy exposes health care to being collusively entangled in the interpersonal defence arrangements of patients. In the psychoanalytic view, individual conflicts can be warded off from consciousness not only by intrapsychic defence, but also by interpersonal defence mechanisms. These mechanisms involve the patients' close social environment, often including doctors and hospitals. The functioning and the motivational structure of health care itself shows features of neurotic defence: not only its representatives, but health care as a whole act in a rigid, obsessive manner in order to separate the healthy from the ill and to battle against (presumed) diseases. This obsession sometimes results in excessive diagnostic activism and in inconsiderate application of aggressive medical treatments. Both are inappropriate with regard to the salient problem of modern medicine: the increase of chronic nonfatal diseases like depression and chronic pain. The described defence mechanisms are unconscious not only to patients but also to health care professionals (let alone health politicians), and are contributing to dysfunctional health care overuse.

Mental health and healthcare utilization in adult asylum seekers

“…On the other hand, asylum seekers consult doctors and receive treatment more frequently, resulting in above-average healthcare costs. This somewhat contradictory finding underlines the important role of the medical system in the care of marginalised populations and the high credibility of doctors despite their occasional shortcomings [54]. It also suggests that mechanisms of somatisation may play an important role in asylum seekers' patterns of healthcare utilisation (and in the patterns of healthcare delivery to this population).…”

“My Head is Like a Bag Full of Rubbish”: Concepts of Illness and Treatment Expectations in Traumatized Migrants

“…Thus, the results of these interviews confirm the eminent and beneficial role of basic medical services in the treatment of traumatized migrants. In the pattern of trusting, almost ideal relationships with doctors, the patients' strong need for human compassion and basic appreciation is expressed (Maier, 2006b). The trusting relationship and affirmative attitude within patients' incredible disclosures appear to be fundamentally important to the treatment process.…”

Is personality a driving force for socioeconomic differences in young adults’ health care use? A prospective cohort study

“…First, use of health services was measured rather than health per se. It is not unlikely that certain personality characteristics, even with the same type and severity of disease, might increase the probability of looking for medical help and actually getting the health care services (Maier 2006 ; Olsson and Dahl 2009 ; Ten Have et al 2005 ). Hence, it is important to frame our findings in terms of health care use and medical consumption rather than health per se.…”