Americans may be spending less money on going to the doctor -- in large part because they have less money to spend. A new Commerce Department survey indicated last week that for the first time in more than a decade, the steady rise in what consumers pay for services provided by physicians in private practice may have stopped.
At this point, federal health officials do not have full confidence in the intriguing figures that could, if solid, represent an important trend.
But what Commerce and federal health officials have concluded is that there has been a real slowdown in growth in personal income in the past few years -- "and we know there's a relationship between personal income and spending on health care," said Gail Wilensky, head of the Health Care Financing Administration.
In short, when people don't have enough money, they put off medical visits until they're really sick.
According to the Commerce Department figures, based on a Census Bureau survey:
The nation in 1989 spent $113 billion on doctors. In constant dollars -- that is, dollars adjusted for inflation -- this is .8 percent less than people spent in 1988. On the face of it, this is a striking decrease after many years of steady increases. In 1988, individuals spent 5.3 percent more in constant dollars on doctors than they did in 1987.
The nation also paid just 9 percent more on all medical care services -- for doctors, other professionals, hospitals and health insurance premiums -- than it did did in 1988, compared to an 11.5 percent increase in 1988 over 1987.
"This doesn't mean we've tamed the health care monster," Wilensky said, "but we'd like to think this represents our many cost containment efforts, as well as general economic trends.
"We know employers have increased cost-sharing" -- the extent to which employees must pay their own health care bills or health insurance premiums -- "and there's also a strong possibility that doctors are starting to price themselves out of the market" by raising their prices to an extent that people are avoiding or delaying medical visits.
The nation's so-called "personal" spending on all health care totaled $434 billion in 1989, less than in previous estimates. But this does not include care in public facilities, medical research or public health efforts. Total national spending on health, federal and private, is estimated at some $600 billion in 1989.
Federal and local spending on Medicaid -- the far-from-complete medical poverty program that actually covers only about 40 percent of the poor -- has been increasing. Part of the reason is probably new congressionally mandated coverage of care for pregnant women.
At the same time, there has been a modest slowing in Medicare Part B expenditures -- federal payments to doctors to care for Medicare recipients. They increased by 11.7 percent between 1987 and 1988, but just 10.3 percent in 1989.
In this year's first quarter, the nation's overall inflation rate dropped from 6.6 percent in late 1989 to 3.9 percent. This means that, overall, health care inflation is still running at approximately twice general inflation. Over the past year, the American economy grew by just 1.2 percent, the smallest increase in output since the end of the last recession 7 1/2 years ago.