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."
