Patients seeing physicians less often

Census data bear out what physicians already know: Patients were visiting them less frequently than 10 years ago. In 2010, adults age 18 to 64 made an average of 3.9 visits per person, compared with 4.8 visits in 2001. The U.S. uninsured rate rose during that period, from 17 percent to nearly 22 percent. Only 1 out of 4 uninsured people went to the doctor in 2010, compared with nearly 3 out of 4 of the general population of working adults.

However, physician visits rose 4.8 percent in the second quarter of 2012 compared with the same quarter in 2011, which reversed a two-year decline. Nearly every health insurer reported lower earnings during that quarter. Humana said in its quarterly report that more of its members were seeking care—and more of it—because they had put off going to the doctor during the economic downturn. It said wellness visits were up 200 percent over the previous year, and routine physician visits were up by 22 percent. The first-dollar coverage of preventive care also was a fueling factor.

Rising insurance premium costs for 2014 because of the ACA’s ban on pre-existing condition underwriting and more comprehensive policies—combined with rapidly growing high-deductible insurance plans—may short-circuit the rebound in physician visits.

Even so, any rebound is welcome. Physician-office visits had declined 4.7 percent in 2011 and 4.2 percent in 2010, and had declined in four of the previous five years.

A Stanford University analysis for the Kaiser Family Foundation found a 17 percent decline in office visits between 2009 and 2011. Office visits had risen from 140 million to 160 million between 2000 and 2005 and held at that rate until the start of the recession in late 2007.  The rate dropped below 130 million visits in the second quarter of 2011.

More than 9 million people lost health insurance coverage during the recession. Fewer than half of unemployed adults had health insurance, compared with more than 81 percent of employed adults. Unemployed adults have poorer mental and physical health, yet they are less likely to receive needed medical care, because of cost.

Even people with private insurance have been cutting back on routine care. Rising deductibles and copayments make people more reluctant to seek care, even if they have chronic conditions. Employees with high-deductible health plans are 3 to 4 times more likely to delay or forgo care, compared with those in more traditional plans.

The share of employees with an annual deductible of at least $1,000 grew from 18 percent in 2008 to 31 percent to 2011.

Fewer office visits also helped slow prescription drug spending. The number of prescriptions filled grew only 1.2 percent in 2012.

Employers held health-benefit cost growth to 4.1 percent in 2012, which was the lowest in 15 years. They have stepped up cost management in anticipation of added cost pressures from health reform. Many health-reform opponents expected more businesses to stop offering  health insurance. According to business consultant Mercer, that number actually rose slightly in 2012.

Experts say there are too little data to determine whether the slower increase in health-care spending is permanent or a temporary function of the weak economy.

Harvard economist David Cutler told The New York Times, “The recession just doesn’t account for the numbers we’re seeing. I think there’s much more going on.”

Economist Gail Wilensky, who headed the CMS under President George W. Bush, said, “If there’s something else going on, we don’t know what it is yet. The most honest thing to say is that, one, the reduction in use is greater than the recession predicts; two, we don’t understand why yet; and three,  you’d be foolhardy to say that we can understand it.”