The effects of latent social needs on physician utilization by immigrants: a replication study

The research reported in the present paper is a replication of Shuval et al.'s study of the effects of latent social needs of new immigrants on their utilization of health care services. By restoring to path analysis, the replication undertook to explore two questions: (1) Is the need for catharsis (i.e. for emotional support) found by Shuval et al. to affect utilization directly (i.e. not via illness) indeed characteristic only for the first years of stay in the host country. (2) Isn't it rather the differential access to social resources, ad determined by social class and age, which at present explains the need-utilization relationship? The findings show that even though the need still persists among the one-time immigrants, it is a quite poor predictor of all other attributes found to affect physician utilization: viz. the emotional and physical illness and the tendency to define oneself as ill. With the passage of time the former immigrants seem to have abandoned the previously customary mode of gratifying the need for catharsis by turning to the health services. Hence, even the respondents with a keen experience of that need tended to refrain from turning to physicians in the absence of 'concrete' symptoms. At the same time, the lower classes and the elderly, without experiencing the need for catharsis, turned to have higher rates of physician visits, simply by virtue of being relatively more ill. In conclusion, a plea is made for the improvement of the design flaws common for the type of causal inquiry into the need-utilization relationship, which this study represents.