CAPITOLA -- Increasingly, a lack of access to children's insurance is showing up -- albeit in subtle ways -- in pediatricians' waiting rooms.

While doctors are not reporting a marked fall-off in patients, they are taking more phone calls from parents who can't afford to bring their kids in for a visit. And when families do come in, parents often express an unsettling level of anxiety about whether they'll lose their job or be able to keep up with the rising cost of insurance.

Dr. Bruce Block, whose Santa Cruz practice is affiliated with Palo Alto Medical Foundation Santa Cruz, said this is "probably the worst time" he's seen in the past 12 years in terms of stress on parents. He is worried about the rising number of kids needing insurance colliding with a reduction in access to public programs like Healthy Kids.

"We use to be able to say that in Santa Cruz, all kids could get insurance from Healthy Kids or Medi-Cal; there was just a small percentage that wasn't covered," he said. "I have the strong sense that that's growing."

Healthy Kids, a local program that a little more than two years ago was able to find health insurance coverage for most children and cover nearly all those who could not qualify for other programs, now has a growing wait list. The program froze enrollment in June due to uncertain funding.

Pediatricians are concerned that parents of the increasing numbers of uninsured children will delay immunizations. And, as one consequence, hospitalizations will rise as the kind of preventative care typically offered at clinics or through a primary care physician goes by the wayside.

Dr. Garry Crummer, whose Capitola pediatric practice is connected to Dominican Medical Foundation, said parents are increasingly seeking medical advice over the phone as opposed to bringing their children in.

"People have told me that, I really don't want to come in, I can't afford to leave my work or pay the co-pay,'" Crummer said. "Or they don't have insurance to cover it, or only have catastrophic insurance."

Crummer said he doesn't believe it's right to insist that parents come in for every problem, adding, "While I get paid only for a visit, I have to think about what's right and good for them."

However, he can't diagnose and treat everything on the phone. So, to deal with the increasing number of calls, his office has enlisted the help of a nurse advice line that patients can call with questions.

He said parents also try to squeeze a lot of questions and concerns into each appointment.

"It really changes the way I do health care, because rather than really addressing what's going on, I am trying to anticipate what could go on," Crummer said.

He also sets aside medicine samples for poorer patients or, as now is sometimes the case, even upper-middle-class families who have suddenly fallen on hard times due to job losses or rising health care costs.

"I keep samples for those who are down and out," he said. "I just never know, families I think are well-to-do, suddenly they are on Medi-Cal."