The role of personality traits in health care utilization

Why we asked

Whether someone sees a doctor depends on a lot of things. They have to be able to get there and pay for it, they have to be sick or think they are, and they have to decide it is worth the trouble. Insurance used to be the biggest piece of that puzzle in the United States. As coverage has expanded, we suspected that the person’s own tendencies might matter more than they used to. Personality is one of those tendencies, so we wanted to know whether it tracks with who uses health care, even after accounting for how healthy someone is.

What we did

We used the Health and Retirement Study, which followed 14,358 older adults across roughly two decades (141,401 measurements in all). Every two years, participants told us whether they had used several kinds of services, including general practitioners, dentists, hospitals, outpatient care, prescription medication, and special facilities. They reported their personality once, and we fit a separate multilevel model for every combination of trait and service. Each model included age, gender, race, education, the number of chronic conditions, and self-rated health.

Our second question was whether personality changes how closely someone’s health tracks their use of care. Some people call the doctor at the first sign of a cold, and others avoid treatment even with a serious diagnosis.

What we found

Traits were associated with using services above and beyond health, and the associations were modest. Odds ratios were mostly between about 1.05 and 1.2. For example, a one standard deviation increase in extraversion went with roughly 10% higher odds of seeing a general practitioner. Extraversion and openness were associated with the most services. More conscientious participants were more likely to see a general practitioner and a dentist, which fits the idea that they keep up with routine care. We found little evidence that traits changed the link between health and care, although conscientious participants showed a stronger link between chronic conditions and some services.

What it means

These data are observational, so we cannot say that personality causes anyone to seek care. We suspect (this is speculation) that rule-following, a facet of conscientiousness, explains part of the pattern, because people who follow advice tend to go to the dentist twice a year. Testing that will take measures of narrower traits than the Big Five.

Personality is one piece of who uses health care.