Eisenberg D M, Kessler R C, Foster C, Norlock F E, Calkins D R, Delbanco T L
Department of Medicine, Beth Israel Hospital, Boston, MA 02215.
N Engl J Med. 1993 Jan 28;328(4):246-52. doi: 10.1056/NEJM199301283280406.
Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic.
We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy.
One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among socio-demographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States.
The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.
许多人针对健康问题采用非传统疗法，但这种疗法的使用范围及花费尚不清楚。我们开展了一项全国性调查，以确定非传统疗法（如针灸和脊椎按摩疗法）的使用 prevalence、花费及使用模式。
我们将所研究的疗法限定为16种常用干预措施，这些措施在美国医学院校中未广泛教授，在美国医院中也通常无法获得。1990年，我们对全国18岁及以上成年人样本中的1539名成年人进行了电话访谈（回复率为67%）。我们要求受访者报告任何严重或令人烦恼的医疗状况以及他们使用传统医疗服务的细节；然后询问他们使用非传统疗法的情况。
三分之一的受访者（34%）报告在过去一年中至少使用过一种非传统疗法，其中三分之一的人寻求非传统疗法的治疗。后一组在前一年平均拜访此类治疗提供者19次，每次拜访的平均费用为27.60美元。非传统疗法的使用频率在不同社会人口群体中略有差异，年龄在25至49岁、教育程度相对较高且收入较高的非黑人使用频率最高。大多数人使用非传统疗法治疗慢性疾病，而非危及生命的疾病。在因严重医疗状况使用非传统疗法的人中，绝大多数（83%）也因同样的状况寻求医生治疗；然而，72%使用非传统疗法的受访者未告知他们的医生自己使用过该疗法。根据对美国人口的推断，1990年美国人估计拜访非传统疗法提供者达4.25亿人次。这个数字超过了拜访所有美国初级保健医生的人次（3.88亿）。1990年与使用非传统疗法相关的支出约为137亿美元，其中四分之三（103亿美元）是自掏腰包。这个数字与美国每年用于所有住院治疗的128亿美元自付费用相当。
美国非传统疗法的使用频率远高于先前报道。医生在获取病史时应询问患者使用非传统疗法的情况。
