Perceived access barriers to conventional medicine and the utilization of complementary and alternative medicine (CAM): A population-based study

Objectives: Although plentiful studies have documented the relationship between dissatisfaction with conventional medicine and CAM usage, little attention has been paid to the connection between perceived access barriers to conventional medicine and CAM usage. The purpose of this paper is to investigate whether perceived access barriers to conventional medicine are associated with CAM usage.

Method: This is a cross-sectional quantitative study using the 2002 National Health Interview Survey (NHIS) (N=31,044). The target population is noninstitutionalized U.S. residents aged 18 to 64. The outcome variable is CAM usage categorized into practitioner-provided or self-administrated. Perceived access barriers are grouped into distinct dimensions including accommodation, accessibility, or affordability. Perceived access barriers are considered endogenous. To deal with this selection problem, a recursive bivariate probit model will be utilized to test the impact of perceived access barriers on CAM usage by constructing perceived access barriers as endogenous regressors in the equation for CAM usage controlling confounders including sex, age, race, education, health insurance, and income.

Results: In 2002, around 60 percent of the target population had used at least one form of CAM in the 12 months before interview, with 13 percent using at least one practitioner-provided CAM in contrast to 56 percent using at least one self-administrated CAM. Over 20 percent reported at least one perceived access barrier to conventional medicine. In bivariate analyses, there were statistically significant differences at the 0.05 level between people who perceive access barriers to conventional medicine and use CAM. Results from the recursive bivariate probit models indicated that any access barrier or accommodation access barriers to conventional medicine are statistically significantly negatively correlated with practitioner-provided CAM usage at the 0.05 level. Results from simple probit models showed that the other perceived access barriers to conventional medicine are statistically significant positively associated with the use of CAM at the 0.05 level.

Conclusions: Ignoring the endogenous nature of perceived access barriers will bias estimates of the relationships between perceived access barriers to conventional medicine and CAM usage. People perceiving access barriers to conventional medicine use CAM as a coping strategy. Some perceived access barriers to conventional medicine have more general impact on health care services utilization since not only do they prevent people from using conventional medicine but they also keep people from using CAM. These access barriers should be addressed to ensure people have adequate access to health care services both conventional and alternative to improve their health.