Patients feel a little more confident they can pay for care

An index measuring patients' confidence in their ability to pay for care is going up -- but not yet to a point that indicates they're feeling out of the economic woods.

The Thomson Reuters Consumer Healthcare Sentiment Index for December 2011, released Jan. 12, increased to 99 -- up from 98 in November 2011 and 96 in October 2011. An increasing number means more patients feel better about their ability to pay for care in the future and were less likely to have delayed or postponed medical services in the recent past. The number is derived from a survey of a demographically representative sample of 3,000 households.

However, the index is not yet back to a baseline of 100 set in December 2009 -- mere months after the official end of the recession, and a time when the unemployment rate was higher and the number of uninsured was lower.

"This is an indication of increased optimism," said George Popa, research scientist with the Thomson Reuters Center for Healthcare Analytics. "If we continue to see an uptick, that's when we will see patients returning to doctors' offices, but we have to wait and see."

The recession began in December 2007 and officially ended in June 2009, according to the National Bureau of Economic Research. Despite some growth, the economy was in rough shape as of December 2009.

The unemployment rate was 9.9%, compared with 8.5% in December 2011. At the end of 2010, 49.9 million Americans had spent at least part of the previous 12 months uninsured, compared with 49 million at the end of 2009, according to a Sept. 13, 2011, report by the U.S. Census Bureau.

Other data sets and surveys suggest that the economy -- and patients' confidence in paying for care -- is far from fully recovered.

According to a Harris Poll of 2,237 adults conducted from Dec. 5 to Dec. 12, 2011, and released Jan. 4, 19% said they expect their household's financial condition to improve in the next six months. This was a decline from the 27% who said this at the end of 2010. The proportion who believed finances would worsen held steady at 28% at the close of 2011 while 27% said this in 2010.

Various reports have said patients' finances have pushed down the number of visits they make to physician offices. For example, the Kaiser Family Foundation issued research on Nov. 15, 2011, suggesting that visits to physicians by insured patients dipped 17% in two years. The number of visits went down from 156 million in the second quarter of 2009 to 129 million in the second quarter of 2011.

"I don't think we know whether utilization is going to kick back up," said Alwyn Cassil, director of public affairs with the Center for Studying Health System Change. "We just don't have enough information in real time. But history tells us that as people feel more comfortable, we will start to see utilization go up again."

In addition, physician offices are unlikely to see a huge impact from health system reform yet because the most important aspects are not due to roll out until 2014.

"Health system reform hasn't even really started," Cassil said. "So far, it's only impacted relatively small groups of people."