Patients, Physicians Can Work Together to Lower Costs

According to a recent study from Harvard, illness and medical bills caused half of the 1,458,000 bankruptcies in the in US in 2001. Estimates are that medical bankruptcies affect about 2 million Americans annually counting debtors and their dependents and including about 700,000 children.

Most of those bankrupted had health insurance at the beginning of their illness, with 38% losing that insurance at the time of filing. Most filers were middle class, homeowners, and college educated. In many cases the illnesses forced breadwinners to take time off work, losing their income and job-based health insurance at the time they needed them most. To complicate matters, many Americans with health insurance have high deductibles, co-pays, and many exclusions as opposed to the comprehensive plans that many assume are universal.

One wonders if as a consequence people avoid seeing a physician until a situation becomes urgent - often resulting in ultimately higher costs and potentially greater disability due to more advanced illnesses. Because many if not most physicians do not know the costs of medications, procedures, and diagnostic testing and are often unaware of the financial limitations of the kinds of insurance that patients have, expenses for a potentially severe illness can quickly escalate. In medical specialties where the potential for litigation is higher, physicians may order more tests and procedures to protect the patient from unlikely injury and themselves.

The situation is made more complex by virtue of the absence of information available on the charges for health care, making it very difficult for patients and their families to be careful shoppers. Hospitals are only just now beginning to post the charges (not costs or discounted rates) of some basic procedures. Prescription medication costs are unavailable to the public at large, requiring information from a pharmacist or physician who has access to pricing information. It is easy to see how quickly large medical bills can accumulate that would stretch the budgets of most Americans - particularly if there is little in the savings account or other sources of funds beyond one's weekly paycheck.

The good news is that for all but the most catastrophic conditions, there are ways to limit your health care costs while lowering yours or your family member's risk for life-threatening illnesses.

• Seek age-appropriate preventive care. There are clear recommendations for screening for potentially serious illnesses before they become both life-threatening and expensive. If you know that a particular medical condition runs in your family, let your physician know and seek care at a younger age. A consultation with a doctor in the form of an office-based visit for a history and physical absent any laboratory testing should run in the neighborhood of $150.00.
• Look for free screenings for high blood pressure, diabetes, prostate cancer, and elevated cholesterol. If you find yourself at risk for one or more of these conditions, see a physician and do some research on what you can do on your own.
• Do not delay care as a cost-saving strategy. Delayed care of a serious illness will often result in higher costs, more severe illness, and longer time away from work.
• Tell your doctor if you have health insurance with a high co-pay, high deductible, or exclusions and what those restrictions are.
• Ask your doctor to prescribe generic medications whenever possible. Many physicians should carry with them a pocket reference that provides accurate information on drug costs that can be easily accessed during the patient-doctor encounter.
• If an expensive test or procedure is being considered, ask your doctor if it is absolutely necessary. You should get an explanation of what the risks of not having the test are and expect the doctor to document in your chart if you choose to defer the examination or procedure and why.
• Ask to meet with the clinic manager or hospital accounting office to see if there are payment plans available to stretch out the time for repaying expenses or if there are programs for assisting with very high bills.

Don't be embarrassed to admit that your health insurance has limitations. Most if not all physicians should be understanding once this information is revealed and will try to work with you within the constraints of the finances at your disposal. Keeping silent about your finances hurts you and puts the rest of your family at risk. The last thing that I want you to do is to tell me you are following through with a treatment plan while actually not getting the care prescribed in order to save money.

"Your Health" provides easy-to-understand information about common health conditions.