A question of medical priorities: Hip replacement? No. Smiles and Botox? Yes!

REGION – Looking for something, anything, recession-immune? Try the mirror, says one area cosmetologist rep.

"We're bustling because people still want to look great," said Kelly Bolton, office coordinator for The Clear Clinic, a skin care practice with locations in Traverse City and Petoskey. "Botox services, especially, have not been affected."

The Clear Clinic offers dermatology services beginning at $25 and running into the thousands, and though Bolton said "Mercedes-type" services with a high status and a price tag to match are down, the demand for most of the other skin care services, including Botox injections, has remained steady. The practice offers brow shaping, dermal fillers, skin rejuvenations, and more.

"Some people are more careful about how they chose services. They'll say, 'I have $250 to spend. What's the best value for that money?' We're very open to working in that way with our clients."

Hospitals across the country are reporting a decline in many elective surgical procedures from hip replacement surgery to carpal tunnel syndrome treatments. The most recent study by the American Hospital Association (AHA) found that approximately one third of hospitals nationwide were experiencing a moderate to significant drop in elective procedures. At the Northwest Michigan Surgery Center in Traverse City, elective procedures are down eight percent, according to CEO Jim Stilley.

"The largest thing I'm seeing right now is the drop for employed people where the recovery would be two weeks or longer," said Stilley. "They don't want their employer to see them as expendable."

The challenging economy is the general culprit, according to both the AHA study and Stilley, though the specific reasons are more varied. The AHA points to a loss of employee-paid health insurance coverage, a loss of personal and retirement income for out of pocket medical expenses, and even an unwillingness to pay for regular testing. Stilley adds the increased co-pays and deductibles insurance companies charge are also a factor.

A second study by Longbow Research that targeted surgery centers like Northwest, was released April 15. This study found that 40 percent of centers had a drop in procedures. As for the future of care, nearly 80 percent predicted either flat or very modest growth for the remainder of 2009. Only 14 percent predicted further declines, however.

The Northwest Michigan Surgery Center, which has ten operating rooms and performs as many as 1,600 surgeries a month during peak times, has also seen their bad debt accounts increase, said Stilley. Higher medical bills, a lack of ability to pay, and a drop in patient numbers are worrying the industry, but a bigger problem for both patients and the medical community may lurk in the months to come.

"The real concern about self directed care is what happens when you put off these things and what was a screening becomes an emergency? What could have been $250 colonoscopy might turn into a life threatening surgical emergency."

It will be months until the repercussions of such decisions are seen. Stilley said he's hopeful that recent economic indicators show some recovery and that patients will not delay important procedures for more than a few months. In April the Surgery Center saw a slight break in the continuing decline, he said.

While they might be skipping health screenings at their own risk, locally people are still willing to pay not just for wrinkle-free skin, but also for an attractive smile. At Northway Orthodontics in Traverse City, new treatment starts are up, even if more patients are asking about financing options.

"We're being a little more creative than we've ever had to be before," said office manager, Lisa Crouch. "And, we do caution our insured patients that if they lose their job during treatment they'll probably still have a balance due. But we're not seeing a drop in new patients." BN