Get access

Older Persons' Evaluations of Health Care: The Effects of Medical Skepticism and Worry about Health


  • Tyrone F. Borders,

    Search for more papers by this author
    • Address correspondence to Tyrone F. Borders, Ph.D., Division of Health Services Research, Texas Tech University Health Sciences Center, 3601 4th St., Suite 1C165, Lubbock, TX 79430. With the Division of Health Services Research, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Tyrone F. Borders, Ph.D., is an Assistant Professor and the Division Chief, James E. Rohrer, Ph.D., is a Professor, and K. Tom Xu, Ph.D., is an Assistant Professor. David R. Smith, M.D., is Chancellor, Texas Tech University System, Lubbock.

  • James E. Rohrer,

  • K. Tom Xu,

  • David R. Smith

  • This research was supported by grant no. HS11606-01 from the U.S. Agency for Healthcare Research and Quality and grant no. 90AM2378 from the U.S. Administration on Aging. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Agency for Healthcare Research and Quality or Administration on Aging policy.


Objective. To describe how skepticism about medical care and other individual differences, including worry about health status, are associated with evaluations of health care among the noninstitutionalized elderly.

Data Sources/Study Setting. Data were collected through a survey of approximately 5,000 community-dwelling elders (aged 65 and older) in a southwestern region of the United States.

Study Design. Global evaluations of health care were measured with two items from the Consumer Assessment of Health Plans Study (CAHPS) instrument, an overall care rating (OCR) and a personal doctor rating (PDR). Multivariate ordered logit regression models were tested to examine how medical skepticism and other factors were associated with ratings of 0–7, 8–9, and 10.

Principal Findings. Consumers who were skeptical of prescription drugs relative to home remedies, who held attitudes that they understand their health better than most doctors, and who worried about their health had worse OCR and PDR. Those who held attitudes that individual behavior determines how soon one gets better when sick had better PDR and OCR.

Conclusions. Health policymakers, managers, and providers may need to consider the degree to which they should attempt to satisfy skeptical consumers, many of whom may never rate their care highly. Alternatively, they may need to target skeptical consumers with educational efforts explaining the benefits of medical care.