Patients put off health care to save money - and wind up in hospital

Published: 3/23/2009 12:14 AM

The cardiologist told his patient he needed to clear a clogged artery. The patient said he couldn't miss work or he'd lose his job. The doctor told the patient he might die without treatment. The patient decided he'd have to take his chances for now.

It's the kind of story physicians are hearing more and more lately, said Michael Deering, spokesman for Advocate Good Shepherd Hospital in Barrington. More patients are putting off elective procedures and routine medical care, like doctors' visits, to save money.

"Some primary care physicians feel like the Maytag repairman," he said, "because their schedules are wide open."

But when patients put off routine care, health officials warn, they sometimes end up getting sicker, and wind up crowding suburban emergency rooms and hospital beds.

"It's like the old ad," Edward Hospital spokesman Brian Davis said. "You can either come in now or you'll probably be coming in later."

Nationwide, the American Hospital Association found in November that one third of hospitals reported elective surgeries and admissions were down from projections.

Preventive screenings like radiology scans and colonoscopies often are the first thing postponed. One woman with a history of breast cancer in her family put off a mammogram so she could afford to have her daughter's wisdom teeth pulled.

Donald Hendricks of Lombard lost his job last summer. When two of his children developed a fever and sore throat, he couldn't afford to take them to a doctor, but nursed them at home until they got better.

"I never felt the crunch like this before," he said.

But with the erratic economy, the effects vary from place to place.

Doctors affiliated with Edward Hospital in Naperville, for instance, remain busy, but elective procedures and emergency rooms visits are down slightly, in part because of the opening last year of nearby Adventist Bolingbrook Hospital. Traffic at immediate care facilities also was down slightly.

At Northwest Community Hospital in Arlington Heights, beds have been essentially full since the beginning of the year, and patients sometimes wait hours in the emergency room until they can get admitted.

Those who enter are sicker than usual, with an increase in the case mix index that measures the acuity of each patient's condition, Chief Nursing Officer Dale Beatty said.

One problem is that some patients chose not to fill their prescriptions to treat hypertension, for example - which in some cases costs $200 a month - and ended up with their blood pressure so high they had to be admitted.

Even those with insurance aren't immune. Some have high deductibles, to reduce their premiums, or have to pay 20 percent of costs to get the doctors they prefer. In some cases, they're putting off elective procedures like cataract surgery or joint repairs.

"There's a myth this only happens with the uninsured and it's not true," Beatty said. "It cuts across all economic classes."

The economy is affecting physicians as well. Those in private practice are increasingly approaching hospitals to ask for help in buying expensive equipment, or for increased pay for on-call services, or to be employed and cut expenses.

At the same time, many hospitals are reducing staff or looking into other ways to cut costs.

Dr. John Sage is a physician at Metrodocs in Mount Prospect, which remains a privately owned family practice. He estimates businesses is off about 10 percent since the beginning of the year.

Other factors may be involved, such as the light flu season this winter. But at least once or twice a day, it seems, patients tell Dr. Sage they lost their job or fear they are about to.

Sage took a call from a patient Thursday who'd lost his job and insurance and wondered if he could get some kind of discount. Sage offers a 20 percent discount on all charges for those in such a position.

Other patients try to cut costs where they can. Veterans go to the Veterans Affairs to save money on prescriptions and testing, but call Sage to ask for his medical opinion.

The flip side to putting off treatment are patients who need to have a procedure done immediately while they are still employed and getting health insurance. One man who had been postponing hip surgery while he was working is now out of a job, and wants to get the work done while he still has federally guaranteed group insurance rates.

"That's the other side," Sage said. "Get what you need before you can't afford it."

• Daily Herald wire services contributed to this story.