Wednesday, December 9, 2009

A Ten Tip Guide to Lower Priced Health Care

Bottom line: The only way to get health costs down is when consumers are presented with a range of options in a truly competitive marketplace.

Grace Marie Turner, The Galen Insitute, "More Nutty Ideas from the Senate," December 8

Two thousand seventy-four pages and trillions of dollars later, this bill doesn’t even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs.

Mitch McConnell, Senate Minority Leader, December 8, on Senate Health Care Bill

It’s beginning to look like health care consumers are going to have to take lowering health care into their own hands since no answers are coming down from above.

Here are ten tips for lowering your costs.

One, encourage your employer to offer a health savings account with a high deductible. Encourage the employer to pay half the deductible. Your premiums will be much lower, and your employer will save up to 50% over current HMOs and PPOs.

Two, investigate a company called Simplecare. The SimpleCare story has appeared in U.S. News & World Report, in Forbes, and on NBC News. SimpleCare , a fee-for-service organization, accepts money for medical treatment without the bother and hassle of insurance forms, co-payments, and other third-party payment related procedures. SimpleCare has an alliance of doctors offering cash discounts. Itsmembership includes 38,000 patient members working with 1,500 doctors nationwide. Discounts range from 15 percent to 50 percent for patients paying in cash.

Three, ask your doctor if he or she accepts cash only. About 10 percent of doctors accept cash only. The idea is to pay for care at the time and point of care with cash, check, or credit card without the expense or trouble of going through an insurance company. Dealing with third parties creates a 50 percent to 60 percent overhead, and many doctors are finding they can charge less and make just as much or more money without going through a third party. Often the doctor’s fee is negotiable.

Four, find out if your doctor dispenses prescriptions in the office. Prescriptions dispensed in this way average 50 percent less. A company called Physicians Total Care has installed prescription systems in 30 states and is growing by 170 percent a year. For more information, google Physicians Total Care or read a chapter “Physician Office Dispensing Stages Comeback” in my book Innovation-Driven Health Care (Jones and Bartlett, 2007).

Five, fill your prescriptions at Walmart, Target, or discount stores. Walmart has more than 300 generic drugs and 1000 over-the-counter medications it sells at $4 for a 30 day supply and $10 for a 90 day supply. Fifty percent of Americans live within 5 miles of a Walmart or Target.

Six, ask your primary care physician if he or she performs common procedures like skin biopsies, abscess drainage, joint injections in the office. An organization called the National Procedures Institute ( has trained over 15.000 primary care doctors to perform simple office procedures, and these can be done less expensively without waiting than in a surgeon or other specialist’s office.

Seven, consider visiting a retail clinic in drug store or discount outlet for minor ailments or immunizations. Nurse practitioners using protocols and electronic medical records run these clinics, which may have physician or hospital backups. The charges are listed are transparent and predictable. About 2000 of these clinics are now operating, and their locations may be found at The services of these clinics cost about half as much as a visit to a physician’s office but do not have a physician’s expertise and may miss serious underlying conditions.

Eight, if you work for a larger employer, ask executives if they are considering setting up worksite clinics. About half of the nation’s corporations with headquarters employing more than 100 employers on site are organizing these clinics, which offer the services of a primary care physician and staff, which may include a nurse, nutritionist, and other health professionals. Employees can receive free generic drugs and other treatments or advice on site, or may be referred to cost-effective networks of specialists off-site.

Nine, if you are uninsured or underinsured consider visiting a federally-qualified community health clinic. These were launched by President Bush as a Health Centers Initiative in 2002. These clinics, which are present in all 50 states, have 4000 locations and have served 15 million people. They are administered by Health Resources and Service Admistration (HRSA. Services include checkups when well, treatments when sick, complete pregnancy care, immunizations, dental, and mental care. To find a clinic near you, google HRSA – Find a Health Center.

Ten, in general low cost and convenient care is available at a local primary care physician. There is now a shortage of these physicians. Therefore, these physicians are now very busy, and you may have to wait for an appointment. Because of low reimbursements, some no longer accept new Medicare or Medicaid patients.


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