Economy Led to Cuts in Use of Health Care – what do we make of this?

I read an article today that stated that a study done by the  National Bureau of Economic Research says that the recession reduced the utilization of health care services, across the board (  They compared our country to others with lower out of pocket costs and found that the higher out of pocket expenses contributed to the reduction of utilization.

Our office experienced this as well over the past 3-4 years.  I am aware of a recovery taking place since May of 2009 when business in our office picked up. Part of it was pent up demand and the other part of it is likely people coming to terms that higher copayments are here to stay and they are probably used to it by now.

I am troubled by this data for a few reasons:
1. There were fewer doctor visits and therefore fewer procedures done, yet, the overall health of the nation has not been compromised.  One would wonder that perhaps, many recommendations for tests and procedures may not be needed after all and are part of the problem.  In other words, people can be left alone, with fewer interventions which does not appear to affect life expectancy.  I hope the authors are looking at their data more closely now, and looking past the obvious.  In other words, do we need to lean on the health care system as much as we are advised to do if there is no real benefit, or possible detrimental effect of procedures and tests that just are not necessary?

2. Higher co payments means insurance companies paid out less and consumers were expected to pay more. Since we also used our doctors less and had fewer procedures, why did rates increase an average of 20 percent this year for many of us, yet there is evidence that medical inflation this year has almost come to a halt?  In other words, why the increase and who is benefiting (hint: its not the doctors and we personally were hit for another 18 percent on chiropractic fees by Aetna again)? In my opinion, health care reform did not go far enough and should have included a public option.  This would have prevented these increases which make our country less competitive in the world economy because of the ridiculous cost of health insurance.

3. Over the last year, chiropractic utilization is up markedly.  Perhaps, people are shifting their spending habits to a more cost effective and overall effective type of care.  It costs less to get problems taken care of the right way, regardless of the visit costs.  In other words, in our office treats a person with shoulder and neck pain.  Doctor A before us evaluates the neck and shoulder, sends the patient for 2 months of rehab and orders an MRI, the problem returns two months later.  The cost – Thousands of dollars for a non solution.  The patient visits us Doctor B.  We find out during the evaluation the person has right foot flare on the side of shoulder pain and his hip flexor is pulling the shoulder forward causing neck and shoulder pain.  The problem resolves in 12 visits and the person purchases foot orthotics and is now aware of why the problem exists.  The costs, slightly over $1000 but the person has to put our $40 per visit because of an outrageously high copayment which is not compatable with rehab.  The person shoulders much of the costs but is pain free with money well spent and we got it right the first time.  The lesson is that it is not the cost of the visit, or the amount of stuff that is done to someone.  It is the quality of the health care experience that counts.  Getting it right and improving the persons health for years to come is always better than having tests and procedures.  Perhaps, this study also is a reflection of market forces which have been largely absent from our monopolized healthcare system.

What do you think?  As always, I value your opinion.