Vulnerable Populations More Likely to Delay or Forgo Treatment

June 27, 2008 — -- New data tracking the health care habits of Americans highlighted gaping holes in the country's health care system -- and who is falling through them. And it appears that those who are most vulnerable -- the youngest, oldest, sickest and poorest -- are the ones getting medically shortchanged.

The number of people who delay or do not get medical care, including those with insurance plans, increased to 59 million people in 2007, up from 36 million people in 2003, according to the report from the Center for Studying Health System Change in Washington, D.C.

"It's more than a wake-up call. This is an alarm clock in terms of the system not working well, and not caring for the vulnerable," said Dr. Rick Kellerman, chairman of the American Academy of Family Physicians Board of Directors.

The cost and logistical problems involved in visiting the doctor are the main deterrents for people who need to see a physician.

The study cited rising out-of-pocket costs, high insurance premiums, higher deductibles and co-payments as a few of the expenses that caused some families to put off a visit to the doctor or to not go altogether.

Patients were even less likely to seek treatment when rising costs were coupled with an increased difficulty in securing an appointment, clinics with short hours or finding a suitable primary care physician.

"I think it's a health system issue," said Laurie Felland, a health researcher at the CSHSC and co-author on the report. "It's about receiving that primary care, that appropriate level of care when needed."

No Rest For the Weary

The net effect of delaying health care could cost families more, both financially and in terms of health, than seeking preventive or immediate care.

"More children from low-income families are not getting preventive care, and their families are waiting longer to bring them in for sick visits in the hopes that the illness will resolve without medical intervention," said Dr. Kenneth Haller, associate professor of pediatrics at the Saint Louis University School of Medicine in St. Louis.

"The irony is that, if these kids had had adequate insurance coverage and gotten preventative treatment, they would not have needed an expensive hospital admission, which ultimately is much more costly to the health care system."

In addition, many preventive procedures and screening tools are not paid for by most insurance companies, leaving sick patients with no choice but to wait until they are sicker before seeking treatment.

Many Sacrificing Preventative Care

Children and low-income families are not the only ones who put off a visit to the doctor.

Dr. William Hall, director of the Center for Healthy Aging at the University of Rochester School of Medicine, pointed out that delaying medical care is particularly perilous for the elderly population, where the body is less likely to tolerate advanced illness.

And as the baby boomer population ages, sidestepping preventative care could put unnecessary stress on the U.S. health care system, according to Kellerman.

But finding that primary care can be a problem. The number of practicing physicians has been steadily declining for the past decade. A 2006 report from the American College of Physicians said that 19 percent of first-year internal medicine residents planned to pursue careers in general medicine in 2003, compared to 54 percent in 1998.

"We have a health care system that works against family physicians and physicians who are trying to provide primary care," Kellerman said. "We must have a primary care based health care system."

Kellerman suggested changes that focus on preventive medicine, primary care and a focus on a doctor model, where patients had more options such as digitized information or group visits, might be one way for the U.S. health care system to move forward in order to prevent delayed treatment.