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Does a sour economy mean fewer visits to the doctor?

A recent Gallup survey says that yes, it does. To that shift, add the surprising news that some women are postponing childbearing in a tight time.

June 2009 · Vol. 21, No. 06

In today’s debilitated economy, more women are putting off childbearing and preventive care. That’s the main finding of a Gallup survey conducted this year for the American College of Obstetricians and Gynecologists (ACOG).

“The good news is that children are priceless,” said. Rebekah Gee, MD, MPH, at the 2009 ACOG Annual Clinical Meeting in May in Chicago. “The bad news is that children are pricey.”

And because delivering and rearing a child are expensive undertakings, a sour economy is persuading many women to postpone, or forego, these choices.

Dr. Gee, an ObGyn at the Philadelphia Veterans Affairs Medical Center and a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania, spoke at a press briefing to call attention to the effects of job loss and other economic woes on women of reproductive age.

Two thirds of women have been affected by the economy

Here are a few findings of the survey:

  • Two thirds of women 18 to 44 years old report that they have been affected, to some extent, by the nation’s economy, including 18% who say the economy has affected them a great deal and 48% who say they have been personally affected.
  • Respondents who say they have been greatly affected were more than twice as likely as those who say they have been affected to a limited extent to report that they have decided to limit the size of their family (29% vs 13%). They are also more than twice as likely to talk to their partner about their fear of having an unintended pregnancy (26% vs 12%), and more than three times as likely to postpone a planned pregnancy (15% vs 5%).
  • One in seven (14%) respondents has postponed an annual ObGyn checkup.
  • Fifteen percent have cut back an some medications, or stopped taking them altogether, because of cost.
  • Roughly 10% of women who are using some form of birth control say they are worried they may not be able to afford contraception—compared with what was reported 12 months ago; 13% of respondents who use a hormonal contraceptive say they are worried they may not be able to pay for it.
  • One in eight women (12%) say they have lost a job.
  • Six percent of respondents have lost health insurance.
  • Nine percent have taken on an extra job.

Without health care, economic and health consequences will compound over time

“As women are losing jobs, they’re losing their health-care insurance,” observed ACOG President Douglas H. Kirkpatrick, MD. One “incredibly dramatic” statistic to consider is that, with every 1% increase in the jobless rate, 1 million people lose their health insurance, he said. “I can tell you that, in Denver, Colorado, where I am from, we have a lot of women who are not showing up for their annual exam.”

Iffath A. Hoskins, MD, agrees that there had been a significant decline in the percentage of women who are able to get routine health care.

“When women are worried about their financial situation, they skip much-needed routine health care, they cut back or stop their medications. And these are disturbing trends that are having a negative impact on the long-term health of women.”

“This is obviously a concern for us in the ObGyn field because we are the primary care providers for women in this age group,” Dr. Hoskins noted.

Dr. Hoskins is Vice President of ACOG and Senior Vice President, Chair, and Residency Director of the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, New York.

Women who lose their insurance often do not consult a physician until they have a significant health problem, said Dr. Hoskins. But when needed health care is postponed, both the financial and health tolls rise.

In terms of preventive health care, women of reproductive age need screenings such as Pap tests and mammograms, said Dr. Gee.

“And for an uninsured patient, mammograms cost an average of about $102, not including the doctor’s visit, and Paps cost $25 to $60,” she said. Moreover, “women are primary caregivers, and when women get sick it really costs society a lot.”

What can you do to help?

In the face of economic downturn, how can an individual physician help his or her patients maintain a healthy body and lifestyle?

Dr. Kirkpatrick maintains that the most important strategy is encouraging patients who smoke to stop.

“Smoking is the Number 1 habit that gets most people in trouble with chronic medical illness,” he said. For example, smokers tend to have persistent HPV infection. “They do not get rid of it, and they are prone to cervical dysplasia or precancer. These women end up having multiple procedures” to treat these conditions.

Another important health booster is stress reduction. Patients should be encouraged to adopt an exercise program, said Dr. Kirkpatrick.

“I think everybody has something that they can do, whether it’s bike or walk or swim.” And regular exercise helps ensure good sleep, he added. A minimum of 7 to 8 hours is recommended.

Other ways to help the patient save on health care:

  • Prescribe a generic drug rather than the branded medication, when possible.
  • Encourage the patient to attend a health-care fair. Most large cities in the United States have an annual fair where, for a small fee (usually less than $100), the patient can have a physical examination and comprehensive lab panel, said Dr. Kirkpatrick.
  • Help the patient find low-cost, mammography. Dr. Kirkpatrick’s staff calls mammography centers in the Denver area and negotiates a reduced fee for uninsured patients.
  • Remind the patient who does have health insurance to take advantage of wellness perks, such as subsidized gym membership, access to a weight loss program, and other benefits.
  • Consider offering a substantial discount to any uninsured woman who pays cash for an office visit.
  • Postpone any test that is not vital—but see to it that the patient has a mammogram every year.
  • Refer a financially strapped patient to any nearby clinic that may be able to see her at lower or no cost.

Gallup conducted its online survey on behalf of ACOG between March 26 and April 1, 2009. The sample comprised 1,031 women 18 to 44 years old. Results were weighted as necessary for race/ethnicity, region, age, education, and marital status. The survey has an estimated error rate due to sampling and other random effects of ±3%.

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