Volume 17, No. 1, Winter 2009
Recessions are bad for your health. This one more so than many in the past. Now for the really bad news. The worst is yet to come.
This was the unanimous consensus of the Advisory Board of To Your Good Health, A Health Care Newsletter, during its most recent meeting at Cape Cod Community College.
Dr. Herbert E. Gray is director of the Emergency Department at Falmouth Hospital. The ER normally is the caregiver of first resort for the uninsured and thus would feel the brunt of an uptick in patients who have no place else to go.
“We haven’t seen any increase (in activity) yet, but the operative word is yet,” he declared.
When people find themselves unable to afford their medications and stop taking them, he explained, “it can take a while before you start seeing things like strokes and other serious complications.”
Dr. Arthur Bickford, co-founder of the Duffy Clinic, agrees. “People who have lost their jobs just stop taking the meds,” he said. “But I’m not finding a lot of sudden attacks…yet.”
“One of the standard questions physicians are going to have to start asking whenever a patient comes in is, ‘How many days have you not taken your pills and when did you last refill your prescription?’” noted Dr. Herbert O. Mathewson, medical director of the VNA of Cape Cod.
The Advisory Board meeting was held in mid-December. Van Northcross, regional marketing director of Cape Cod Hospital, said he hadn’t seen any changes in the ER or in-patient census, but added that “we’re very apprehensive in the next couple of months when we get into the respiratory season. It’s going to play out right in front of our eyes.”
Mr. Northcross also noted the extra risk factor when people “stop taking their tests and doing the routine things that people normally would take care of.” Many also are passing on elective procedures.
Steve Abbott, recently retired President/CEO of Cape Cod Healthcare, said this is something new.
“In past recessions, people would scramble to get things done electively before their full coverage insurance ran out,” he related, “But with today’s insurance, just the reverse is happening because you have to pay all of these out-of-pocket co-pays and deductibles.”
And several panelists noted that even the low cost of the Commonwealth’s new mandatory health insurance plan was proving too much for many residents and they prefer to take a chance and pay the fine instead of the premiums and other fees.
Cape Cod’s healthcare institutions long have been bolstered by heavy philanthropic support from the community. That also is threatened.
“People may be looking at their portfolios and not be as generous as they have been in the past,” Mr. Abbott said.
And the stock market collapse has been a double-edge sword, he added, explaining, “Part of hospital economics few are aware of is that hospitals rely for their financial health on the return from their investment portfolios. This represents cash you must keep on hand to offset any losses in operations that you’ve invested until needed. It’s now a big issue.”
State financial support also is problematic because of budgetary constraints.
Sue Rohrbach, aide to Senator Rob O’Leary, predicted that “there would be another round of budget cuts” but at the time she was unable to speculate on what form they would take.
“Everybody’s running scared when it comes to grants,” Dr. Mathewson said, referring to the non-profits. “They’re at the edge of the cliff and peering over as they look at their budgets. Gearing up their philanthropic efforts is the only way they can make up shortfalls.”
The panel agreed that the most threatened aspect of local care is mental health.
“Because none of them are self-supporting any cuts would be devastating,” Mr. Northcross said.
“If you ran it according to your margin, we’d have gotten out of it years ago, which is what so many (hospital systems) have done,” Mr. Abbott added, noting that these programs had represented a $6 million loss during his tenure.
One positive recession by-product has been the end of a nursing shortage. Some nurses who tried other professions such as real estate are returning to their original vocation. Other wives whose husbands have lost their jobs are returning to the workforce if only to obtain health benefits.
“We’ve had an increase in applicants for our healthcare programs,” reported Rosemary Dillon, Director of Allied Health and Gerontology at Cape Cod Community College. “Our phones are ringing constantly as people call with desperation in their voices. Nursing gets the most calls, because it’s quick and they know there’s a job at the end.”
How long will this recession-fueled crisis last?
Andrew Young of the Cape Cod Five Cents Savings Bank and a former trustee of Cape Cod Hospital, said he could see long-term healthcare effects still surfacing three or four years in the future. Truly accurate predictions of an upturn can’t be made “until we hit the trough and I don’t know if we’ve hit the trough yet, maybe 2010,” he said.
By Dr. Shannon J. Scarry,
Medical Director, Division of Behavioral Health, Cape Cod Healthcare
In general, people are worried about the state of the economy, but I have not personally seen patients whose illness is causally related to the economy, except as they list it as another stressor in their lives. I’m concerned that there may be more and more patients who are losing their health insurance as a result of layoffs and will not be able to pay for appointments or for their medication. This could have a direct effect over time of making people more ill.
Actually, this problem is beginning to surface here, and we are trying to refer patients to pharmacies that have discount programs for generic medications. This may affect some patients clinically, as some people do not respond well to generic medications. We try to find medications that work, but it can be difficult. And, we cannot treat patients we cannot see.
By Carol Sim,
President/CEO, Rehabilitation Hospital of the Cape and Islands
We’re hearing from all quarters that census is down–in acute care hospitals as well as in rehabilitation hospitals. This is a national phenomenon, not just a local problem.
Health care used to be thought immune to downturns in the economy. But now, we’re seeing the effects of people curtailing many of the behaviors that led to a need for healthcare services.
For example, due to high gas prices this summer, people were staying closer to home, driving and traveling less. They also have been forgoing riskier (and often pricey) activities such as skiing that had the potential for accident and injury. Also, given the increase in unemployment and uncertainty about jobs, it appears that people are postponing elective surgery and even routine visits. They are trying to avoid co-pays for office visits and procedures. And they’re also wary of being away from their jobs for weeks or months to recuperate from a surgery.
People are circling the wagons, being very conservative in their behaviors, postponing what they can while they wait for the dust to settle.
According to a recent American Hospital Association survey of 700 CEOs, here are some national trends: