Economic Distress: Patients Delay Doctor Visits, Skimp on Meds

12.20.2007AARP Bulletin Today

by: Sid Kirchheimer

Janet Egielske says it’s hard to deal with the constant pain in her shoulder. But even tougher would be seeing a doctor to treat it. “I already take 14 drugs a day, and I just can’t afford another prescription,” explains the 71-year-old widow in Rushville, Ind. “That would also mean another doctor’s bill that I can’t pay.”

After paying her living expenses and health care costs—$260 a month for medications plus monthly installments to whittle down five previous hospital bills—Egielske, who had open-heart surgery eight years ago and has respiratory illness and other health problems, made it through September with only 99 cents left. Her only source of income: a $1,037 monthly Social Security check.

Egielske survived October with $16 to spare. “But that’s because I couldn’t pay my water bill,” says the retired owner of a day care center. “Luckily, my son’s girlfriend lent me the money so they wouldn’t shut off my water. She tells me not to worry about paying her back, but all I do these days is worry. It’s always been a hard balancing act, but with the economy being the way it is and everything getting more expensive, it’s gotten so much worse.”

Joe, a Pennsylvania health care worker who asked not to be identified, is skipping doses of the pain medication prescribed to help him mend from recent surgery. “I go without it on some days in order to stretch out my supply,” says the 51-year-old. “The pills are expensive, and my insurance covers only so much.”

And in Florida, hand surgeon Dennis Sagini, M.D., also feels the pain—in his own pocket and in the welfare of his patients. “Some of them should be treated sooner rather than later, but they are canceling the surgery they need because they cannot afford their insurance deductibles or to take time off from work to recuperate” he says. “They are worried about losing that income for a few weeks … or losing their jobs altogether because they didn’t go to work.”

Paying for medical care has long been a struggle for many—including those with health insurance—but as budgets tighten because of the economic crunch, more are skimping on needed treatment.

Nearly half of Americans now report that someone in their family has cut back on their medical care or prescribed medications—postponing checkups, recommended tests and procedures; cutting pills or skipping doses of required medications; or not filling new prescriptions, according to a Kaiser Family Foundation poll conducted in October. That’s up from 42 percent of those surveyed six months earlier. One in three now has trouble paying medical bills, and one in five reports medical debt of at least $1,000.

“Even in 2007, before the economy really took a downspin, we saw that one in five people was having problems paying medical bills—up from one in seven in 2003,” says Alwyn Cassil, director of public affairs for the Center for Studying Health System Change, a nonpartisan health policy research organization in Washington. “But what we didn’t see last year were these rising rates in unemployment and the problems on Wall Street. The economy may not have been great then, but it wasn’t as bad as it is now.” Before the fall economic fallout, at least 79 million Americans—including some 7 million people age 65 and older—were already struggling with health care bills. Now, more are doing what they can to avoid joining those ranks, even when it means their health and comfort suffer.

“I see my doctor every three months because I’m diabetic,” says Christine Bartiromo, a Chicago resident in her 80s. “But I have spinal stenosis”—a narrowing in one or more areas of the spine—“and I’m in a wheelchair, and the cab fare is $16 each way. That’s a lot of money to go back and forth. Since groceries have increased and my rent is up, I have to pick and choose which doctors I see and which I don’t.” When two broken teeth made eating difficult, Bartimoro decided to forgo dental treatment because of the expense—until a local dentist learned about her situation and offered to fix her teeth for free

“As rough as it is for me,” she says. “I know there are other people worse off.”

Since the recent financial crisis made news, the American Psychological Association reports a 12 percent increase over last spring in people saying the economy is a significant source of stress; those hardest hit are women middle-aged and older. Yet as stress levels increase, psychiatrists and psychologists, along with other health providers, report a drop in patients seeking therapy, largely because of the expense.

 In a recent national survey conducted by AARP, one in five respondents blamed health problems on financial stress. About the same percentage said they had delayed seeing a doctor or other medical professional; many reported cutting back on drugs and necessary health care. Roughly one in five respondents also reported seeking outside assistance through drug companies, pharmacies and other programs to reduce their health costs.

“It’s hard to connect any uptake in calls we’re getting specifically to the current economic crisis, because our calls have been increasing anyway for several months,” says Mark Rukavina, director of the Boston-based Access Project, a nonprofit research and advocacy group that helps people get health care. “But we are talking to more people with health insurance who are struggling just to pay their premiums.”

Just ask Susan Blankenship, a 62-year-old accountant in Ohio. Last year, at her doctor’s recommendation, she underwent a blood test for chronic hypoglycemia—abnormally low blood sugar—only to learn she had to pay the entire $900 cost because of her high deductible. This year, when her doctor advised her to repeat the test, she refused.

“I have what may be considered good health insurance, but my premiums doubled last year. My deductible used to be $100; now it’s $300. But I know people with deductibles of $500 or $1,000, which for many people is like having no insurance at all,” she says. “I’m one of those who invested wisely. I bought quality, I bought dividends, I bought safe. But like many others, my nest egg just got scrambled because of what happened on Wall Street. So when you have to plunk down $1,000 to get a blood test for a condition that probably won’t kill you anytime soon, you wait—and take your chances that it won’t.”

Help When You’re Hurting

Ask for a discount. Few people ask for one, but when they did, 70 percent of patients who negotiated with hospitals got a price break. Sixty-one percent succeeded in getting a discount from their doctor and 64 percent got a deal from their dentist, according to a Harris/Wall Street Journal survey. For best results, call a local insurer to inquire about its reimbursement rate (usually one-half to two-thirds of the billed amount). Then politely ask the doctor or dentist—not a staff member—or hospital official in person, not by phone, for a discount.

Tap into community programs. Start with your local or state health department. Or visit the U.S. Department of Health and Human Services to learn about available services, from preventative screenings to primary care. These tax-supported programs primarily serve the uninsured, but sometimes accept insured patients, often on a sliding payment scale. Also try your member of Congress, state representative and even the attorney general’s consumer protection office for the inside scoop on little-publicized programs in your area.

Make a formal follow-up. If you are billed for services you thought were covered by your insurer, write a letter—rather than calling—to find out why. “Oftentimes, insurers play a cash flow game with providers, saying your treatment costs weren’t submitted on the proper form,” says patient advocate Mark Rukavina. To better ensure a quick resolution, note on this “formal letter” that copies are being sent to the above mentioned officials.

Think generic—across the board. It’s a no-brainer that generic prescriptions are usually cheaper than their brand-name counterparts. The same applies to over-the-counter drugs, vitamins and other health care products, with store brands costing up to 40 percent less.

Consider a flexible spending account (FSA). These underutilized employee savings accounts let you sock away pretax money for health care costs. Funds set aside can also be used to stock up on eligible over-the-counter drugstore items, such as acetaminophen or mouthwash. Any money not spent by year’s end is forfeited.

Apply for hospital charity care. Older Americans with annual household incomes below $23,000 automatically qualify, but even if you earn more, you may be eligible—depending on the average household income in your ZIP code.

Sid Kirchheimer writes regularly for the AARP Bulletin on health and finance.