Rough economic times are forcing Americans to put health care on hold.

An American Osteopathic Association survey finds more than half of respondents considered their budgets before making health care decisions.

One in three say they've skipped or reduced annual visits to their primary care physician or other health care provider as a way to save money.

Obviously, doctors say, cutting back on expenses should not come at the expense of one's health.

“Annual and follow-up visits to your primary care physician should never be cut from your budget. Even if you don't feel sick, the routine screenings conducted during physical examinations can help detect the warning signs of heart disease or other illnesses,” says Dr. Ron Danoff, an osteopathic family physician in Philadelphia. “Armed with this knowledge, your physician can work with you to help prevent an illness before it starts and follow-up visits for ongoing or treated health concerns are important to ensure your personalized treatment plan is working.”

One in four also reported skipping or reducing visits to specialists that were recommended by their primary care physician or health care provider.

One in five say they're trying to reduce their spending on health care. Respondents who have been negatively affected by the economy were twice as likely to reduce spending on health care. And more patients (about 25 percent) say they are seeking alternative or free sources of health care.

Women were more likely than men to skip important screenings (such as mammograms). And patients under 60 were about twice as likely as their older counterparts to cut back on health care services (such as bloodwork, lab tests and physical therapy) to save money.

For people struggling financially, Danoff says patients can speak with their physician about alternative options for treatment, such as the availability of free samples of medication being prescribed, reduced fees or locations of free health clinics.

The survey was conducted from March 30 to April 2. A total of 1,069 respondents completed the online survey.