News & Events

Waves of Suffering (MC)

Judi Campbell inches along at work with the help of a walker. Degenerative arthritis has ruined her hip and ravaged much of her body, so she takes prescription painkillers every four hours to cope.

"I cannot walk. I cannot live," she said. "I am in such pain. And I feel guilty about what I’m putting my husband through. If I have to get out of bed, I need his help."

Hip replacement surgery, however, will have to wait. Campbell, 62, already owes a Northampton hospital $1,000 for medical expenses not covered by her insurance – two $500 copayments for arthritis-related surgeries in 2007. She doesn’t want to add to her debt, especially since the status of her secretarial job at a nonprofit organization is uncertain.

As the economic recession persists, people who are unemployed or worried about losing their jobs are putting off medical care and living with illnesses and conditions that aren’t critical, but can be debilitating. Some are delaying having precancerous tumors removed; others are forgoing knee or shoulder surgery. While insurance often covers much of the costs associated with such procedures, there are usually deductibles and other out-of-pocket expenses that can add up to thousands of dollars. For those lacking insurance, the price of most elective procedures is beyond their reach.

According to a recent Massachusetts Hospital Association survey, 59 percent of hospitals statewide reported a drop in elective surgeries in 2008 and into the beginning of fiscal 2009. The Red Cross, which supplies blood used in surgery, has also seen a drop in demand, causing it to cancel Massachusetts blood drives scheduled for March and April.

And as more people forgo treatment, hospitals are suffering financially, industry specialists say. Their profits depend heavily on lucrative surgical procedures paid for by private insurers. In addition to seeing fewer patients for elective day-surgeries and overnight treatments, hospital income from investments is dramatically down because of the economy. Profit margins at Massachusetts hospitals have dropped from an average of .7 percent in the last quarter of 2008 to .3 percent in the first quarter of this year, according to the hospital association.

To compensate, hospitals are cutting jobs, and canceling or postponing expansion projects. Nursing jobs, once abundant, for the first time in a decade are in short supply.

"Surgery is a very large cost and profit center for a hospital," said Erica Drazen, a managing partner at CSC, a Virginia-based hospital consulting firm with offices in Waltham. "It’s almost a perfect storm: elective admissions are down, people with insurance coverage are down, donations are down and investment income [for hospitals] is down," Drazen said. "None of the CEOs are laughing."

Richard P. deFilippi, a trustee for Cambridge Health Alliance and chairman-elect of the American Hospital Association, has posted a YouTube video on how the recession is affecting business at the chain, which has community hospitals in Cambridge, Everett, and Somerville.

"We’re certainly seeing people reluctant to come for treatment we feel they need," deFilippi says in the video. "A lot of elective treatments are being put aside."


Officials at Caritas Christi Health Care, the state’s second largest hospital system, said it also is performing fewer optional procedures. Teresa Prego, vice president of marketing, said there has been a 1 to 2 percent drop in elective surgeries this year. She was unable to provide specific numbers for each hospital. But, she said, fewer patients are coming in for procedures such as colonoscopies, perhaps because patients don’t want to spend on copayments, which can range from $5 to $100.

"People are either concerned about their job or left it and lost insurance coverage," Prego said.

In December, the hospital chain said it would lay off 160 employees, out of a workforce of about 12,000, to cut costs.

Officials at some other hospitals, including Massachusetts General Hospital and Brigham & Women’s Hospital in Boston, said they have not seen a decline in surgeries. Dr. Marc Bard, a hospital consultant for Chicago-based Navigant Consulting, said such large, internationally known hospitals haven’t been as deeply affected by the decline in elective procedures as community hospitals, although he noted that waiting times for surgeries have gone "way down" even at prestigious teaching hospitals.

At the Lahey Clinic, a 320-bed hospital in Burlington, chief strategy officer Joe Healy said the usual 3 to 4 percent annual revenue growth rate has flattened in 2009. Earlier this year, the hospital said it was delaying plans for a $100 million emergency center and expansion of a wing.

Fewer people are coming in for carpal tunnel surgery, spine, back, or knee operations, Healy said.

"I think patients are being more thoughtful, [asking], ‘Do I really need to do this now?’ " he said. "They’ll just wait and hope it doesn’t get worse."

Campbell, the secretary in Northfield, said the pain in her hip has worsened since she postponed surgery in November. Her hip often feels locked in place because degenerative arthritis has worn away cartilage between bones. Campbell said she’s not sure what is worse: her physical agony or the guilt she feels from knowing she can’t pay off debts.

"I’ve never owed money in my life and I don’t know how to live with that," she said.

Megan Woolhouse can be reached at