Fewer getting prenatal care
Dr. Ted Epperly, a family physician at a Boise, Idaho, clinic for the poor, said office visits were down 20 percent in August, mostly in prenatal visits by pregnant women and checkups for chronic conditions such as high blood pressure, asthma and diabetes.

"The longer it goes and the more skipped visits, the greater the opportunity there will be for bad outcomes," Epperly said. "It's not a matter of if. It's a matter of when."

Walgreen Co. pharmacies have been calling customers, making emotional arguments for why they should be getting prescriptions refilled. "For example, do they want to be around when their kids grow up, or their grandkids?" Jeff Rein, Walgreen's chief executive, told analysts last month.

In Sacramento, Calif., an area with lots of home foreclosures, primary care physician Dr. Ron Sokolov said he saw a 5 percent drop last month in patient visits compared with the year before.

He said the decline is mostly in cash-paying patients. It means those with rashes, sore ankles and other non-emergency symptoms put off treatment, he said. He has also noticed more patients are overdue for screening tests such as Pap smears and mammograms.

"A lot of people have to first put food on their table and keep their shelter," Sokolov said.

'Everything gets stretched out'
In the Palm Beach, Fla., area, another spot rife with foreclosures, Dr. Richard Hays said patients ask him to phone in prescriptions because they cannot afford an office visit or a missed day's work. Patients are demanding more generics and more drug samples, too, and stretching annual visits to 18 months.

"Everything gets a little stretched out," he said. "People have become acutely aware of the cost."

At Ohio State Medical Center in Columbus, Dr. Andrew Thomas said one of his patients put off having an MRI done for severe back pain "because literally she didn't have the gas money to drive across town."