"These are not dramatic drops, but in our healthcare system we're used to our numbers going up... So just seeing a reverse in the trend is interesting," said Karoline Mortensen, the study's lead author from the University of Maryland in College Park.

Using a national database of medical expenses from about 54,000 people between the ages of 18 and 64 years old, Mortensen and her colleague compared how many times people of different races used health services during two-year periods before the recession (2005 and 2006) and during it (2008 and 2009).

On average, white patients went to the doctor's office 7.3 times in the two-year span before the recession, compared to 7 times each during the economic downturn.

Black patients went to the doctor about 5.8 times each before the recession, and 5.3 times during it. Hispanic patients made about 4.5 visits each to the doctors before the recession and 4.1 during it.

That downward trend was similar for the number of people admitted to hospitals, and the number of prescriptions they filled.

Previous studies and surveys have also suggested that people use fewer health services during tough economic times.

In 2009, the American Academy of Family Physicians (AAFP) found in a survey of its members that 58 percent were seeing an increased number of canceled appointments.

The AAFP also found that 60 percent of the doctors reported they had "seen more health problems caused by their patients forgoing needed preventive care." "The first thing that drops off is preventive medicine," said Dr. Jeffrey Cain, AAFP president and a family physician in Denver.

Cain, who was not involved with the new research, said that not getting preventive care can lead to real problems for people.

For example, he said a woman may forgo her mammogram and end up being diagnosed with breast cancer later, when it is advanced.

"When you have a recession, people think of it in terms of dollars in their pocket, but it also affects their health," said Cain.

Mortensen, who published her findings in JAMA Internal Medicine, said she can't say whether or not the decreased usage in her study actually led to worse care or outcomes.

She also said that more research is needed to find out if other factors could have contributed to the decrease.

"There is something else out there that could be behind all of this," she said.

SOURCE: bit.ly/VGWOpj JAMA Internal Medicine, online January 7, 2013.

• A Permanent Economic Emergency