Non-attendance for Social Security medical examination: patients who cannot afford to get better?

This paper reports results from a cross-sectional study of 290 consecutive Invalidity Benefit cases in the north-west of England referred to the Benefits Agency Medical Service in 1994. The hypothesis is that socio-economic factors, such as high locality unemployment rates, may be implicated, not only in the initial causation of ill health, but also in its continuance, by giving incentive to the ongoing adoption of the sick role. Results showed that residence in Liverpool, a diagnosis of anxiety/depression or simple back pain, and age under 40 years were all significantly related to non-attendance (P < 0.01). Claimants from Liverpool were also younger, overall, more likely to be called for examination, but less likely to be found fit for work if they attended. This suggests that some claimants may not attend examination because they fear being found fit for work and losing the benefit on which they and their families depend.