Health care can suffer when job fears affect decisions on drugs, doctor visits

by Scott Monroe Staff Writer Kennebec Journal Morning Sentinel published August 8, 2009 Paul MacDonald thought he had found a way to save a good chunk of money he was spending on his prescription medication. MacDonald, 67, of China, said his medications, such as blood-pressure and cholesterol pills, are covered under a Medicare program, though it still costs him about $250 out of his own pocket each time. MacDonald said he recently found a program through a supermarket in Augusta to save about $580 each year by purchasing generic medication brands, or about $120 out of pocket. But he isn't allowed to under the program, at least not until Jan. 1. MacDonald, who says he's on a fixed annual income of $28,000, said the inability to save on his medications right now is a burden, especially in an economic downturn and with rising expenses. "It would save Medicare what it would cost me," MacDonald said. "Here you are trying to save some money and they don't want to. I'm sure there's plenty of people that really need the program and want to be in it, but surely there are a lot of people in my predicament." MacDonald's efforts to save money on health-related needs and expenses represent one example of how some people are trying to save money when it comes to health care. But are more and more people actually delaying -- or even forgoing -- necessary appointments, medications or procedures? There have been some indicators that, nationally, that could be happening. A study released by the Center for Studying Health System Change, a Washington, D.C. health policy research group, said that, in 2007, more than 28 percent of the 72 million working-age people in the U.S. with chronic illnesses such as depression lived in households that struggled to pay their medical bills. The study also said that while the uninsured are most vulnerable, medical-bill problems were growing among people with insurance, too. According to the National Employment Law Project, more than a million jobless Americans will exhaust their unemployment insurance benefits by the end of the year. More calls have been coming into Crisis & Counseling Centers, a private, nonprofit social-service agency with offices in central Maine. Lynn Duby, CEO of Crisis & Counseling, said calls to the agency increasingly deal with complex needs, in which health services are cut out or cut back. "One phenomenon is people who have been unable to get services they might have gotten in the past and they find their situation worsening, so by the time they call us they're much more likely to need services at a higher level," Duby said. "Our job is to try to help people earlier so they don't need to be hospitalized for services, so when people delay as a result or lose support, then their situation doesn't deteriorate." Hospital officials in central Maine reported no noticeable trend in people cutting back on health needs, though postponing or "spacing out" expenses has been noticed. "Our primary-care physicians have not experienced appointment cancellations associated with the poor economy; in fact, schedules are busier than ever," said Frances Renye-Smith, administrator for employed-physician practices at Inland Hospital in Waterville. "However, several specialists have reported seeing patients postpone routine or elective procedures because of their concerns regarding extended recovery times, time away from work, etc. It's a concern because postponing certain medical procedures can put a patient at risk for future complications." For example, a patient had been scheduled for a colonoscopy at Inland, but after learning of a pending layoff at his place of employment, he postponed the procedure out of fear of losing his job for time he would be away from work, Renye-Smith said. Karen Mosher, clinical director of Kennebec Behavioral Health, echoes that observation. "I know we've seen some of that -- people feeling they need to space things out, so they can afford their co-pays and so forth," Mosher said. MaineGeneral Health Associates, with hospital campuses in Augusta and Waterville, is seeing more "self-pay" for services, perhaps highlighting the pressures on employer-offered health insurance, said company president Dr. Barbara Crowley. That could suggest employees sharing more of a burden with employers to pay for health-insurance premiums and higher deductibles. In order to help people avoid facing costly services, MaineGeneral offers several programs such as preventative visits and screenings, Crowley said. One example is an outreach effort to encourage women over 40 to have mammograms to detect breast cancer, she said. Crowley also pointed to the company's CarePartners program, which is a group of doctors, hospitals and other health care providers who volunteer to provide check-ups and other preventative services to people either under-insured or uninsured and not covered by MaineCare. Although there are signs nationally of the economic downturn leveling out, the cost pressures on health needs are bound to get worse in Maine where state government faces mounting deficits, according to Duby, of Crisis & Counseling. "Hopefully legislators ... are open to creative ideas to address the problem because just cutting services is not always the best solution," Duby said. Scott Monroe - 861-9253 smonroe@centralmaine.com FIRST IN A THREE-PART SERIES Sunday: Why doctors offer fewer free prescription samples. Monday: Area hospitals offer voucher programs to help fill the health-care gap. BENEFITS 'EXHAUSTION' According to the National Employment Law Project, about a half-million people in the U.S. will exhaust their unemployment benefits by the end of September. That number will total more than 1 million by December. The organization estimated these "exhaustions": * 542,921 in the U.S. by the end of September * 1,492,830 in the U.S. by the end of December * None in Maine by the end of September * 5,573 in Maine by the end of December