CHICAGO (AP) – The ailing economy is leading many Americans to skip doctor visits, skimp on their medicine, and put off mammograms, Pap smears and other tests. And physicians worry the result will be sicker patients who need more expensive treatment later.

"I have to pretty much be very ill to go to the doctor," said Julie Shelley, a 49-year-old office manager and mother of three from West Milton, Ohio.

"I'm probably at the age where I should have a checkup or physical. I'm not going to do it. I am last on the list."

In Lombard, Illinois, Donald Hendricks lost his job over the summer at an event-planning company. When two of his six children came down with a fever and sore throat several weeks ago, he could not afford the gas money to drive them to the doctor. He gave them soup and soda instead, and they got better.

"I never felt the crunch like this before," Hendricks said.

In Indianapolis, Raechelle Miles lost her job at an auto parts plant in July, and lost nearly everything else in a tornado. Now her dental fillings are falling out, and she is putting off a visit to the dentist, even though she realises that may lead to more expensive treatment later on.

"The health care system was not in a good state really any time in the last five to 10 years. This has simply stressed it to a very severe degree," said Dr. Eric Schackow, a family physician in Chicago. "It does become very disheartening and discouraging because we find ourselves with our fingers in the dike."

The numbers show Americans are increasingly putting their health at risk:

¦ More and more are postponing needed care, according to a Kaiser Family Foundation poll released this week. The portion who said they or a family member have put off needed care climbed to 36 percent in the October 8-13 telephone poll, up from 29 percent in April. Almost one-third had skipped a recommended test or treatment, up from 24 percent. In both cases, about one-fifth said their condition got worse as a result.

n The number of prescriptions filled dropped 0.4 percent for the quarter ending in June – the first time it hasn't risen, according to IMS Health, which has been tracking such data for 12 years.

¦ A July survey by the National Association of Insurance Commissioners found that 11 percent of Americans had either reduced the number of prescription medicines they take or cut the dosage by such means as splitting pills in half.

¦ Elective surgeries like hip and knee replacements, diagnostic tests and outpatient procedures fell roughly one to two percent in recent months at many hospitals, said Dick Clarke, president of the Healthcare Financial Management Association. While the decline seems small, the numbers typically climb two to four percent a year as the population ages.

¦ US hospitals are reporting an uptick in emergency room patients, according to the American Hospital Association. Clarke said that includes a rise in uninsured patients with conditions that could have been treated elsewhere, and he expects that to increase.

The US unemployment rate has climbed from 4.7 percent to 6.1 percent over the past year, costing many newly jobless people their health insurance. But the uninsured are not the only patients feeling the economy's sting.

Shelley, the Ohio office manager, said that because of the worsening economy and rising co-payments under her health plan, she is putting her husband's medical needs first.

He is a substitute teacher who has had kidney and pancreas transplants, is on a dozen medications and needs bloodwork every month.

"It's tough even when times are good," she said. "The out-of-pocket is still thousands a year."

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.