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As recession holds down health spending, have you made choices to forgo or delay treatment?

Medical costs are down, but are people forgoing care?
REUTERS/Hyungwon Kang
Medical costs are down, but are people forgoing care?

Has the economy forced you to forgo or put off medical care? Have you postponed care or gone without it — even if you have insurance?

Evidence that you either have or will is mounting, according to local health economists and social welfare researchers.

On Monday, the U.S. Department of Health and Human Services reported that health-care spending, as a share of the overall economy, stabilized in 2010. People may be using less care for a variety of reasons, including more prevalent cost-shifting provisions in insurance policies, job loss and greater awareness of the true cost of care.

But the economy is doubtless a factor, the report found.

"Although medical goods and services are generally viewed as necessities, the latest recession has had a dramatic effect on their utilization," the Associated Press (via the Star Tribune) quoted the report as saying. "Though the recession officially ended in 2009, its impact on the health care sector appears to have continued into 2010."

Trend seems likely to hold or accelerate in MN
Minnesota health officials agree. Though they won't have a corresponding local statistical portrait until June, researchers and economists say 2009 numbers [PDF] suggest the trend will either hold true or be accelerated here.

As in so many other arenas, Minnesotans have had farther to fall. In 2007, almost 81 percent of working-age Minnesotans had access to employer-sponsored insurance. By 2009, only 71 percent, did and a significant number had been forced onto high-deductible plans. Nationally, the number fell by 8 percent.

According to Minnesota Compass, a social indicators tracking project spearheaded by Wilder Research, average spending on health care by household in the 13-county Twin Cities metro area fell from $3,834 in 2007 to $3,354 in 2008 and $3,314 in 2009. At the national level, household spending on health care rose from $2,952 in 2007 to $2,966 in 2008 and $3,126 in 2009. 

According to the Kaiser Family Foundation, Minnesota's 2009-2010 health spending per capita is $7,409, higher than the national rate of $6,815, and the average employee contribution to workplace family coverage is lower – at 23 percent versus 27 percent. Nine percent of the state's population was uninsured during that time period, versus 16 percent nationally. 

Making cost-conscious choices?
There are those who argue that the stabilizing level of spending reflects growing consumer awareness of the need to make cost-conscious choices.

"It's possible patients are looking more critically at the care they are using," said Stefan Gildemeister, director of the Health Economics Program at the Minnesota Department of Health. "We need to wait until the [economic] recovery to see. It's crucial to understand whether it's a one- or two-year change or a change in the way we consume health care."

More likely, he noted, any change in consumption patterns has been triggered by the decrease in insurance plans that do not require consumers to bear a greater share of the cost.

Lynn Blewett
Lynn Blewett

Economist Lynn Blewett is a professor in the Division of Health Policy and Management at the University of Minnesota's School of Public Health and the director of the State Health Access Data Assistance Center.

"The data shows the movement is not because of cost-containment strategies," she said. "That's what people have in their head was supposed to happen, but it's just not true.

"It's the lack of ability to access health care at all."

Have you postponed or forgone care, be it preventive, elective or simply out of reach? Scroll down just a few more lines to our comments thread and share your experience.

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Comments (6)

The company I work for has raised both our deductible AND our co-pay, and these days, a "simple" trip to the doctor can end up being a very expensive proposition indeed. So yes - unless I'm in debilitating pain or experiencing a condition that interferes with my ability to get my work done, I tough it out and save the money on doctor's bills.

Shortest answer: Yes.

For the dozen years I lived in Colorado, I had no health insurance at all beyond a very basic dental plan – my dentists described it as “average” – and the co-pay for anything beyond the semi-annual checkup and cleaning was 50 percent. Not being blessed genetically with unusually robust teeth, I spent thousands of dollars on dental care, and would argue that dentistry is one of the most costly and most often missing ingredients in discussions of health care.

Everything else came directly out of my pocket. I paid for doctor visits, prescriptions, and when I had surgery for skin cancer, that, too, came out of my pocket entirely, as did the post-op treatment regimen. I learned to pay close attention to the charges for what are usually labeled as “routine” visits and treatments. The usual “routine” office visit to my doctor in a metro Denver clinic was about $95, and the visit lasted about 15 minutes.

So far, the only difference between having no coverage at all beyond that basic dental plan, and being enrolled in Medicare, is that my semi-annual doctor visits are now being paid by Medicare, but that same 15-minute visit to my doctor in a Minneapolis clinic now costs a handful of dollars short of $200, or at least that’s what Medicare is being billed.

I should add that the visit in question involves no treatment. It’s the usual “How are you feeling?” “Fine.” “Any issues or problems you’ve noticed?” “No.” BP and pulse get checked, and I see, once again, that I’ve not lost the 25 pounds I gained in the year after I quit smoking in 1990.

Have I postponed care that’s elective or preventative? Yes.

Ditto to #1. AND our premiums went up too. You can bet that when I have my allergy treatment recheck appointment this year, I will refuse the lung capacity test (or whatever you call it). That 2 minutes of blowing into a plastic tube cost me $250 last year and told me and my doctor nothing we didn't already know.

Oh. And, yes, there are two surgeries I should have. But not until I am unable to function. I simply do not have an extra $20,000 laying around for coinsurance payments and deductibles.

Don't suggest I should have picked a different plan. Where I work your choice is the plan offered or none at all.

I went to the Dr. Monday after a second bout of fever and fatigue within 10 days and I am glad I did. The Dr. prescribed an antibiotic, an inhaler, and an moderately priced over the counter palliative. After a day of treatment and rest I was able to go back to work altho now I am out of sick days and it is only mid January with no bank for future maladies.
Let us say I had waited. One I would have suffered more needlessly. My return to work would have been delayed. My ability to work well would have been impaired. Now had this happened to the rest of my family who does not have as good a plan which is self paid. There would have been more suffering, and school impairment and a total wipeout (in fact a charge to any savings).

According to the World Health Organization, the USA has the most expensive health care in the world, but only ranks 37th in quality.

Many people who have lived and worked abroad, me included, go to other developed nations for medical care and combine a vacation with it. The savings in medical costs offsets airfare and other expenses. Because many of these nations with better medical care are socialist democracies, we seldom hear anything about medical tourism in our media.

Access is critical to containing costs. And access to culturally appropriate care if also very important. We want to talk to doctors who understand our circumstances and have solid interpersonal skills. This is when a trusting relationship forms so that we are comfortable asking tough questions. Costs matter today. And patients want to know if they can afford treatments & meds and what the alternatives are.