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Correction to This Article
This article incorrectly said that a research company reported a decline in U.S. spending on prescription drugs this summer. IMS Health found that the number of prescriptions filled has declined for the first time in a decade, but drug companies' revenue has remained flat.
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As Budgets Tighten, More People Decide Medical Care Can Wait

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[Poll: Health-Care Sacrifices]
Health-Care Sacrifices

For Sandra Harrington, a waitress from Oxon Hill, the trade-off comes in treatment for an infected eye. Her doctor prescribed administering steroid drops twice a day. But as her tips have shrunk, she has decided that applying the $100 medication once a day is all she can afford.

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"It's a vicious cycle," she said, explaining that because it is too painful for her eye to be exposed to direct sunlight, she works only night shifts. "People cut back. Then people like me suffer."

In the past month, traffic on the five-year-old advice site JustAnswer.com rose 14 percent. The site, which allows customers to pose a health question and "bid" $9 to $30 for a doctor's or a nurse's response, had nearly 400,000 page views in 30 days, said chief executive and founder Andy Kurtzig. In a telling sign, inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.

At the Arlington Free Clinic, the surge in people seeking care has been overwhelming, said Executive Director Nancy Sanger Pallesen. Last week, the clinic provided free preventive screenings to 19 new patients, but it turned away 27 others, she said.

"Those numbers are higher than what we were seeing just this summer," she said. "Unfortunately, we can't take them all in."

Even free care may not be a good deal for people with limited means. For some, the price of transportation is prohibitive; others fear discovering an illness they do not have the money to treat.

Many are forced to juggle competing medical needs. Pietrangelo must balance the importance of the MRI, which detects brain lesions, and the costly medications that prevent her from relapsing. She pays co-payments of $500 per drug per month. There are no generic alternatives.

"I can't shop around," she said. "My hands are tied."

Most analysts expect the medical crunch to worsen.

"We know from past experience that an economic downturn drives more people to be uninsured," said Len Nichols, director of health policy at the nonprofit, nonpartisan New America Foundation, a think tank. "They lose their jobs, they lose their income and their insurance."

That is what happened to Tim Doss. On Sept. 18, after driving a cement truck for an Indiana company for 10 years, he was laid off.

"They told me, 'As of midnight, your insurance is lapsed,' " he said. Doss, 50, and his wife have illnesses that require medications, regular doctor visits and tests. Creditors have come to their home trying to collect the $3,000 they owe in hospital co-payments from when they did have insurance.


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