Better Care at Lower Costs

Topic Overview

Good health care doesn't just happen. You have to do your part. Taking an active role in your health care is the best way to make sure you get great care and reduce costs at the same time.

It is likely that you will be faced with one or more of the following health decisions at some time. Use the skills described in the topic Making Wise Health Decisions to help you compare your options and decide if the services or treatments in question are right for you. Try to find out how much you'd have to pay for the care you are considering. If you have health insurance, find out if your plan pays more of the medical care costs if you go to a certain doctor or facility.

Should I See a Doctor About a Health Problem?

If your symptoms and the guidelines in this website suggest you should see a doctor, don't put it off. Ignoring problems often leads to complications that are more expensive to treat.

Should I Have a Test to Diagnose My Health Problem?

Make sure you understand how any medical test will help you before you agree to it. For instance, ask your doctor if the test results would change how your health problem needs to be managed. Think about your willingness to have treatment or make lifestyle changes if you tested positive for a health problem. The only good reason to do a test is because the benefits to you outweigh the risks and costs. No test can be done without your consent. For more information, see the topic Smart Decisions: Know Your Options.

Medical tests are expensive. If you need a test, do your part to make sure that you do not have to repeat it. The tips below can make a big difference:

1. Follow instructions about how to prepare. Are you supposed to stop eating the night before? Not drink alcohol? Stop taking medicines, or take a special medicine? Get written instructions from your doctor or nurse, and follow them. This reduces the chance of error and the need to repeat the test, which saves you money. Before you have a medical test, look it up on this website so you know more about the test and what you need to do.
2. Keep a copy of all your results. Get a copy of the full test results, even if they are normal. You may get a printed copy, or you may be able to see your test results online. Do not assume that no news is good news. If you do not hear from your doctor, call to get your test results. This helps in three ways:
   • It makes sure you have the results if you later need to compare them to past or future tests.
   • You have a backup record in case you see a different doctor who does not get your test results from your previous doctor. If you can provide a copy, he or she may not have to repeat the test.
   • Having the results helps you better understand what's going on with your health.
3. Don't have tests more often than you need to. If you have a health problem that requires frequent tests and you are worried about the cost, tell your doctor. Maybe you can go a little longer between tests. Maybe you can have a less costly test some of the time and the more expensive one less often.
4. Ask about options, and shop around. The cost of some testing can vary widely without any difference in how reliable the results are. For expensive tests, it may pay to compare the costs of your best options.

Should I Take Medicine to Treat My Health Problem?

Always ask your doctor about prescription and over-the-counter medicines that you think you want to take. Find out if there are generic options. Ask what would happen if you chose not to take a medicine and whether there are alternatives to taking medicine. For more information, see the topic Smart Decisions: Know Your Options.

Should I Have Surgery to Treat My Health Problem?

Review the questions to ask about surgery in the topic Smart Decisions: Know Your Options. Get as much information about the surgery as you can, and consider your needs and values. Seek a second opinion. If you are not convinced that the benefits to you outweigh the risks and costs, don't have the surgery.

Do I Need to Go to the Emergency Room?

Hospital emergency rooms (ERs) are set up to focus on medical emergencies. They are not set up to focus on routine health care. If you go to the ER for a problem that is not an emergency:

• It will cost a lot more than it would at your doctor's office or a walk-in clinic. A trip to the ER for an earache, for example, may cost three to four times as much as it would at your doctor's office.
• You will probably spend a lot more time there than you would at a walk-in clinic or doctor's office.
• You will get care from a doctor who has probably never seen you before. It's always best to get as much of your care as you can from a doctor who knows and understands you.

Go to the ER if you think you are having a medical emergency. That's what the ER is for. Otherwise, call your doctor's office first, or go to a walk-in clinic. It will save you money and time.

How do I know when it's an emergency?

There are few clear rules about what is an emergency and what isn't. Most doctors would agree on a short list of problems that should always be treated as emergencies- heart attack symptoms, not being able to breathe, severe and uncontrolled bleeding, stroke symptoms, and a few others.

Most health problems are not emergencies. You may want to take care of the problem right away because you feel sick or uncomfortable, but nothing bad is going to happen to you if you wait a bit. Then again, you don't always know that for sure. Some problems that seem minor can become serious if you ignore them. And it may be even harder to know what to do when a child is sick.

One good question to ask yourself is, "Am I thinking about going to the ER because it's convenient or because it's necessary?" If you are choosing the ER because you can get in without an appointment, keep in mind the high price you will pay for that convenience. You may also have to wait a long time before you are seen by a doctor. And you may have other options. You can always call your doctor's office or a nurse line for help.

What if a problem happens on a weekend or at night?

If you think you are having a medical emergency, call 911 or other emergency services immediately or go to the ER.

If you don't think the problem is an emergency:

• Use the "Search" feature to look up your problem on this website, and read the information about when to call a doctor. See if there is home treatment you can try.
• Call your doctor's office, and see if there is a number to call for after-hours service.
• Call a nurse line for advice. The nurse can help you decide whether you need to get help now or whether it is safe to wait.
• Go to a walk-in clinic (if one is open).
• Go to the ER if you feel the problem cannot wait until your doctor's office or a walk-in clinic is open.

What is a walk-in clinic?

Walk-in clinics are often called "minor emergency," "urgent care," or "immediate care" centers. They deal with all kinds of health problems and are often open in the evenings and on weekends. You do not need an appointment.

These types of clinics can be a great option when:

• You can't or don't want to wait for an appointment at your doctor's office.
• You don't need the level of care an ER provides.

Care at a walk-in clinic costs a lot less than care for the same problem at an ER.

If it turns out you are having a true medical emergency, a walk-in clinic will send you to the ER.

Unless you have a walk-in clinic in your neighborhood or already know where one is, it may be hard to find one when you need it. So at your next doctor visit, ask your doctor to recommend one. Check with your health plan to see if it offers better coverage at some clinics than others.

Do I Need to Be Hospitalized?

If you need inpatient care, get in and out of the hospital as quickly as possible. This will reduce costs and your risk of hospital-acquired infections. For more information, see Navigating Your Hospital Stay. To avoid extra days in the hospital, you may be able to bring in extra help at home. Ask about home nursing services to help while you recover.

If you have a terminal illness, hospitalization may not be your only choice. Many people choose to spend their remaining time at home with the people they know and love. Special arrangements can be made through hospice care programs in most communities. For more information, see the topic Hospice Care.

Should I See a Specialist About My Health Problem?

Specialists are doctors who have in-depth training and experience in a particular area of medicine. For example, a cardiologist has years of special training in dealing with heart problems. A visit to a specialist often costs more than a visit to your regular doctor, and the tests and treatments that you receive may be more expensive and invasive. Of course, specialists often provide the information you need to help you decide what to do about a major health problem and can perform certain procedures not available through your primary care doctor. For more information about specialists, see the topic Medical Specialists.

If you think you need to see a specialist but you have not been referred to one, discuss your concerns with your primary care doctor. When you do have a referral to see a specialist, a little preparation and good communication can help you get the most out of your visit. Before you go see a specialist:

• Know your diagnosis or expected diagnosis.
• Learn about your basic treatment options.
• Make sure that any test results or records on your case are sent to the specialist.
• Know what your primary care doctor would like the specialist to do (for example, take over the case, confirm the diagnosis, conduct tests).
• Ask your primary care doctor to remain involved in your care. Ask the specialist to send new test results or recommendations to both you and your regular doctor.