Serious health care 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 toward bringing health care spending under control. Even people with good medical 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 the Harvard Health Letter 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 is most likely to make decisions and give advice that will keep you healthy. He or she can take care of you in context.

2. Don’t use the emergency department unless absolutely necessary. Call your doctor or the office's answering service to get some advice over the phone — or, better yet, in person. Emergency care is fantastically expensive partly because the doctors and nurses often need to order a lot of tests so they can make diagnostic and treatment decisions quickly.

3. Get — and stick — with the program. Taking prescribed medications, getting regular check-ups, and adhering to lifestyle changes can keep chronic 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. Whenever possible, let your primary care physician coordinate your care. If he or she doesn’t know what’s going on, it can lead to wasteful—and possibly harmful— testing and treatments.

5. Ignore the drug ads. The heyday of pharmaceutical advertising may be winding down, but there are still plenty of slick direct-to-consumer come-ons being broadcast and published. New drugs may have real advantages over older ones, but the virtues of the old standbys often get overlooked. Older drugs are frequently just as effective (if not more so) and safer — and almost certainly cheaper.

6. Go generic. Generic drugs cost less than their brand-name equivalents. 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. But check with your doctor and your pharmacist about what’s available as a generic.

7. Fight inertia. If you’re taking a medication, discuss with your physician how long you’ve been taking it and whether it’s working. If it isn’t, it may be time to reassess.

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 testing and treatment. Talk to your doctor about which screening tests are necessary for you.

 9. Question the need for expensive tests. Don’t push to get new, expensive tests just because you think new is better. If your doctor orders an expensive test like an MRI or CT scan, ask why it’s necessary and how it will make a difference. It’s the expensive inputs into our health care — all the drugs, tests, high-tech treatments, highly compensated specialists — that drive up the collective medical bill, not so much the volume.

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 because the illness-producing stress of work or school lets up, for example, or the immune system fights off the infection. 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. Roughly a fifth of the money that Americans spend on health care goes for care in the last year of life. Talking about your preferences may help—a 2008 study 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.

12. Stay healthy! Quit smoking, eat right, exercise, and get enough sleep. You’ll reduce your risk for conditions that require medical care.

For more information about staying healthy and aging well, order our Special Health Report, Living Better, Living Longer, at www.health.harvard.edu/LBLL.