Reducing Medical Costs: How to stay healthy for less

With the economy floundering, it’s a good time to talk about medical costs, which can contribute to financial worries. It can be expensive to stay healthy. There are costs for medicines, medical visit co-payments, healthy foods, and exercise. What can you do to trim costs in these areas?

Medicines

Medicines can be very expensive, but several strategies can reduce that cost. First, generic equivalents of brand name drugs will be less expensive for you and for your health plan. In the immediate term, you should have a substantially smaller co-pay for generics. Your health plan will pay less, which in the long term might help to reduce your insurance costs.

If the medicine that you are taking is still “on patent” there won’t be any generic versions available for some time, but there may be alternative medicines in the same class that are vastly less expensive. For example, say you take Lipitor (atorvastatin) or Crestor (rosuvastatin), for which there is no generic currently available. You can probably switch to one of the much cheaper generics: simvastatin, lovastatin, or pravastatin.

There is always the question of whether all medicines in the same class are equivalent. Lipitor and Crestor lower cholesterol more potently then the generic alternatives and may not be an option for those with the highest cholesterol. We know that high-dose Lipitor is very effective following a heart attack in reducing the risk of another attack; it’s impossible now to achieve the same dose equivalent with generic alternatives. Months after the heart attack occurred, however, many doctors would be willing to switch a patient to a cheaper alternative.

There are cheaper alternatives for many other commonly prescribed medicines including those for ulcer or reflux, hypertension, osteoporosis - in fact most medical illnesses. Older medicines available in generic form generally also have a great track record with respect to safety. Feel empowered to ask about cost and alternatives when new medicines are prescribed.

You can cut costs even further for selected generic medicines. Wal-Mart and Target each offer a selected list of generic medicines at $4 for a 30-day supply and $10 for a 90-day supply. Mail order pharmacies can also reduce cost and reduce the number of trips needed to your local pharmacy.

Office Co-Pays

What about co-pays? It may be possible to safely consolidate your care into fewer visits. Some illnesses don’t require a doctor’s evaluation. The common cold with nasal congestion and sore throat is usually a viral illness, which will run its course without needing treatment. If your doctor’s office has phone triage, call first for advice to see if a visit is even necessary. Emergency room care will likely cost much more out of pocket, so see your primary care physician first for most issues (though not if your symptoms might indicate a heart attack or another medical emergency).

Your primary care physician may also be able to manage things that you might think require a specialist. For example, women who are not pregnant can normally get routine pap smear screenings and contraception advice from their primary care doctors during a visit for a check up or another reason, rather than seeing a gynecologist separately. The same is true for mild acne or joint pains—see your primary care doctor first to minimize visits to dermatologists or orthopedists. Check in with your primary care physician to see what can be handled in his or her office.

Exercise and Healthy Eating

Regular exercise is even more important when money is tight because it helps to reduce stress, prevents weight gain, and helps with depression. Exercise can be expensive if done in a gym, but there are cheaper alternatives. Bicycling to your destination is great exercise and reduces fuel and parking costs. A switch to public transportation often means a walk to the bus or train. A pedometer can help you to keep track of your walking, motivate you, and allow you to measure your exercise.

My colleague, Dr. Mary Pickett, wrote an article on Gather a few months ago on tips for healthy eating on a budget. Click here to read it.

Don’t be embarrassed to discuss economic issues with your doctors; ask them to brainstorm with you to minimize expense and maximize your health. If you are losing your health insurance, call your doctor’s office and try to make appointments before insurance ends, and ask if there are any programs that might help. Chances are your doctor is hearing about financial worries from lots of other folks.

What have you done to cut back on health-related costs?

Carol Kurtz Bates, M.D., is an Associate Professor of Medicine at Harvard Medical School and a primary care internist at Beth Israel Deaconess Medical Center where she is also Primary Care Program Director.

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