Much has been said and written about health care costs, especially in the last two years. The problem is that we have come to think of costs as premiums and that is not the case. Premiums reflect costs, just as Medicare premiums reflect the ever-growing cost of that program. That is not going to change despite new laws and regulations. Therefore, the real question is, what will it take to control health care costs, in short, a lot, including many things that we may find shocking in the years ahead.
However, regardless of the steps we take, costs are going to continue upward because of our life styles, an aging population and the introduction of new medical technology.
In many ways each of us is responsible for helping to control health care costs, especially when it comes to taking care of ourselves and using the system efficiently. Here are a few things you can do to help keep your premiums and payroll deductions as low as possible.
- Maintain you health as much as possible. That simply means watch your diet, exercise and the all rest you have heard a million times. You are not going to avoid all health care costs, but you may be able to mitigate some of the big stuff. Hey, it’s common sense, not to mention you will probably feel better.
- When you are prescribed a medication, ask if there is a generic. If not, ask for the formulary drug (sometimes called preferred drug) used by your plan. Also, make sure that you have the prescription filled (many people do not) and then take the medication as prescribed…until it is gone. Yeah, you are going to spend money on the prescription, but the idea is to avoid larger costs or medical complications and to get well or manage your medical condition.
- Do not be too quick to go with your doctor’s initial recommendation. Ask about alternatives and discuss your options. When necessary, as with a major procedure, get a second opinion. Overutilization is real and so is the fact that not all tests and procedures are beneficial when considering the risks they entail. For example, read this article regarding testing for heart conditions. Pay particular attention to the escalating treatment and risks questionable findings may cause.
- Avoid the emergency room, unless it is an EMERGENCY. A substantial number of ER visits are not real medical emergencies. In addition, your health plan may not pay for a non-emergency visit to the ER and may require you to call your primary care doctor first. ERs are expensive, very expensive. Sometimes going to the ER is like a 911 call for a burned out street light.
- Be informed, that is, use the vast resources of the Internet to learn about your symptoms or illness and related treatments so that you can have an informed discussion with your doctor. WebMD.com is one of several good resources.
- Use a health care provider that participates with your plan. This will assure that both your costs and the plans are the lowest possible. A participating provider has agreed to a negotiated fee and not to balance bill you beyond your co-payment or coinsurance. Sure, they may not like the fee they are receiving, but remember, those fees are reflected in your premiums. So, when the doctor complains about the cheap insurance company, he is talking about your money.
- Monitor your care and question what may appear to be overutilization. Simply put, if you do not question the need for more follow-up office visits or four weekly visits to the chiropractor no one will until after the fact. That is called medical necessity review and it is one of the ways that costs are managed. There is no reason why you should not participate in that process. It is your body after all. Quality care is appropriate care, not too little and not too much. Consider these findings from the US Department of HHS, Agency for Healthcare Research and Quality (AHRQ).
Variation in services. There continues to be a pattern of wide variation in health care practice, including regional variations and small-area variations. This is a clear indicator that health care practice has not kept pace with the evolving science of health care to ensure evidence-based practice in the United States.
Underuse of services. Millions of people do not receive necessary care and suffer needless complications that add to costs and reduce productivity. Each year, an estimated 18,000 people die because they do not receive effective interventions. For example, a study of Medicare patients who had suffered heart attacks found that only 21 percent of eligible patients received beta blockers. The mortality rate among patients who received beta blockers was 43 percent lower than it was among nonrecipients.Another AHRQ-funded study examined the use of beta blockers before heart bypass surgery and found that patients who received beta blocker therapy before surgery had lower rates of death and fewer complications both during and after surgery than patients who did not receive this therapy. Overuse of services. Each year, millions of Americans receive health care services that are unnecessary, increase costs, and may even endanger their health. Research has shown that this occurs across all populations. For example, an analysis of hysterectomies performed on women in seven health plans found that one in six operations was inappropriate. A study examining the use of antibiotics for treating ear infections in children on Medicaid found that expensive antibiotics were used far more often than indicated. According to the findings, if only half the prescriptions written in 1992 for more expensive antibiotics had been written for amoxicillin, a less expensive but equally effective antibiotic, Colorado’s Medicaid program would have saved nearly $400,000 that year.
- Get in the habit of asking what something costs. Easy, no, but you ask the cost of everything else you buy, why don’t you have the right (and obligation) to ask the cost of an office visit, or an MRI or even a major operation? The reason you do not ask is likely that you do not care. You are paying only a small fraction of the cost, but that is the essence of the health care cost problem. Nobody cares about costs because someone else is paying the bill. Well, not really, you are paying the bill through your premiums, or as part of your total compensation and through your taxes.
- If your plan makes available disease management or other similar resources, use them. It is not a ploy for the insurer to save money; it is a way of helping assure appropriate and high quality care and a way to save money. In other words, it benefits you in many ways.
- Monitor your bills and explanation of benefits for accuracy. During the health care debate, you heard a great deal about Medicare fraud and abuse. That happens with private plans as well, although perhaps not to the same extent. Ask yourself, can hundreds of billions of dollars in fraud occur without the knowledge or complacency of some patients?
Here is the bottom line, health care costs are still going up, but that does not mean we should not try to mitigate those costs as much as possible. In the process, you may just receive better, more appropriate health care. Remember, it is called health “insurance” for a reason. Just like auto, home and even life insurance the idea is to protect us from unforeseen and unmanageable costs that may cause of financial stress, not to pay for an oil change.
We have turned health insurance into something that is expected to pay for virtually every level of expense, planned and unplanned…and that costs a lot of money.
- HHS Now Has Its Own Most-Wanted List – For Health-Care Fraud (blogs.wsj.com)
- Saving Money on Your Medical Bills (outofpocket.com)