More heart attacks, fewer breast implants. More ER visits, fewer trips to the doctor's office. More aspirin, fewer echocardiograms. And many people are afraid to miss work for healthcare because they fear it might cost them their jobs.

That's the anecdotal evidence from several dozen healthcare providers in South Florida about how the deepening recession is effecting treatment.

While it has been well-publicized that many people are losing health insurance when they lose their jobs, doctors and hospital leaders have been surprised about how many who still have coverage are scrimping on care because they can't afford the co-pays or time away from work.

Take South Dade Realtor J. Berry Hamilton, 57. She's gone to a policy with a $5,000 deductible, meaning she has to pay most costs out of her own pocket. Recently, she brushed off her doctor's request for a diagnostic exam when she got a sinus infection. As her business has declined, she figures: "Let me see if the antibiotic works first, and if it doesn't then maybe I'll have the X-ray."

"Patients are spending less, no question about it," says Bernd Wollschlaeger, a primary care doctor in North Miami Beach. "A patient needs a echocardiogram. And they say they can't afford the $100 or $200 co-payment, so they're deferring. In the long run, this just can't be good for healthcare."

People are certainly pinching their pennies. For the five hospitals in Baptist Health South Florida, Vice President Karen Godfrey reports that patients are now hesitating on tests and procedures even with co-pays as low as $15, "which is very surprising.

"One of the registration managers was telling me some are negotiating for services. If a woman gets a prescription for a mammogram and an ultrasound, she wants to know the co-pay for both," then pick the test with the cheaper co-pay.

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