Psychological Causes of Healthcare Overutilization and Underutilization
Why do people sometimes demand low value healthcare or refuse care with proven benefits? Our research explores both of these questions by identifying the psychological factors that drive healthcare over- and under-utilization. This research has studied health contexts such as cancer screening and treatment, vaccination, heart disease, and pediatric illness. Our research has found that diagnostic labels can change how people think about their symptoms, causing them to feel that they need medications even when they have been told that medications will provide little or no health benefit. Also, highly intuitive yet incorrect beliefs about how a disease works—like the plumbing metaphor in heart disease—can drive desire for medical interventions. Affect and emotions can drive both overutilization (e.g. when anxiety about a health threat is high) and underutilization (e.g. when anxiety about the harms of treatment is high).
Our research has also explored the implications of an individual difference called Medical Maximizing/Minimizing for over- and under-utilization. “Medical Maximizers” are individuals who want optional interventions and treatments, whereas “Medical Minimizers” like to avoid healthcare unless they perceive it as absolutely necessary. We are identifying what causes a person to adopt a maximizing or minimizing orientation, what that orientation predicts, and the usefulness of the distinction for clarifying values and promoting value-concordant care.
Read more about Medical Maximizing-Minimizing in our article in The Conversation:
https://theconversation.com/maximizers-vs-minimizers-the-personality-trait-that-may-guide-your-medical-decisions-and-costs-73825
Read more about vaccination decision making in our article in The Conversation:
https://theconversation.com/stories-of-vaccine-related-harms-are-influential-even-when-people-dont-believe-them-58314
Selected Publications
- Scherer, L.D., Shaffer, V., Caverly, T., Scherer, A., Zikmund-Fisher, B., Kullgren, J. & Fagerlin, A. (in press). The Role of the Affect Heuristic and Cancer Anxiety in Responding to Negative Information About Medical Tests. Psychology and Health Special Issue: Emotions, Health Decision Making and Health Behavior.
- Scherer, L.D., Burke, J.F., Zikmund-Fisher, B.J., Caverly, T., Kullgren, J., Steinly, D., McCarthy, D., Roney, M., & Fagerlin, A. (2016). Development of the Medical Maximizer-Minimizer Scale. Health Psychology, 35, 1276-1287.
- Scherer, L.D., Shaffer, V., Patel, N., Zikmund-Fisher, B. (2016). Can the Vaccine Event Reporting System Be Used to Increase Vaccine Acceptance and Trust? Vaccine, 34, 2424-2429.
- McCaffery, K., Jansen, J., Scherer, L., Thornton, H. Hersch, J., Carter, S., Barratt, A., Moynihan, R., Waller, J., Sheridan, S., Brodersen, J., Pickles, K., Edwards, A. (2016). Walking the tightrope: Communicating overdiagnosis in modern healthcare. The BMJ, 352, Article i348.
- Rothberg, M.B., Scherer, L.D., Kashef, M.A., Coylewright, M., Ting, H.H., Hu, B., Zikmund-Fisher, B.J. (2014). The effect of information presentation on beliefs about the benefits of elective percutaneous coronary intervention. Journal of the American Medical Association: Internal Medicine, 174, 1623-1629.
- Scherer, L. D., Ubel, P.A., McClure, J., Greene, S.M., Hensley-Alford, S., Holtzman, L., Exe, N. & Fagerlin, A. (2013). Belief in numbers: When and why women disbelieve tailored breast cancer risk statistics. Patient Education and Counseling, 92, 253-259.
- Scherer, L. D., Zikmund-Fisher, B. J., Fagerlin, A. & Tarini, B. (2013). Effect of a "GERD" diagnostic label on parents' decision to medicate infants. Pediatrics, 131, 839-845.
- Scherer, L.D., Finan, C., Simancek, D., Finkelstein, J., Tarini, B.A. (2016). Effect of the term "pink eye" on perceived contagiousness and willingness to use antibiotics to treat acute conjunctivitis. Clinical Pediatrics, 55, 543-548.