With unemployment rates remaining at an all-time high, one in five Americans chose not to seek medical care for a recent illness or injury, with four out of 10 citing cost as the primary factor, according to a Deloitte Center for Health Solutions survey of more than 4,000 adults in the United States.

Deloitte's survey also revealed a decline in the number of consumers reporting to have visited a physician or health care professional in the past year; 79 percent of respondents sought medical attention in 2010 as compared with 85 percent who did likewise in 2009.

"As the burden of care continues to be shifted to the individual, and more Americans lose their jobs and their health insurance, we expect this trend will continue," said Paul Keckley, Ph.D., executive director, Deloitte Center for Health Solutions. "It will be interesting to see what happens in 2014 when the individual mandates requiring Americans to purchase health insurance kick in. Will we see a significant spike in visits to the doctor as more Americans join the ranks of the insured?"

Consumers Seek Alternative Care Options

Below are some of the alternative options to traditional care that consumers are exploring according to the survey:

- 15 percent of consumers reported visiting a retail clinic and 34 percent said they would do so if it cost 50 percent or less than the cost of a doctor's appointment.

- More consumers are seeking alternative or natural remedies before seeing a physician (17 percent chose this option in 2010 compared with 12 percent in 2009).

- More consumers are supplementing their current regimes with alternative remedies (20 percent pursue this route in 2010 compared to 16 percent in 2009).

- Consumers are also receptive to medical tourism, but only 7 percent sought health care services outside their local community in the last 12 months.

"As consumers increasingly begin to 'shop' for their care, they are seeking new options — price and convenience are key drivers," added Keckley. "Some consumers are heading to retail clinics for their flu shot instead of the doctor's office."

Some health care organizations have reported a decline in utilization of health care services in their most recent quarterly earnings reports. Reasons attributed include declines in admissions at some hospitals, decreases in visits to the doctor, less volume for some prescriptions and, in some cases, a reduction in medical tests ordered.

"While some health care organizations are seeing a dip in utilization, this is not the case across the board," said Russ Rudish, vice chairman and Deloitte health care provider practice leader. "In fact, some hospitals and health care providers have also reported increased demand for health care services. A lot depends on geography and patient population. Overall, the health care provider industry is cautiously optimistic that once deductibles are hit and health insurance kicks in, the volume of activity for medical services may return."