Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

If you're looking for ways to save money on health care, you're not alone: One in three Americans say they've had problems paying their medical bills in the past year, a new study finds. And 18 percent of Americans said their medical bills were higher than $1,000.

To cope in today's bad economy, it seems that people may be taking shortcuts with their health care. For instance, I've read about people who stop taking medicines they need to control a chronic condition, skip appointments with their doctors, or postpone surgery to save money.

As a physician, I worry when I hear these stories. I'm concerned that patients may feel they have to make these decisions on their own. If you find yourself in this situation, consider talking to your doctor, nurse, or pharmacist. These medical professionals can advise patients about steps they can take that won't harm their long-term health. But, I also understand that for many people, today's economy is forcing them to make difficult choices. Paying for medicine that may prevent an illness tomorrow might not seem as crucial as other needs.

However, patients should be very careful about treating their health care expenses in the same way as other expenses. Cutting back on health care—especially without consulting your doctor—is a risky decision. Over time, it could lead to bad results for your health and even for your financial security.

With that caution in mind, there are some steps you can take to make sure you are getting the best health care value you can. For example:

  • If your employer offers health insurance, compare your options to make sure you are choosing the best plan for your needs. Talk to your company's benefits manager or your insurance company to make sure you understand your coverage. Switch to your spouse's plan if it's more affordable and still meets your needs. If they are available, use flexible spending accounts, which are a type of savings plan that allows you to put aside money to pay for out-of-pocket expenses with pre-tax dollars.
  • If you don't have health insurance, find out about free or discounted care policies at your local hospital or community-based clinic. Many hospitals get payments that offset some of the costs of caring for people who don't have health insurance. Policies vary from hospital to hospital, but research shows that health centers at universities give more free care than community hospitals. Many communities have clinics that offer care for reduced fees, or adjust their fees depending on patients' income.
  • If you need prescription medicine, ask your doctor if you can switch to the generic version. The Food and Drug Administration requires generic drugs to have the same quality, strength, and purity as brand-name drugs. They are cheaper because the manufacturer did not invest the money to develop the drug.
  • Check discount big-box stores for savings on your generic medicines. These stores have online pharmacies where you can compare prices and make your purchase. Because these stores buy in large quantities, you may be able to get your prescription filled cheaply.
  • Find out if you qualify for a patient assistance program. Drug companies set up these programs that offer free or low-cost drugs to people who are unable to pay for their medications. All of the major drug companies have these programs, but their coverage policies vary. The RxAssist Web site is a good place to find out more about how these programs work and whether you qualify.
  • Keep up-to-date on routine screening tests that can catch disease early when it is easier to treat. For many people, wellness checks, such as cancer screenings and blood pressure checks, are important practices that should not be skipped. Checklists from the U.S Preventive Services Task Force can help remind men and women which tests they need.
  • Continue (or begin) healthy, daily habits that can stave off illness and disease. Being physically active, eating a healthy diet, keeping at a healthy weight, and drinking alcohol in moderation are all smart paths to good health.

These steps require you to think ahead. Some may require you to explore options you'd rather not have to. But in the long run, these can help you hang on to an asset that even a failed bank can't take away: your health.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
Keeping Healthy When the Economy is Not  (Transcript)

Agency for Healthcare Research and Quality
Men: Stay Healthy at Any Age—Your Checklist for Health
http://www.ahrq.gov/ppip/healthymen.htm

Agency for Healthcare Research and Quality
Women: Stay Healthy at Any Age—Your Checklist for Health
http://www.ahrq.gov/ppip/healthywom.htm

U.S. Food and Drug Administration
Center for Drug Evaluation and Research
Generic Drugs: Questions and Answers
http://www.fda.gov/buyonlineguide/generics_q&a.htm

RxAssist
Patient Assistance Program Center
http://www.rxassist.org/faqs/rxassist.cfm

Kaiser Family Foundation
Growing Number of Americans Report Problems Paying Medical Bills and Delaying and Skipping Care Due to Costs
http://www.kff.org/kaiserpolls/h08_posr102108pkg.cfm

Commonwealth Fund
Hospital Pricing Behavior and Financial Risk, Testimony before Committee on Ways and Means, June 22, 2004
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=229494#areaCitation

Current as of November 2008
Internet Citation: Keeping Healthy When the Economy Is Not. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/110508.html