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Wednesday, July 23, 2008

"Tough Times Prompt Patients to Skip Care"

An indication of how people respond to paying more for health care:

Tough Times Prompt Patients to Skip Care, by Benjamin Brewer, WSJ: With gas prices hovering around $4 a gallon, my patients are cutting back on medical care.

A 59-year-old woman decided not to have a mammogram this year. At her age, she should be screened for colon cancer, too, but she is holding off until she becomes eligible for Medicare at 65. ... If she develops cancer of the colon or breast she won't have saved anything. ...

Rising deductibles, stiff drug co-payments and increasing prices for just about everything are forcing some hard choices about health. Care that doesn't strike patients as critical is getting delayed. As the economy squeezes my patients, they are showing up sicker.

A patient ... came to the office with severe pneumonia two days after refusing to let an E.R. doctor admit him to the hospital. My patient was afraid of the expense and all the time he would go without pay from work.

To make matters worse, he didn't fill the antibiotic prescription he was given either. The $50 co-payment was unaffordable, he said. This is a case when an insurer would have been better off picking up the antibiotic tab to avoid a larger expense. But there's no easy way for a doctor to override a plan's co-pay or to let an insurer know its rules are about to make something very expensive happen.

When the patient came to see me, his condition had deteriorated. I persuaded him to let me admit him to the local hospital. He was in such bad shape that he was soon transferred to the ICU of a large medical center. His care will end up costing tens of thousands of dollars.

It was no surprise to me to read recently that claims severity and costs for health insurers took an unexpected jump this year. ...

As a result of lean times, accounts receivable from uninsured patients in my practice is trending up...

Patients are still having babies at the same rate. But elective procedures, preventive exams and compliance with prescriptions are all down.

Some of my patients are taking themselves off medications. Just last week I encountered patients who stopped their cholesterol medication...

I noticed an uptick in patients canceling appointments and just not showing up over the last few weeks. ...

Many of our patients travel 20 or 30 miles to see us, and I think gas prices are affecting no-show and cancellation rates, particularly with low income patients.

My total number of office visits is off 5% from last year. ... I'm pretty well caught up on my daily deluge of paperwork... When things are busy, I almost never get those things accomplished.

It occurred to me in an idle moment that I would be a lot busier if the $600 government stimulus checks had been spent on a basket of basic primary care services. That would have paid for 130 million people to have had most of their health needs met for a year. Instead, folks around here seem to be spending more on $4 gas.

I think universal insurance offers the best solution to the problem of people skipping preventative measures to save themselves money in the short-run (provided, of course that the insurance covers preventative measures that are cost effective in the long-run). If people are uninsured, or are insured but must pay for preventative measures out-of-pocket, they tend to skip these important cost-saving measures. Perhaps it's due to a type of moral hazard - people believing that society will step in and provide care for life-threatening but curable illnesses - I don't know, it could be some sort of myopia, some other market failure, or an inconsistency in preferences. And insurance companies have no incentive to provide this care if they can disqualify people when they do become sick and shift the costs to the public sector, so the problem isn't necessarily on the consumer side. But whatever the cause, the solution to the health care problem should not induce people to forgo preventative care. Instead, such care ought to be encouraged, and one way to help with this is use universal insurance to forge an unbreakable lifetime relationship between the insurance company and the consumer so that expected lifetime costs are important to the insurance carrier.

    Posted by on Wednesday, July 23, 2008 at 01:44 PM in Economics, Health Care | Permalink  TrackBack (0)  Comments (32)

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