Thursday, October 23, 2008
More people are reporting having trouble paying medical bills.
Scripps Howard News Service
Millions of Americans are skimping on medical visits, prescription drugs and diagnostic tests, even if they have health insurance coverage, because they can’t afford to pay even part of the cost.
Hard times are expanding a trend that affected many even before real estate and stocks declined — some experts calculate that 1 in 7 families are one major illness away from medical bankruptcy.
A poll by the Kaiser Family Foundation released this week found 47 percent of adults surveyed said someone in their family had skipped pills, or postponed or cut back on needed medical care in the past year because of cost concerns.
Nearly a third reported their family has had problems paying medical bills in the past year, up from about 25 percent two years ago.
Another study, released last month by the Center for Studying Health System Change, found that just under 20 percent of Americans lived in families that had problems paying their medical bills in 2007.
Certainly, on the face of things, going without health care is bad. Preventive care, in particular, is likely to suffer. Early diagnosis of many illnesses is less likely to happen, making treatment later on more complicated, expensive and in many cases less successful.
But at the same time, recession is thrusting much of the public into a giant, uncontrolled experiment about what happens when we’re forced to be stingy with health care.
Free-market advocates have long argued that people would shop around for medical treatment and presumably spend more cautiously, if they were more sensitive to the costs.
In this view, medical care is a product like gas, groceries and home electronics. So, along with big cars and McMansions, more folks may have to give up big health care, which in an ideal world would be all the unneeded services ordered through a system used to passing along costs to insurance plans.
The problem, of course, is that in most health-care settings, price tags are nowhere to be seen, and shopping around for all but the most elective care is seldom an option. Most doctors, let alone patients, simply don’t know or don’t have time or expertise to find out if a cheaper treatment option exists. For most families, it’s either do what the doctor recommends or do without.
Another study published this week about emergency-room use makes this point soundly. Researchers at the University of Michigan combed through 127 medical papers done in the past decade on emergency department caseloads to conclude that, contrary to popular and official belief, uninsured people don’t make up a disproportionate share of people in the ER hallways — and they’re not to blame for overcrowding and long waits.
If anything, said researchers, it’s people who have insurance are more likely to contribute to ER overcrowding and to go there for minor complaints or in lieu of a visit to a doctor’s office.
Patients with no insurance face paying the full charge for the visit — hundreds to thousands of dollars, while most people with insurance face ER co-pays of $50 to $200 — still pricey compared with a $10 or $20 co-pay for an office visit, but in good times, a reasonable extra expense compared with the hassle of landing a medical appointment. Now, even for many families with insurance, $100 looks like a lot more money than it did a year or two ago.
Reports of more stress-induced mental illness related to the economy, more suicides and murder-suicides, are already circulating.
But other research suggests an imposed simplification of lifestyles can also have a positive effect on some causes of death — car fatalities are already down with people driving less, and people using public transit also walk more. People are also reported to be eating out less and cooking from scratch at home more.
In a landmark paper published in 2000, a University of North Carolina economics professor, Christopher Ruhm, analyzed death rates and health behaviors against economic upturns and downturns between 1972 and 1991.
He found that overall death rates actually went down sharply during recessions in 1974 and 1982, and increased as the economy recovered starting in the mid-’80s. The effect was most pronounced for heart disease and car crashes.
He also found that deaths from cancer rose substantially during the downturns, along with suicides and homicides, and there were slight increases in deaths from flu and pneumonia.