Economy forcing patients to defer doctor visits

Journal Record, The (Oklahoma City), Jun 24, 2009 by Heather Caliendo

The sick economy is endangering the health of the nation.

Consumers are deferring or canceling preventive screenings including pap smears, mammograms and colonoscopies, according to an American Academy of Family Physicians national survey.

In addition, people are failing to return for follow-up visits and neglecting to refill medications.

Several Oklahoma hospitals and clinics report the recession is causing reduction of care.

Duane Koehler said patient visits are down about 10 to 15 percent at his clinic.

"I think it does have to do with current economic conditions," said Koehler, president of the Oklahoma Osteopathic Association. "When you look at stock portfolios having dropped off so much, people just don't have the disposable income."

Anthony Young, president and chief executive of SouthCrest Hospital in Tulsa, said the hospital and its clinics have noticed a decline in elective surgeries and primary care patients.

With the Oklahoma employment rate reaching 6.3 percent, Young said he is not surprised people are forgoing doctor's visits.

"For most people health insurance is tied to employment," he said. "When you don't have employment, there goes health insurance."

About 58 percent of physician respondents reported having seen fewer patients since the recession began, according to the AAFP survey.

Although people believe they are saving money by avoiding hospital visits, Koehler said it can eventually have a devastating effect on one's health.

"Particularly with some of the chronic illnesses, not being able to pick up a minor problem could become a catastrophic problem," he said. "Some of these catastrophic events are because they have not bothered to catch it early."

If an illness becomes chronically severe it could end up costing the patient more money.

"It's like the analogy of a car and when you don't check your oil and you have to buy a new engine," said Koehler. "Oil is a lot cheaper then buying a new engine."

Hospitals rely on areas like outpatient surgeries to help make money, said Dwight Hardy, family practice physician at SouthCrest.

"A whole lot of hospitals nationwide are putting around and doing OK when they used to be running sort of in the black," he said. "Now they are definitely in the red. It's a problem."

Cathryn Hibbs, chief executive of Deaconess Hospital in Oklahoma City, said many patients are asking physicians for early morning or late evening appointments.

"We speculate that people don't want to take off work and are afraid to take off work to visit the doctor," she said. "They are afraid if they take off work for health care they will be the ones most likely laid off."

From an employer standpoint, Hibbs said healthier employees are more productive.

She said more preventive care can help curb employee sickness in the long run.

"If an employee is really sick that just means they are out of work longer," said Hibbs. "Appointment visits should be made and not forced to be neglected."

Since more patients are requesting after-hour appointments, Hardy said they are exploring extended and evening hours.

"We are thinking about expanding hours a bit to see if that doesn't open availability to people," he said. "Instead of missing the doctor they can find times to come not during work hours."

Young said to say the health care industry is recession-proof is a myth.

"Yes, the demand stays there," he said. "But the recession can affect people's ability to pay for services. I think health care is not positioned well in the recession."