April 21, 2018
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With care, we can cut health costs

By Dr. Erik Steele

In previous recessions, most of us with health insurance looked somewhere other than our health care to save money. Nowadays, high deductibles and co-payments have meant getting health care takes money right out of our pockets, and that has some of you cutting your personal expenses by putting parts of your health care on hold. But cutting your own health care costs is potentially deadly work; if you are not prepared to operate with the care of a surgeon, cut somewhere else. On the other hand, with a little care, many of us can cut our medical spending without cutting our own throats.

The first and required step is to get your physician, nurse practitioner, or physician assistant on this job. They may have considerable discretion in how much of your health care money is spent and when. If you sit idly by while they rack up medical bills for you, or you want “everything, Doc” as though you are a Saudi prince, big bills may follow without you having much control.

Then ask your providers what the downside is to postponing or skipping treatment or tests they recommended. Is it safe to wait, and if so, for how long? Many symptoms will go away if the patient and provider apply the treatment of time and careful watching, rather than rush to the test in order to allay anxiety (the patient’s and the provider’s). Severe low back pain, for example, will often improve over four to six weeks, avoiding the need for an expensive MRI scan.

Related, ask if there is a way for you to avoid the test or pill your health care provider is recommending if you make a concerted effort to fix the problem yourself. The loss of 20 pounds and regular exercise, for example, might get back pain under control, or eliminate the need for additional medications to treat diabetes or high blood pressure. Exercise is cheap treatment with many wonderful side effects, including lower blood pressure, lower blood sugar, better mood, longer life, better life, etc.

Don’t allow your provider to order a bunch of routine tests as part of your annual physical exam without asking whether expert national guidelines (such as the U.S. Preventive Services Task Force) suggest those tests are really necessary for you. Annual chest X-rays for patients with no lung disease, or annual EKGs for patients with no heart disease, for example, are of little benefit for most patients. Ditto routine blood counts and blood chemistry tests for many healthy patients. Some women don’t need a Pap smear every year (now there’s a sacrifice women would hate to make in hard economic times).

If you need a medication, ask your provider to choose one — if possible — off a list of generic meds available at your local pharmacy that offers a month’s supply for about $4, rather than some newer meds that work no better but cost about $60 per month. If you don’t ask, your provider might not think about the $4 generic options. Then ask your provider and-or your pharmacist about other ways to save money on your meds, such as pill splitting.

If you are an adult, consider skipping X-rays for routine sprains and strains unless the involved joint is too painful to use at all or still painful 10 to 14 days after the injury. (A sprain in a child is much more likely to be a fracture than a sprain in an adult.) Ditto chest X-rays and antibiotics for colds and bronchitis episodes; for most of us those are just a waste of our money.

Saving money by postponing or skipping medical care willy-nilly is dumb. It entails risk; putting off the wrong surgery or test could be penny-wise and a ton of bricks foolish. Putting off joint replacement on a bum hip can lead to lack of exercise and progressive deconditioning. But the careful patient and the thoughtful health care provider, guided by common sense and good medical studies, can be a powerful combination for personal — and national — health care belt-tightening in these tough financial times.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.

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