Ten Steps to Better Health Care
1. Think About Your Health
Research the family risk factors—from parents and grandparents to other close relatives—and conduct an inventory in consultation with your doctor or doctors. Become knowledgeable about medical science as it applies to your health.
2. Think About How You Use Health Care
Besides making healthy choices, such as regular exercise and eating right, ask yourself questions about your actual health-related behavior: Do you seek medical treatment when it's really necessary? Do you schedule examinations as appropriate? Do you take medicine as prescribed? Think about your habits, evaluate whether you use health care rationally and make the necessary improvements. Be realistic.
3. Know the Doctor
Whether an obstetrician or an ophthalmologist, choose a doctor based on criteria that match your self-interest. If personal attention is important, call and ask to speak directly with a doctor. Explain that you are considering a visit and prospective relationship with the doctor and that you want to ask some questions. He or she may be busy with a patient, so you might be asked to wait for a returned call but if you wait more than a day or two, personal attention may not be the doctor's priority. Judge how your call is handled.
Ask questions about the doctor's education. Ask whether the practice accepts your plan; some of the best doctors refuse to accept HMOs, PPOs and Medicare. Ask what percentage of his patients are in your age range. Inquire about his plans for the future; if you're a young mother planning to take your family to an internist, a doctor nearing retirement may not be suited to your needs.
Ask for references from other doctors and patients. Ask what hospital the doctor's affiliated with. Ask about the cost of procedures. Show an interest in how and whether the doctor makes money. Ask about fees for cancelled appointments and ask about payment options, such as cash payment or pay-at-appointment discounts.
Schedule a meeting. Prepare for an examination with a list of clinical questions. Monitor wait-times. Go for annual exams, depending on your age and health, and routine checkups. Get to know the staff and the doctor. Let the doctor get to know you. Discuss your family health history and your expectations.
4. Know How the Doctor Is Paid
Payment is the proper reward for someone whose work is good and doctors are no exception. Whether the doctor is on salary with an HMO, routinely waits several months to be reimbursed by a health plan or barely covers his costs through Medicare, how a doctor is paid—and whether he expects to be paid—is revealing. Money matters and it ought to matter to the doctor. Having a doctor who makes money from treating you is better than having a doctor who doesn't. Would you trust a doctor to whom money does not matter?
5. Study the Health Plan
What type of health plan do you have? An HMO? PPO? Fee-for-Service? If you are like most Americans, you probably aren't sure. You may not even know the answer.
If you are covered by a business, find your current health plan. Read it. Mark the next open-enrollment period in your calendar. Read, study and compare various plans. Call toll-free numbers, track operating hours, monitor wait times, ask questions, and take notes on each plan. Call back at night, repeat the process and compare the results. See if you get contradictory answers to basic questions about plan coverage. Measure how knowledgeable the call representatives are. Discuss conclusions with your spouse. If you're covered by a small business, your choices may be limited and you might be better off buying your own insurance.
If you do, or if you buy your own insurance, be prepared. Don't rely on insurance agents, who often sell group plans; many do not know about covering the individual. Insurance is dominated by groups and there isn't much incentive to cover the individual. Finding an individual or family plan isn't easy but it is getting easier.
A plan's fine print dictates the terms and conditions under which you will be treated—and whether you will be treated at all. Looking for individual health insurance may be tedious but independence from job-based coverage is a strong reward. Don't give up; there is no substitute for doing your own research—there is no shortcut to knowledge of complicated health plans—and achieving your own understanding. Don't wait to learn about your health plan while riding in an ambulance. Read, study and know your insurance before you use it.
Among important questions to consider while choosing health plans:
- What constitutes an emergency and who decides?
- Is treatment subject to pre-approval and who approves: nurse practitioner, physician's assistant, doctor?
- Can you go out of network?
- What portion is paid for treatment out of network?
- Are you covered for an annual physical examination?
- Does the plan stipulate that drugs be generic?
- Are name brand drugs covered?
- Are you covered out of state?
- Are you covered at a non-network hospital in state? Out of state?
- Are you covered outside the United States?
- Does the plan cover your emergency medical travel back to the United States—or require that you be treated in the foreign country?
- What is the plan's lifetime maximum?
- What is the monthly premium?
- What is the insurer's professional rating?
- Where is the insurance company based?
- Is the insurer a subsidiary?
- How much money does the plan's underwriter have in assets and reserves?
- How is the plan rated in paying claims?
- When was the plan's insurance company established?
- Where is the company's call center for emergency and non-emergency medical approval based?
6. Know How the Health Plan Is Paid
Most Americans depend on others—an employer, the state, an organization—for health insurance. Employers are often forced through regulations and escalating premiums to change health plans, compromising the stability associated with employer-based coverage.
Ask your employer how much the employer is paying for your health care (some employers already provide average annual per-employee health care costs during open enrollment). When the employer's premiums rise, employees receive fewer pay raises and what may appear to be an advantage—employer-based coverage—becomes a health care rollercoaster: rising premiums for the employee, changing plans with changing approved doctors and hospitals and rising co-pays, increased restrictions on choice of doctors and hospitals. Depending on your employer for health care means you risk losing your health coverage if you leave the employer—and you may not be eligible for insurance as an individual when you leave.
Some employees opt out, choosing to buy insurance as an individual and there are advantages to individual insurance: better quality medicine, free choice of doctors and hospitals, fewer restrictions on drugs, lower co-pays, and the peace of mind that comes from knowing your health care is not attached to a job. Others can't afford independence, though cost is contextual. In either case, an informed decision starts with knowing how your health coverage is paid. Explore the choices.
7. Save Money
Whether the medical profession continues toward socialism or moves toward individual rights and capitalism, money is essential to obtaining quality health care. Like retirement and estate planning, saving money for health care is important for everyone, young and old, rich and poor, healthy or sick. Take advantage of Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Flexible Spending Accounts (FSAs), Roth IRAs, or other investments. Strive to save as much money as possible for an uncertain future in health care.
8. Ask for Cash Discounts
When you pay out of pocket for health care—for routine visits to the pediatrician, dental hygiene, orthodontics, annual examinations, PAP smears, eyeglasses—ask the doctor for a cash or pay-at-appointment discount. Explain that, because the doctor will not be forced to wait several months to be reimbursed by the health plan, your cash expenditure will lower expenses (because the doctor will not be forced to chase reimbursement) and, subsequently, you are requesting a discount. In our experiences, dentists, orthodontists and doctors typically grant 15 percent to 40 percent discounts depending upon the patient, the treatment and the health plan.
9. Recognize That Health Care Is Not a Right
Today's dominant ideas emphasize entitlement, not personal responsibility. So the fallacy that health care is a right—that you're born with a right to force others to heal you and pay for healing you—may creep into your attitude. Check and double-check thoughts, choices and actions, examine your behavior, and be honest about your own sense of entitlement. Health care is not a right.
10. Be Personally Responsible for Your Health Care
Don't expect someone else to take care of you, your health, your health care or your health insurance. Take care of yourself. Strive to be healthy. Save money. Know your doctor, your plan, your choices and how everyone from the doctor and the plan is paid. Take ownership of your health care.
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