A trip to the doctor’s office (within the for-profit American healthcare system, of course) is increasingly a roll of the financial dice, which is making it harder and harder to just... go to the doctor. This has become very clear anecdotally, but the stories are often muddied by the fact that they involve the experiences of under-insured or uninsured patients.
However, a study published Tuesday in the Annals of Internal Medicine showed a sharp decline in the number of annual primary care visits, by privately insured adults. Between 2008-2016, visits to primary care providers declined by 24.2%, while the proportion of adults with zero primary care provider visits in a given year rose from 38.1% to 46.4%. Young adults, ages 18-34, were more likely to opt out of their primary care provider visits.
Another 2019 study on adults who see a primary care provider showed they are “significantly more likely to fill more prescriptions and to have a routine preventive visit in the past year,” according to Harvard Health Blog, as well as “receive more high-value care such as cancer screenings, including colorectal cancer screening and mammography.”
But prohibitive costs make that kind of high-quality care a luxury item. Best case scenario, a patient goes to one preventative care visit a year and the story ends there. Worst case? Their doctor discovers they have bigger health issues, triggering a series of costly followup appointments, possibly with specialists, plus a treatment regimen to boot. Sounds like the perfect way for the average adult in the U.S. to get a jumpstart on the $5,000 they’ll spend on healthcare in a given year!
The study also found that the number of preventative care visits and visits to alternative venues like emergency rooms and urgent care centers rose, but the rate of problem-based “sick” visits fell—as the out-of-pocket cost of sick visits rose.
The authors attribute this to possible “decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care.” In other words, people feel so poor and distrustful of the system they are denying they are sick or trying to fix problems themselves, again, and we can’t stress this enough, even if they have insurance.
Not only does healthcare cost way too much, it leaves sensitive personal information in the hands of companies willing to sell it to tech behemoths like Google; results in charges that are frequently inaccurate; and forces people outside of the regulated market in order to obtain life-saving medications like insulin or estrogen. It’s not a question of whether or not Americans want to live healthy, dignified lives—it’s about whether or not they can even afford to.
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