As Budgets Tighten, More People Decide Medical Care Can Wait
- From: Jim Higgins <gordian238@xxxxxxxxxxx>
- Date: Sun, 19 Oct 2008 12:56:57 -0400
As Budgets Tighten, More People Decide Medical Care Can Wait
http://tinyurl.com/4wsc45
To monitor the multiple sclerosis attacking Ann Pietrangelo's central
nervous system, her doctor recommends an annual MRI. Last year, the
49-year-old Winchester, Va., woman had to pay a $3,000 co-payment to get
the imaging done.
This year, she's skipping the test. Even with insurance, it's more than
her budget can tolerate, especially with the roller coaster on Wall
Street devouring her retirement savings.
"I'm doing everything I can to avoid going to the doctor," she said.
From Park Avenue dental offices to the Arlington Free Clinic, the
global economic crunch is forcing a growing number of Americans to scale
back on medical care. Consumers are attempting their own form of triage,
pushing off seemingly less-urgent services in the hope that their
financial health will improve. But the danger, say physicians, is that
the short-term savings may translate into more severe long-term health
implications.
At the extreme are cases such as the Texas woman who went to the
hospital complaining of back pain. Physician Doug Curran immediately
spotted cancer on the X-ray.
"She'd had a lump in her breast for a while, but things were tight and
she said she couldn't get it looked at," he recalled. "We're going to
see more of that."
Nationwide, the number of consumers who went without a prescription,
tapped into retirement savings to pay for health care or skipped a
doctor visit for themselves or a child has risen since last year,
according to a survey released this summer by the Rockefeller Foundation
and Time magazine. One-quarter of the 2,000 respondents, for example,
said they had decided not to see a doctor because of cost in 2008, up
from 18 percent the year before. Ten percent said they did not take a
child to the doctor for the same reason.
"When the economy is in the situation we have today, people make tough
choices," said Kansas Insurance Commissioner Sandy Praeger, who is head
of the National Association of Insurance Commissioners. "Things are just
not going to get done."
After nearly a decade of steady -- often double-digit -- increases in
drug spending, the research company IMS Health this summer recorded the
first actual decline. And a survey by the Center for Studying Health
System Change found that nearly 20 percent of Americans report having
difficulty paying medical bills.
Layoffs, shrinking bank accounts, rising medical prices and widespread
anxiety that the economy is likely to worsen are prompting people to
split pills, forgo screening tests such as colonoscopies, delay elective
procedures such as laser eye surgery and turn to home remedies as
cheaper alternatives. Hospitals report that unpaid medical bills are on
the rise, pharmacists see a spike in cheaper generics, and demand for
low-cost care is climbing.
Falls Church music teacher Lisa Emrich is coping with a dwindling number
of piano students by cutting back on physician visits.
"I have too many doctors and specialists who all wish to see me twice a
year," said Emrich, who is being treated for multiple sclerosis and
arthritis. "Sometimes I might skip one if I'm doing well in that area. .
.. . When I see my neurologist, I'll ask about my arthritis, which
doesn't make much sense. But I try to get as much as possible out of my
doctor visits."
For Sandra Harrington, a waitress from Oxon Hill, the trade-off comes in
treatment for an infected eye. Her doctor prescribed administering
steroid drops twice a day. But as her tips have shrunk, she has decided
that applying the $100 medication once a day is all she can afford.
"It's a vicious cycle," she said, explaining that because it is too
painful for her eye to be exposed to direct sunlight, she works only
night shifts. "People cut back. Then people like me suffer."
In the past month, traffic on the five-year-old advice site
JustAnswer.com rose 14 percent. The site, which allows customers to pose
a health question and "bid" $9 to $30 for a doctor's or a nurse's
response, had nearly 400,000 page views in 30 days, said chief executive
and founder Andy Kurtzig. In a telling sign, inquiries related to
stress, high blood pressure, drinking and heart pain jumped 33 percent.
At the Arlington Free Clinic, the surge in people seeking care has been
overwhelming, said Executive Director Nancy Sanger Pallesen. Last week,
the clinic provided free preventive screenings to 19 new patients, but
it turned away 27 others, she said.
"Those numbers are higher than what we were seeing just this summer,"
she said. "Unfortunately, we can't take them all in."
Even free care may not be a good deal for people with limited means. For
some, the price of transportation is prohibitive; others fear
discovering an illness they do not have the money to treat.
Many are forced to juggle competing medical needs. Pietrangelo must
balance the importance of the MRI, which detects brain lesions, and the
costly medications that prevent her from relapsing. She pays co-payments
of $500 per drug per month. There are no generic alternatives.
"I can't shop around," she said. "My hands are tied."
Most analysts expect the medical crunch to worsen.
"We know from past experience that an economic downturn drives more
people to be uninsured," said Len Nichols, director of health policy at
the nonprofit, nonpartisan New America Foundation, a think tank. "They
lose their jobs, they lose their income and their insurance."
That is what happened to Tim Doss. On Sept. 18, after driving a cement
truck for an Indiana company for 10 years, he was laid off.
"They told me, 'As of midnight, your insurance is lapsed,' " he said.
Doss, 50, and his wife have illnesses that require medications, regular
doctor visits and tests. Creditors have come to their home trying to
collect the $3,000 they owe in hospital co-payments from when they did
have insurance.
The couple decided that Doss's annual checkup took precedence because he
needed it to keep his commercial driver's license. The checkup, plus
blood work for a fatty liver and high cholesterol, cost $300. He
persuaded his doctor to provide free samples of his liver medicine.
Helen Doss does not plan to get an annual mammogram this year, even
though her mother died of breast cancer at age 56. Doss was offered a
free stress test at St. Vincent Indianapolis Hospital, but she is afraid
it will turn up more problems that she can't take care of.
"I'm just holding off for a year and hoping nothing happens," she said.
Their primary-care physician, Steven Wilk, is devoting more time to
helping patients decide what to postpone.
"Folks are asking us to try to limit what we order or pare it down to
the bare-bones minimum," he said. "As a doctor, I worry about the risk
of missing something at an early stage. It could lead to more serious
problems down the road."
In past recessions, health-care spending briefly spiked -- as people
raced to doctors before their insurance ran out -- and then fell
sharply, according to industry analysts.
"Many times in health care there's a lag of three to six months before
it hits really hard," said Donald Fisher, president of the American
Medical Group Association, which represents large, multi-specialty
providers. "If they have a problem, they get it fixed while they still
have health insurance. Then we see a decline in elective procedures, and
then we really see a drop-off."
In Plano, Tex., life feels like an endless downward spiral, Victoria
Freudiger said, for herself and her husband. Losing jobs meant
eliminating health insurance. No insurance meant Thomas Freudiger went
to the hospital when he developed pneumonia this summer. That resulted
in a $363 bill they couldn't pay. Now their credit is shot.
As the economy crumbled, both started canceling preventive screenings.
She hasn't had a pap smear or a mammogram for close to two years; he is
overdue for a colonoscopy. They use do-it-yourself dental cement to
patch their teeth and put their best face forward in job interviews. And
although her doctor prescribed Neurontin for her seizures, Victoria
Freudiger tries calming techniques instead of the pills.
"Instead of taking them every day, I wait until I start feeling sick,
and then I take them again," she said. "Both of us are suffering
mentally, emotionally and physically."
Though the burden is especially heavy for uninsured Americans, even
those who have coverage are feeling the pinch as employers shift higher
deductibles and co-payments onto employees.
"The reason why health care was immune [to recessions] in the past was
because most people were covered under good insurance plans," said Jean
Mitchell, a professor of public policy at Georgetown University. Now,
"people are realizing, 'Oh my gosh, I have to pay for this out of pocket.' "
In Durango, Colo., Marsha Porter-Norton and her husband, both
entrepreneurs in their mid-40s, switched to a high-deductible plan when
insurance premiums skyrocketed. Their new catastrophic policy costs $479
a month, but they have to pay the first $6,000 in expenses.
She is supposed to get ultrasounds twice a year to check on the fibroid
tumors in her uterus. But the couple's retirement portfolio "has taken a
massive hit," and they worry about their jobs, Porter-Norton said. So,
for now, she's going to wait on the $500 ultrasound.
--
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