Doctors say active inflammation generated by inadequately treated arthritis can also increase your risk for coronary disease. Getting sicker can also cause your blood pressure to rise, and medications that people take for chronic diseases often have serious side effects they can’t always see or feel.

For example, medications commonly used for these diseases can cause changes in liver enzymes. Undetected, that can cause potentially irreversible liver damage. 

Delaying surgeries like knee replacement may require patients to take more pain pills, which increases their risk of falls and often leads to increased costs and worsening injuries down the road.

“This is so troubling because we’ve had so many studies done on chronic illness and there’s a chronic care model that supports ongoing evaluation of patients to prevent the progression of their disease,” says Mary Ryan, a nurse practitioner with Kansas City Family Medical Care, in Missouri.

“That saves us health care dollars, and right now, we can’t do that because the patients don’t come in. They don’t see that they have any choice but to stay home and hope their disease stays at least stable. A lot of choice has been taken away from the patients,” she says.

Hard Choices in a Soft Economy

Studies show that the problems faced by people who are trying to manage their health and protect their finances are widespread.

A poll conducted in December by the Kaiser Family Foundation found that within the last year, 31 percent of those asked had skipped a dental visit or checkup, and 29 percent had put off or postponed getting health care they needed.

“People are coming in less often for control and follow-up on their chronic diseases. They're coming in only when it’s a problem,” says Ryan.

“We have seen a lot of people, when they come in, they are sicker. Their blood pressures are higher. They have more swollen joints because they are trying what they can at home. They're trying to wait it out and see if it goes away or gets better,” she says.

The same Kaiser Family Foundation poll also found that 23 percent of those surveyed had skipped a recommended test or treatment.

Among the blue collar patient population treated in the orthopaedics department at Johns Hopkins in Baltimore, Bashir Zikria, MD, says he has seen at least a dozen people who have delayed much needed surgery in the last year, fearful it would put them out of work.

That delay means risking loss of function, jeopardizing their ability to work at all.

“I had a truck driver who injured his shoulder. I told him he needed surgery,” Dr. Zikria says. “But he said he couldn’t do it because he was afraid of losing his job because it would require so much time off."