Since the advent of the Great Recession of 2008, more Americans have been splitting pills, postponing needed visits to doctors, skipping dental care, and avoiding recommended medical tests due to the cost of those health care services.

Call it health care self-rationing: the Kaiser Family Foundation (KFF) has been tracking this trend for the past several years, and the proportion of American adults rationing health demand is up to 58%. This KFF Health Tracking Poll interviewed 1,218 U.S. adults age 18 and older via landline and cell phone in May 2012.

As the chart illustrates, 38% of people are “DIYing” health care at home using self-help remedies and over-the-counter drugs, and 1 in 3 is skipping dental care and oral health check-ups. 29% are postponing necessary care, 25% skipping medical tests and treatments, and 24% aren’t filling prescriptions.

Furthermore, even when someone is filling a prescription, 16% are cutting pills in half or skipping doses to make the medication last longer.

All of these self-rationing actions aren’t because people think they’re being over-treated, or lack faith in the medical regiments — both of which are rational questions for health consumers to ask. In these cases, the KFF poll asks people if they’re taking these actions because of cost.

The Poll also asked U.S. health citizens their views on women’s health in light of recent media coverage on reproductive health, along with overall issues for the November 2012 Presidential campaign. Top among voters’ concerns are the economy and jobs, among 60% of Americans, followed by health care (23%), social issues such as gay marriage and abortion, and security/war and education tied with 8% of Americans identifying these as their #1 issue.

Support for the Affordable Care Act dipped to 37% in this May 2012 Poll, which had a high of 50% favorable a few months after the law was signed in July 2010. Unfavorables were steady at 44%.

Health Populi’s Hot Points:  Health care is a top concern for Americans, following the economy and jobs. With most Americans self-rationing care, our personal health microeconomies in our households will be tied up in the larger context of the U.S. macro-economy approaching the November 2012 elections.

In the past couple of months, I’m often asked to opine about the impact of the Supreme Court ruling for or against the ACA mandate which would compel people to purchase health insurance, among other aspects of the law. The private sector commercial health plans, driven by employers seeking to control health costs and improve population health outcomes, as well as State Medicaid programs, with Governors looking for creative solutions to provide health care to state health citizens, are already moving toward value-based health programs that pay for quality and performance. As far as scenarios go, health planners, marketers and policymakers should keep their eye on value, not volume, as the way forward.

Health reform is already happening in the home, in State houses, and with employers who are footing the other portion of health care costs. The art of creating value-based health plans is to nudge people to do the right thing when it comes to health: and that’s not self-rationing necessary care. It’s getting people the right kind of care at the right time in the right (often lower-cost) setting.