Skimping on medical care now will cost more later

The struggling economy is forcing many Americans to cut back on lots of things, including travel, eating out and shopping.

But they're are also putting off medical care. More than half of Americans have cut back on health care because of cost concerns, according to a recent Kaiser Health survey. They're avoiding or postponing doctor visits, annual physicals or regular treatment for chronic conditions such as diabetes or asthma.

Doctors warn that skipping care now will likely cost you more later. A January study in the New England Journal of Medicine showed that when Medicare beneficiaries skipped needed outpatient care because of rising co-payments, that resulted in more hospital admissions and longer hospital stays.

With this in mind, we asked a number of doctors at Suncoast Medical Clinic and Bayfront Medical Center: What types of medical tests or treatments should people — especially the 133 million Americans with at least one chronic condition — not postpone, and why?

If you're healthy

Cancer screenings. The American Cancer Society recommends yearly mammograms for women starting at age 40 (other authorities say they can start at 50 for women not considered at high risk), colorectal cancer screenings for men and women starting at age 50, and cervical cancer screenings (Pap tests) for women starting three years after they have become sexually active, but not later than age 21.

Annual physicals. Doctors say these can help identify problems early and improve your chances for effective treatment. The National Institutes of Health says that the exams and screenings you need depend on your age, health, family history and lifestyle choices such as your diet, level of physical activity and whether you smoke.

If you have diabetes

Checkups every three months. Dr. Aparna Asher, a family practice doctor, says the checkups are especially important for uncontrolled diabetics — those who don't regulate their lifestyles to keep their glucose levels in a healthy range. Regular visits can help doctors better monitor fluctuating blood sugar levels, and the numerous medications that many diabetics take.

Annual foot exams. Diabetics are more likely to have foot problems. Dr. Asher says what starts as a corn or callous can develop into a more serious foot ulcer. She says diabetics should have their feet examined by a doctor at least once a year, so any problems can be treated before becoming more serious.

If you've had a heart attack (myocardial infarction)

Taking aspirin and beta blockers daily, unless you are allergic to them. St. Petersburg cardiologist Vibhuti Singh says taking aspirin daily reduces your chance of having a second heart attack by 20 to 25 percent, and daily beta blockers reduce your heart attack chances by another 15 to 20 percent. A patient with high blood pressure in addition to heart problems should also be taking statins. And if the patient's heart is not pumping out enough blood, the patient should also be taking ACE inhibitors. Singh also recommends patients see their doctor every six months.

If you have high blood pressure

Checkups every six months. Dr. Asher calls hypertension "a very silent disease that creeps up on you," meaning that many people with high blood pressure don't feel any symptoms. Six-month visits enable doctors to more closely monitor your blood pressure, update your lab work and monitor the medications you take to reduce your chances of a heart attack or stroke.

If you have chronic kidney disease

Checkups every three to four months. St. Petersburg nephrologist Ignacio Sotolongo says seeing patients at that interval allows him to make sure they have their diabetes and blood pressure under control, and to see how their medications are working. Putting off care, Sotolongo says, puts patients at much greater risk of kidney failure, which can result in the need for dialysis or a kidney transplant.

If you're pregnant

Level II ultrasound. Dr. Kesha Flantroy, an obstetrician and gynecologist, says that most expectant mothers undergo an initial ultrasound. If abnormalities are detected, a Level II ultrasound may be recommended. She said some moms are skipping that, sometimes because of cost. But Flantroy says a Level II ultrasound can take a closer look at organs such as the baby's heart, and skipping the procedure can represent a "lost opportunity to intervene with any problems in the fetus."

Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330.

Skimping on medical care now will cost more later 02/21/10 [Last modified: Tuesday, February 23, 2010 4:32pm]

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