Hard-pressed consumers are putting off routine medical exams, physicians say, and clinics are seeing a rising number of uninsured patients as well.
As the unemployed lose their health benefits, or residents simply scale back on spending, many delay routine preventative exams that can prevent catastrophic care in the future, clinic administrators say.
Women's Health Specialists of Nevada, an obstetrics and gynecology specialist group in Reno, saw about a 30 percent decrease in the number of women getting annual exams and a 25 percent increase in uninsured patient visits in 2008 as compared to 2007, says Administrator Mary Nieberlein.
"People will not go to the doctor unless they absolutely have to," Nieberlein says. "Annual exams are very important for health and wellness, but with the state of economy people are not doing that. It's sad because lot of things can be detected with annual exams, such as early prevention and detection of cancers."
The experience of northern Nevada health-care professionals is repeated across the nation. A new study of 1,204 adults by the Kaiser Family Foundation of Menlo Park, Calif., Calif., found that 53 percent have cut down on health care due to cost in the past year, with 19 percent forgoing preventative-care procedures.
"It all comes down to money, and if they don't have money to do preventative maintenance they put it off until something comes up," says Gary Sorge, administrator for Digestive Health Associates in Reno. The clinic's doctors perform roughly 11,000 screenings for colon cancer each year.
Sorge says patient visits in 2008 were similar to 2007 numbers, mainly due to strong growth early in 2008. But the number of uninsured patient visits doubled in the fourth quarter of 2008 compared to year-earlier figures.
"I suspect that first quarter of 2009 will continue to be worse," Sorge says. "I am glad those uninsured people are still coming in because it is so important to get this particular test done and not wait for problems to come to you. But simple fact of the matter is that people have lost their jobs and don't have insurance."
And without health insurance, out-of-pocket costs soar. A colonoscopy at Digestive Health Associates typically costs an insured consumer $200 for the insurance co-payment. Without insurance, the out-of-pocket cost is about $1,000.
Digestive Health Associates offers cash discounts and a flexible payment plan for those who have tough time paying up front, says Dr. Paul Sheykhzadeh. The clinic also works with CareCredit healthcare financing.
Sorge says consumers haven't abused the Digestive Health Associates' liberal payment policies.
"Our accounts receivable has been steady," he says. "But we have been somewhat insulated from this drop. We don't think we will be insulated forever, but so far we have not seen the brunt that other practices have."
Nieberlein says Women's Health Specialists of Nevada also looks at patients' financial status on a case-by-case basis and often makes payment arrangements. The clinic also offers cash discounts for uninsured patients, and tries to offer free follow-up care.
"When a patient comes in for annual we try to take care of them for the whole year," Nieberlein says. "Oftentimes things can be taken care of with a triage nurse or by just speaking with a doctor. We try to do best we can for our patients so that are not putting up out-of-pocket costs that they cannot afford. We have to take care of one another, especially in these lean times."
Preventative care and wellness screenings can help control employers medical costs in the future, Sheykhzadeh says.
"For businesses that are paying their employees' insurance, if they encourage their employees to do health prevention and colon cancer screening, that is going to keep their cost down by keeping their plan costs down," he says.
Elective-care facilities such as plastic surgery centers, cosmetic dentistry and laser vision correction offices also have experienced sharp reductions in patient visits.
Lisa Skogerson, practice manager for the Center for Plastic Surgery in Reno, says most major elective surgeries have declined, but the clinic has seen a rise in smaller, more affordable and less-invasive procedures.
And securing financing for patients who can't afford to pay for procedures up front poses yet another problem, says Daniel Rowan, co-managing doctor for Lasik of Nevada and optometrist for Eyezone on Caughlin Parkway.
"The biggest challenge has been getting people financed," Rowan says. "We have had to get creative with patients who want to do these procedures."
