November 7, 2023
5 ways to give the ER the cold shoulder this winter
- Family Medicine
- Urgent Care
April 29, 2019 | Value-Based Care
As patients, we use health insurance to help cover the costs of our medical care, but because we have insurance, and because of the way that healthcare payments have been structured for decades, many of us aren’t as cost-conscious about our healthcare as we could be.
Many people think that if their insurance pays for a procedure, it doesn’t matter how much it costs. The truth is it absolutely matters.
Although you might not have to pay additional out-of-pocket costs for a high-cost procedure or test your insurance covers (the amount you will pay today depends on your coverage levels), receiving expensive or unnecessary medical services today affects you and everyone else in the future. As we spend more on healthcare services as a population, part of that cost comes back to us in the form of premium increases, which are monthly fees we pay each month to have health insurance.
That’s why it’s essential to be mindful of how much your healthcare costs, even if you’re not paying it out of pocket.
There are lots of steps you can take to reduce medical spending (including both your out-of-pocket expenses and what your insurance pays on your behalf). Although some of these steps may not make an immediate impact on the cost of care, they can still reduce overall healthcare costs over time.
Nearly half of all Americans have at least one chronic illness, (e.g., diabetes, heart disease, arthritis, kidney disease, etc.), and chronic physical and mental illnesses account for 90% of healthcare costs in the United States.
By taking steps to prevent chronic disease, or actively manage your disease when prevention isn’t possible, you can significantly reduce your own medical costs over time. Get age- and gender-appropriate preventive screenings, stay physically active, eat a healthy diet and consult with your doctor on what you can do to either prevent chronic disease or keep your condition under control to avoid expensive complications.
Research shows that 71% of ER visits are unnecessary. Visiting the emergency room is also expensive, costing nearly 12 times more than urgent care. Even if your insurance pays for most of the cost of an ER visit, you can help save a lot of unnecessary costs by going wherever is most appropriate for the level of care that you need, and only going to an ER when your emergency is life- or limb-threatening. This guide can help you determine whether to go to an ER or urgent care. Emergency rooms may also not have access to your medical information, which means that instead of treating you based on your history, they treat you based on your symptoms—this can lead to unnecessary treatment and extra costs.
Taking your medications as directed by your doctor or pharmacist (we call this “medication adherence”) is crucial to not only your health today but also to your long-term cost of care. In fact, a 2016 study reported that patients with three or more health issues who did not regularly take their medications saw their costs increase by an average of $5,535.
If you are not taking your medications because you cannot afford them, ask your doctor about generic substitutions for the medicine you take or about programs that can help you cover the cost of your medication on top of your insurance. Pharmacies and medication manufacturers, for example, may offer discount programs to help patients with expensive medications.
A study of patients in Washington state found that, in just one year, more than 600,000 patients received medical services (an imaging scan, lab test, procedure, treatment, etc.) that they didn’t need, totaling $282 million in unnecessary healthcare spending. The challenge for patients is that they may not know what is unnecessary, and they rely on healthcare providers to tell them what they should have done.
You can prevent unnecessary healthcare costs by:
The location of your care can also have a big impact on your costs. For example, services in outpatient labs or outpatient surgical centers (sometimes called ambulatory surgical centers, or ASCs) can cost significantly less than the same services at a hospital. Ask your doctor if your procedure can be performed at an outpatient facility, or if there are other freestanding lab and imaging centers in your area.
Ultimately, reducing the cost of healthcare is not up to the government, healthcare providers or insurance companies alone. Patients also play a major role in keeping costs in control by making smart choices about their care. Whether you have health insurance or pay for medical care on your own, always look for ways to be cost-conscious.
“The Rising Cost of Health Care by Year and Its Causes.” The Balance.
“Health and Economic Costs of Chronic Disease.” The Centers for Disease Control and Prevention.”
“The Cost of Unnecessary Emergency Department Visits.” Encounter Telehealth.
“Non-adherence to drug therapy and drug acquisition costs in a national population – a patient-based register study.” BMC Health Services Research.
“Unnecessary Medical Care: More Common Than You Might Imagine.” National Public Radio.
The Live Better Team
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This information is not intended to replace the advice of a medical professional. You should always consult your doctor before making decisions about your health.