Costs keeping patients away from doctors' offices

A survey echoes other studies' findings that people are putting off care because they can't afford it.

By Emily Berry — Posted Aug. 23, 2010

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Karl Watts, MD, a family physician in Boise, Idaho, said he frequently sees what multiple surveys are finding: Patients are putting off seeing a doctor, often because of cost.

Deloitte Center for Health Solutions in August released the latest numbers reaching that conclusion. According to those findings, 79% of 4,008 patients surveyed visited a physician or health professional in the previous year, down from 85% in 2009. Among those without insurance, 74% -- up from 70% in 2009 -- said cost was the main reason for skipping care. Overall, 40% of respondents said they delayed care because of cost, up from 38% in 2009.

Dr. Watts said he sees the consequences of these decisions. For example, Dr. Watts saw a father of two in his free clinic who had put off getting a skin lesion examined because he was worried about the cost. By the time Dr. Watts saw him, the patient had stage II melanoma.

"Unfortunately, that is occurring multiple times in our community, here and across the U.S., and it's definitely getting worse, because more and more businesses are not offering insurance," he said.

The Centers for Disease Control and Prevention's National Center for Health Statistics said 15.4% of Americans were uninsured at one time in 2009, and major health plans have reported declining membership, as businesses stopped offering coverage or have laid off employees.

The Deloitte survey found that the percentage of patients who decided not to see a doctor when they were sick or injured actually declined, going down to 20% in the 2010 survey from 25% in 2009. However, cost was more frequently cited as a reason for people not to visit a physician, particularly for those without insurance. Deloitte said 74% of those uninsured gave cost as the main reason for skipping care, up from 70% in 2009.

Insurers are noticing their members cutting down trips to the doctor. Most of the largest shareholder-owned health plans reported lower-than-expected utilization in the first half of 2010. The trend was driven in part by a flu season that was milder than expected, which drove down every insurer's medical-loss ratio, the portion of every premium dollar spent on health care.

Health plan executives also figure the drop is economically driven, at least in part.

"We are seeing it everywhere, in every segment of the business at this time," Aetna President Mark Bertolini told analysts during the company's second-quarter earnings call. "There are a number of impacts, but the economy does definitely have an impact here."

Deloitte's findings echo those from a survey by BlueCross BlueShield of North Carolina released in October 2009, and one by the American Academy of Family Physicians in May 2009.

The North Carolina survey found that 15% to 17% of those surveyed were skipping routine checkups and preventive care, specialist visits and recommended treatments. Twice as many were taking fewer prescriptions, skipping prescription doses or not filling prescriptions because of cost.

Ninety percent of the physicians who responded in the AAFP survey said their patients were expressing concerns about their ability to pay for care.

Figures from 2009 telephone surveys released by the Centers for Disease Control's Behavioral Risk Factor Surveillance System Survey Data and analyzed by the Kaiser Family Foundation found that 14.9% of adults said they had not seen a doctor in the last 12 months due to cost.

The health consequences of delayed care won't be good, said Russ Rudish, vice chair and U.S. health care provider sector leader at Deloitte.

"These are people who need care," he said. "That's a big deal."

For some families, health care has become the biggest budget item, and people will go without a visit to the doctor when food and housing are more essential, Rudish said.

Dr. Watts said he sees more and more patients in the free clinic whom he used to see in private practice. Typically, either they have lost a job or their employer has stopped offering health insurance, he said.

When an individual health insurance mandate takes effect in 2014, some, like Dr. Watts, expect to see newly insured patients overwhelm physicians' offices and hospitals looking for care for long-ignored health problems.

"I do not think we'll have the work force to handle that," he said. "I think that's going to be a big dilemma for us."

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Patients' attitudes about care

Deloitte's third annual consumer health survey found an increasing number of patients putting off or skipping visits because they feel they can't afford care. Other highlights of the 2010 survey, which included answers from more than 4,000 adults:

  • 8 of 10 respondents had a primary care physician, unchanged from 2009, but more of those without a primary care physician cited cost as the major contributing factor.
  • 13% of respondents said they switched physicians in the last year, versus 16% in 2009.
  • 23% of respondents said they believe they understand how the health care system works.
  • 1 in 3 respondents said they believe the market needs 10 or more insurance companies competing to ensure consumer choice.
  • 7 out of 8 respondents believe themselves to be in "excellent," "very good" or "good" health, yet more than half have been diagnosed with one or more chronic conditions.
  • 24% remained confident about managing future health care costs, but of the people who skipped care when sick or injured, 4 out of 10 did so due to cost.
  • More of those surveyed said they were seeking alternative or natural remedies before seeing a physician (17% in 2010 versus 12% in 2009).
  • More respondents were supplementing their current regimens with alternative remedies (20% in 2010 versus 16% in 2009).

Source: "2010 U.S. Survey of Health Care Consumers," Deloitte Center for Health Solutions, August (link)

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