Americans cut back on doctor visits, prescriptions

Americans made fewer visits to the doctor last year and were issued fewer prescriptions, a clear indication that many people are struggling to pay for health care. This decline came despite the introduction of 34 new medicines by the pharmaceutical industry, the largest number in a decade.

The report from the IMS Institute for Healthcare Informatics shows that visits to the doctor in 2011 declined by 4.7 percent compared to 2010, while the number of prescriptions issued fell by 1.1 percent. The report links these drops to the loss of health insurance resulting from long-term unemployment.

By contrast, visits to emergency rooms increased by 7.4 percent, as people without health insurance sought this route of care as the only available option. The decline in office visits and increase in emergency care indicates that many adults and children are foregoing routine preventative care and treatment for illnesses.

The study notes that at the beginning of the recession many people actually increased their visits to the doctor for routine care and exams out of fear that they might lose their jobs and insurance coverage. This effect has now dissipated.

Older Americans, in particular, used fewer medicines. For patients 65 and older, prescriptions fell by 3.1 percent last year, with the largest decline in prescriptions to treat high blood pressure and osteoporosis. Struggling to survive on fixed incomes, seniors are apparently rationing their use of these drugs. In the case of medicines to treat hypertension, the consequences of stopping treatment or rationing the drugs can be deadly.

The decline in the use of prescription drugs by older Americans coincided with a decline in out-of-pocket expenses for this segment of the population. For people 65 and older enrolled in the Medicare Part D prescription drug program, total out-of-pocket spending on medicines fell from $11.5 billion in 2010 to $9.7 billion in 2011. These savings did not translate into increased use of prescription drugs.

One segment that did see an increase in prescription drug usage was the young adult population, aged 19 to 26. Prescriptions issued to this age group rose by 2 percent over 2010. The largest increases were in prescriptions for antidepressants and drugs to treat attention deficit hyperactivity disorder (ADHD).

The increase of prescriptions for young adults is due in large part to a change under the Obama-sponsored health care legislation that allows this group to obtain coverage under their parents’ health care plans. This also most likely means that these young adults are either unemployed or unable to get insurance through their employer.

While the number of prescriptions fell, overall spending on drugs reached $307 billion in 2011, a 2.3 percent increase over 2010. Since 2001, spending on pharmaceuticals has increased by $135 billion. This means that drug companies continue to rake in profits even as fewer people receive medications.

While more generic drugs have been introduced in recent years, prices for brand name drugs have continued to skyrocket. The top drugs by spending in 2010 were Lipitor ($7.2 billion), Nexium ($6.3 billion), Plavix ($6.1 billion), Advair Diskus ($4.7 billion), and Abilify ($4.6 billion). Crestor (rosuvastatin), a lipid regulator, led spending increases, growing by $717 million.

The report found that while prescriptions were down in 2011, several new medicines were introduced, including drugs to treat hepatitis C, multiple sclerosis and several types of cancer. According to the report’s authors, these new medicines could be used to treat an estimated 2.5 million people newly diagnosed with related medical conditions each year, as well as about 20 million people currently suffering from these conditions.

As families feel the continuing effects of long-term unemployment, depressed wages and underemployment, the trend toward decreased doctor visits, combined with a resulting decline in prescriptions issued, is likely to persist, even as the pharmaceutical companies enjoy increased profits and insurers raise premiums.