News Column

Strapped Americans Skipping Doctor Visits

Oct. 2, 2012

Todd Ackerman

health

Buffeted by the sluggish economy and rising insurance co-payments and deductibles, working-age Americans are visiting the doctor less frequently.

New U.S. Census Bureau data released Monday showed that non-retired adults made an average of 3.9 visits to doctors or other medical providers in 2010, down from 4.8 in 2001. The decline was reflected in those insured and uninsured, in excellent health and poor health, and in all surveyed ages, ethnicities and sexes.

"It's a widespread decline in the use of medical services," said Brett O'Hara, chief of the Census Bureau's health and disability statistics branch and a co-author of the report. "It's really affecting everyone."

Pauline Rosenau, a health policy professor at the University of Texas School of Public Health in Houston, called the data unsurprising. She said people always cut back on the use of medical services during tough economic times and when employers shift more insurance costs to employees.

Rosenau said the Census Bureau report does not provide enough information, such as whether doctors have increased their fees, to assess the trend's financial impact on Houston's medical community.

Vivian Ho, a Rice University health economist, said the census findings are not likely an "ominous sign" for the important health-care sector of Houston's economy.

Doctors are doing higher-tech procedures that generate more revenue, Ho said, and demand is likely to increase in 2014 when the insurance provisions of the Obama administration's health care reform law take effect.

Rosenau noted that uninsured people postpone health services if they know they'll have insurance in the near future, and insured people make greater use of their coverage when the economy improves.

Local vs. national data

But Stephen Linder, another professor in the UT School of Public Health, said some of the statistics don't bode well for the health of the Houston community. Linder, who surveyed Houstonians about their health last year, was struck by the contrast between the national census data and his local findings.

The census report found roughly 10 percent of people consider themselves to be in fair or poor health, compared with 20 percent in Linder's survey. In addition, nearly 33 percent of people in the census report rated their health as excellent, compared with 13.6 percent in Linder's survey.

Previous studies have shown people's assessment of their health corresponds well to their doctors' records.

"That suggests that the health needs here are greater, that people are in worse condition," said Linder. "That's not a good population to be postponing visits to the doctor."

The census report, taken from survey questions asked of adults ages 18 to 64 for the first time in 2001 and in most years since then, found the average number of annual visits dropped from 12.9 to 11.6 among those in fair or poor health; from 5.3 to 4.2 among those in good health; and from 3.2 to 2.5 among those in excellent or very good health.

Women were more likely than men to have seen a medical provider in 2010 -- 78 percent vs. 67 percent. Only 42 percent of Hispanics saw a provider, the lowest total of any racial or ethnic group.

Other census findings:

--People were less likely to visit a dentist (59 percent) than a medical provider (73 percent).

--92 percent of people did not spend a night in a hospital and only 1 percent spent eight or more nights.

--More than half of people (57 percent) didn't take prescription medications at any point in 2010, while more than a third took them regularly.

--Surprisingly, the percentage of people insured was just as high (85 percent) among those in poor health as those in excellent health. In last year's Houston survey, insured people were in better health than those without medical coverage.

Keeping their savings

Rosenau said another possible reason for the decline in doctor visits is the increased use of health savings accounts, whose deductibles -- $2,000 on average -- discourage the owner from seeking care and which often allow the owner to use the money later. In some cases, owners may withdraw the money at age 65.

The census report found 37 percent of adults 18 to 24 didn't visit a doctor in 2010, a trend noticed by local doctors.

"Younger adults, often seeing themselves as invincible, increasingly aren't seeing a doctor for a yearly exam," said Dr. Keith Bourgeois, president of the Harris County Medical Society and a past chairman of the Texas Medical Association's Council on Socioeconomics. "The problem with that is that everyone needs a medical home to maintain records. Without it, the prognosis tends to be worse when you find out."



Source: (c)2012 Houston Chronicle. Distributed by MCT Information Services.


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