Unemployment, Higher Co-Pays Add Up to Fewer Doctor Visits

Fewer consumers with health insurance are accessing medical services, but there’s a debate over whether the decline in healthcare utilization is a result of the current economic slump, rising insurance copays and deductibles, or a longer-term change in the way people access healthcare.

The affect of the decline in visits to primary-care doctors and specialists was made apparent in healthcare companies’ quarterly financial results: A host of hospitals, insurers, lab-testing companies, and billing firms all reported that patient visits, drug prescriptions and procedures were down in the second quarter from a year ago, according to a report in the Wall Street Journal.

Drugstore giant CVS Caremark Corp., on Wednesday attributed a drop-off in new prescriptions for maintenance drugs to the recent decline in doctor visits. People are "visiting fewer primary care doctors and specialists," said Chief Executive Tom Ryan, in a conference call.

Indeed, the number of physician office visits have declined each month this year, including a 7.6 percent drop in May from the same period last year, according to Thomson Reuters. Hospital admissions were down in three of the first four months of the year compared to last year, the Wall Street Journal reported.

The most-likely culprit for declining doctor visits is the protracted downturn in employment -- as more people lose their jobs, and eventually lose their access to Cobra, the federal program that allows people to keep their employer coverage for 15 months after a job loss, they’re less inclined to visit doctors for non-emergency issues.

But studies have shown that increasing out-of-pocket costs are keeping seniors from scheduling doctor appointments. A recent study published in the New England Journal of Medicine found that higher Medicare copays led to fewer doctors visits.

The study of 899,060 seniors in 36 Medicare managed-care plans from 2001 to 2006, showed that half of those plans raised copays for visits to doctors and specialists. The average copay for a doctor visit roughly doubled, from $14.38 to $7.38, while the copay to see a specialist climbed to $22.05 from $12.66. For every 100 people enrolled in plans that raised copays, there were 20 fewer doctor visits, according to the study. Doctor visits decreased the most among enrollees living in low-income areas and among plan participants who had hypertension, diabetes, or a history of myocardial infarction.

Access may also be a factor: The shortage of doctors in many areas of the country -- and an increase in the number of physicians who won’t accept Medicare patients -- means patients who want or need to see a doctor are prevented from doing so.

Physician’s Money Digest wants to know:Is your practice experiencing a decline in patient visits? What do you think is the most like factor causing patients to avoid seeking medical attention? Do you think healthcare reforms will encourage, or discourage, more patients from visiting their doctors?