Although she survived lung cancer and has such difficulty breathing she can't walk more than 60 feet without stopping, Sandy Kintz of Westport, N.Y., can't afford to take all the medication doctors prescribe for her.
"I'm on two inhalers and I have to take those," Kintz said. "Some drugs I couldn't afford, so I gave them up."
In 2006, doctors diagnosed Kintz, now 58, with late-stage non-small cell lung cancer. The former nurse underwent radiation and chemotherapy and since she had no health insurance at the time, cashed out a retirement account to pay for her medical care. The cancer went into remission, but she still suffers from lingering effects of the chemotherapy as well as lung disease.
She now has Medicare and receives disability income, but since she is unable to work, she lives on limited means.
"The inhalers cost $35 each, and then there are all the co-pays for doctor visits, and I live an hour away from the doctor, so there are the back and forth costs. I just don't take all the meds, because I'd have to give up on something else."
Kintz is far from alone in making health care sacrifices. According to a nationwide survey of more than 2,000 people by Consumer Reports, the economy has led 48 percent of Americans taking a prescription medication to make cost-cutting medical sacrifices, such as skipping doctor visits, refusing tests or buying cheaper drugs from foreign countries.
Nearly 30 percent of this group skimps on medication by not filling prescriptions, skipping dosages, cutting pills in half or taking expired medications. A higher percentage of low-income individuals engage in these money-saving practices.
The poll also found about half of Americans regularly take a prescription medication, and on average, they take more than four different ones.
"We've been doing this survey on an annual basis for three years, and more people than ever are taking some sort of action to cut medical expenses, and some things are risky, such as putting off a doctor's visit, delaying a medical procedure or refusing medical tests," said Lisa Gill, Consumer Reports' prescription drug editor. "In that group of people, it's a big jump from last year when it was 39 percent."
The majority of the people surveyed also said their doctors do not help lessen the financial burden by prescribing generics or talking about drug costs.
"We know that doctors may not be able to find out the exact price of a drug because of different insurance plans, but doctors definitely know there are generics available," said Gill. "Even though they may not know the exact co-payments, it's a trigger for the doctor to ask patients about their ability to pay for this medication."
Doctors agree they need to better communicate with their patients about potential financial barriers to care, but say patient load and the current health insurance model make it difficult to manage multiple aspects of care.
"There's a movement in this economy for clinicians to understand the financial barrier before recommending drugs, devices or diagnostic tests," said Dr. A. Mark Fendrick, professor of medicine at the University of Michigan Medical School.
"We need to do better, but more physicians are doing something to help patients," said Dr. Roland Goertz, board chair of the American Academy of Family Physicians (AAFP). Goertz referenced a 2009 AAFP survey that found 66 percent of doctors took some action to help financially-strapped patients, such as offering lower-cost office visits, providing free screening and prescribing more generic drugs.
"Many patients are resistant to talking about their financial situation," said Goertz. "I always ask if they have enough money for the co-payment."
Patients should also be more proactive when it comes to their prescriptions.
"Make sure you ask about lower-cost alternatives," said Fendrick. "Many drug manufacturers have programs for people who are economically challenged."
"Communities also often have programs to help with medical costs. Doctors' offices may have rosters of agencies that can help, so ask about it," said Goertz.
"If you have to follow-up after a treatment and you don't have insurance coverage, it makes sense to ask if you can check in by phone or by email," said Robert Field, professor of health management and policy at the Drexel University School of Public Health.
Pharmacists are also a valuable source of important information. They can help in various ways, such as by looking up drug prices, finding out if generics are available and checking for drug interactions.
In addition, every chain pharmacy and big-box store pharmacy has a $4 generic drug program, Gill said, so consumers should seek those out.
"Even with insurance, the cost of a generic drug may be more expensive than these $4 programs," she added.
Experts stress that trying to split pills, skip doses or take expired drugs can often render the medicine completely ineffective, which can be dangerous.
Some experts say the health care system is slowly moving in a more affordable direction.
Fendrick believes there will be a shift toward a value-based insurance design that will make the most important health services cheaper depending on a person's condition while making ineffective or harmful treatments much more expensive. Under the current system, the patient's out-of-pocket cost is the same regardless of how vital or unimportant a particular service is.
"This design provides the nudge to allow easy access to services people absolutely need and if it's necessary, makes it really hard to do something that's inefficient," said Fendrick.
Goertz explained there is also a shift toward a more comprehensive system of patient care that helps clinicians coordinate better. With this model of care, a patient's primary physician can manage care across specialties and can also incorporate information about insurance coverage and the situation at home, making it easier to get a sense of a patient's financial burden.
But until the health care system drastically changes in a way that makes getting medical care much more affordable, Kintz, who lives with damaged lungs and can't afford all her medication, advises people in situations like hers to reach out for help.
"There is help out there," she said. "You can call organizations like the American Cancer Society and get phone numbers and help for little things like gas. Joining a support group is also helpful. Just let people know you need help."