Who goes without medical care?

The U.S. Census Bureau recently reported that working-age adults made an average of 3.9 visits to doctors, nurses or other medical providers in 2010, down from 4.8 visits in 2001. Among those with at least one visit, the average number of visits also declined, from 6.4 visits in 2001 to 5.4 visits in 2010.

Perhaps Americans are getting dramatically healthier. Or perhaps they can’t afford to go to the doctor.

“The decline of the use of medical services was widespread, taking place regardless of health status,” said Brett O’Hara of the Census Bureau.

But people lacking insurance were far less likely to go to doctors. Just 24 percent of the uninsured went to a doctor at least once in 2010, compared with 72 percent of the general population of working age adults, the census report found.

The census data contradicts the common-sense supposition that people in bad health would be more likely to avoid being uninsured. People under 65 whose health was poor, fair or good were more likely to be uninsured than those with very good or excellent health.

Spending a night in a hospital has become a rare event. The chances of spending no nights in a hospital ranged from 96 percent for children to 83 percent for people 65 or over.

Among people in poverty, 38.6 percent went without seeing a medical provider over the previous year, compared with 19.1 percent of people whose family income was greater than 400 percent of the poverty threshold.

Clearly, a lot of sick people don’t get government assistance — even when they can’t afford medical care. So they go without doctor visits, lab work and medications.

In an article, Ruth Fishbeck, director of the Health Initiative in Potsdam, recently described the serious health consequences of a lack of affordability in St. Lawrence County in the far northwestern corner of the Adirondacks. “People are dying,” she said. “We rank in health 58th or 59th out of 62 [New York counties], and that means premature death and sickness. And a lot of it is simply the lack of money to get adequate health care.”