During the recession from 2007 to 2009, fewer Americans visited doctors or filled prescriptions, according to a new report.

The report, based on a survey of more than 54,000 Americans, also found that racial disparities in access to health care increased during the so-called Great Recession, but emergency department visits stayed steady.

"We were expecting a significant reduction in health care use, particularly for minorities," said co-author Karoline Mortensen, an assistant professor in the department of health services administration at the University of Maryland School of Public Health.

"What we saw were some reductions across the board — whites and Hispanics were less likely to use physician visits, prescription fills and in-patient stays," she said. "But that's the only disparity we saw, which was a surprise to us. We didn't see a drop in emergency room care."

Whether these altered patterns of health care resulted in more deaths or suffering isn't clear.
In terms of unemployment and loss of income and health insurance, blacks and Hispanics were affected more severely than whites during the recent economic downturn, according to background information in the study.

That was borne out in health care patterns. Compared to whites, Hispanics and blacks were less likely to see doctors or fill prescriptions and more likely to use emergency department care, Mortensen said.
Mortensen believes the Affordable Care Act will help level access to care for such people, and provide a buffer in the event of another economic slide.

"Preventive services without cost-sharing will entice people to use those services," she said. "And insuring all the people who don't have health insurance should level the playing field to some extent."

For the study, which was published online in the journal JAMA Internal Medicine, Mortensen and her colleague, Jie Chen, an assistant professor in the same department, collected data on health care use from 2007 to 2009 from the nationwide Medical Expenditure Panel Survey. Adults aged 18 to 64 participated in the survey.

Experts weren't startled by the findings.

"People tighten up during a recession," said Ted Epperly, M.D., former president and chairman of the board of the American Academy of Family Physicians.

"In tough times there will be a disproportionate impact of use of health care on the disadvantaged," said Dr. Epperly, who is program director and CEO of Family Medicine Residency of Idaho, in Boise. The disadvantaged are usually "sicker and die younger," he said.

Dr. Epperly said the Affordable Care Act's emphasis on preventive care is overdue. "We are a nation based on reaction to health care not pro-action, if you will," he said. "We are way behind the eight ball in terms of treating things late, when it's more expensive. That's part of our crisis in health care costs."

Another expert, Pascal James Imperato, M.D., dean of the School of Public Health at SUNY Downstate Medical Center in New York City, said federal and state programs may have enabled some people to pick up health care coverage during the recession.

"But some unemployed individuals may be ineligible for Medicaid, and the absence of that safety-net coverage prevents them from accessing self-pay health services," he said.

Also, he added, "some who remain employed in a depressed economy may not have employer-sponsored health insurance, or, if they do, cannot afford what have become for many very high deductibles."

Dr. Epperly said getting people health coverage "so we can drive them toward primary care and access to prevention, wellness, chronic-disease management and less reactive care" will be the game-changer.