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12 ways to cut health care costs

Reforming health care and extending medical insurance to all Americans have become national priorities, despite — or maybe because of — the weak economy. But those efforts are likely to founder unless spending on health care is brought under control.

Serious reform and belt tightening can’t happen without new policies from Washington, but individual responsibility and action can both set an example and make a contribution. It all adds up. Besides, even people with good health coverage are paying a larger fraction of their health care bills these days, in the form of co-pays, deductibles, and other out-of-pocket expenses. There’s a direct personal interest in reining in costs, not just a societal one.

We polled our editorial board to get some ideas about what people might do as individuals about health care spending. Here are a dozen suggestions for making yours a bit smaller:

1. Develop a good working relationship with a primary care physician. A primary care doctor who knows you, your medical history, and your circumstances stands a much better chance than a relative stranger of making decisions and giving you advice that will keep you healthy, out of the hospital, and in no need of specialized medical care. She or he can take care of you in context. The catch is that primary care physicians are in short supply. And primary care may be evolving into more of an ensemble approach, with the physician being the head of a large supporting cast.

2. Don’t use the emergency department unless absolutely necessary. Call your doctor or his service and try to get some advice over the phone — or, better yet, in person. Emergency care is fantastically expensive.

3. Get — and stick — with the program. Most of American health care these days is devoted to treating chronic conditions — like arthritis, diabetes, heart disease, and high blood pressure — and to care at the end of life (see #11). Taking medications as prescribed, getting regular check-ups, and adhering to lifestyle changes can keep those diseases under control at relatively modest cost.

4. Don’t go directly to a specialist without checking with your primary care doctor, even if your insurance allows it. Medical care is increasingly specialized, but as much as possible, you should let your primary care physician coordinate that care. If she or he doesn’t know what’s going on, it can lead to wasteful — and possibly harmful — overtesting and duplication of treatments.

5. Ignore the drug ads. New drugs may have real advantages over older ones, but the virtues of the old standbys, which don’t have big ad budgets behind them, often get overlooked. Older drugs are frequently just as effective (if not more so) and safer — and almost certainly cheaper.

6. Go generic. Most insurers have higher co-pays for brand-name drugs, so using generic medications can mean a cost savings both for you and for the health care system.

7. Fight inertia. If you’re taking a medication, discuss with your physician how long you’ve been taking it, whether it’s working, and if it isn’t, not taking it anymore. Get some instructions about signs that would show if the drug is working, and see the doctor if it’s not.

8. Screen the screening tests. Screening tests can save lives by catching a disease at an early, more treatable stage. But a screening test can also cause a lot of mischief: false alarms, a false sense of security if a disease is missed, and unnecessary diagnostic testing and treatment.

9. Question the need for expensive tests. Don’t push to get new, expensive tests just because you think new is better. And if a doctor orders an expensive test like an MRI or CT scan, you can ask why it’s necessary and how it will make a difference. The number of imaging tests being done in the United States has exploded and by some reckonings, almost a third of them are unnecessary.

10. Wait, and it may go away. Often it’s critically important to get medical care straightaway. Prompt treatment of a heart attack or stroke can save your life or prevent devastating disability. But people frequently get tests and treatments for aches, pains, and other discomforts that might have gone away on their own. If you are feeling sick, by all means get evaluated, but if your doctor suggests the test of time, take the test.

11. Discuss end-of-life issues with your family and physicians. A study published in The Journal of the American Medical Association in 2008 found that cancer patients who had discussed end-of-life care with their physicians received hospice care sooner and had lower rates of ventilation, resuscitation, and admission to an intensive care unit. Because they talked to their physicians, these people were treated the way they wanted to be and avoided a waste of precious resources.

12. Stay healthy! Not needing health care is perhaps the surest way of spending less money on it, both yours and society’s. So don’t smoke, eat a good diet, and exercise.

May 2009 update

Stroke symptoms are covered in our special report on healthy aging
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