Everyone is talking about the excessive cost of medical care, and people are proposing many top-down solutions. But you can start saving money on health care today, according to our guest Dr. Cynthia Koelker,

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Dr. Koelker is author of the book 101 Ways to Save Money on Health Care. She points out that one of the primary problems with the high cost of health care is that people don’t even know the costs of what they are buying. There’s no transparency. Even the doctors don’t know the costs (and I can personally vouch for that!).

Koelker points out that many conditions can be treated at home with over-the-counter medications, saving the need for a doctor’s visit. Patients with self-limited viral respiratory infections may not need to see a doctor. And there can be even more savings when people who do need to see a doctor do it right away, before they develop a more serious problem that would require a hospitalization.

Koelker is also author of Armageddon Medicine, How to Be Your Own Doctor in 2012 and Beyond explains how to treat hundreds, even thousands of conditions as a family doctor would. Armageddon Medicine was featured on one of our previous shows.

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On our show last week, we discussed a list of 20 tips to help you avoid medical errors. But who can remember 20 tips? One way is to create a checklist. Checklists help avoid errors.

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But there may be a simpler way to improve patient safety. The National Patient Safety Foundation has come out with the Ask Me 3 program. The Ask Me 3 program is designed to encourage better communication between patients and their doctors. The program would have patients get and understand answers to three questions:

What is my main problem?

Patients ask their health care providers these three questions regularly. Doctors should work to make sure their patients understand the answers to these questions.

People who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure. They may also get well sooner or be able to better manage a chronic health condition.

Take responsibility to make sure you get great medical care.

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The U.S. Agency for Healthcare Research and Quality (AHRQ) notes that one in seven hospitalized Medicare patients experience a medical error. That’s too many, despite the efforts of doctors and other health care provider to improve patient safety. If you are sick or hospitalized, there are many things you can do to avoid medical errors.

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AHRQ has published a list of 20 tips to help you avoid medical errors. These tips include good, practical, common sense ideas like making sure your doctor knows all the medicines you are taking (including prescription medicines, over the counter drugs, and supplements), making sure your prescription is legible, understanding your medical condition and it’s treatment, getting advice from your pharmacist to make sure you take your medicine the right way, and getting written information on potential side effects and how to manage them.

We don’t have to wait for government to make our health system better; we can take responsibility to make sure we get great medical care.

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University of Chicago Booth School of Business professor John Cochrane says, there is a “coherent free-market, deregulated alternative” to our current health care system, and that the “Affordable Care Act” isn’t the way to get there. Cochrane believes there are ways to assure that people with pre-existing conditions can get health care without the need for individual mandates.

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How can this be? We explore the possibilities with Professor Cochrane to see how regulation is at the heart of the problem, and that 1,000’s of pages of more regulations in the Affordable Care Act will likely only make things worse. Introducing more competition—both among insurers and providers of health care—would be a better solution.

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The prices of some drugs are extraordinarily high. Patients may need those drugs but may find the high price, even just the copayment after insurance, to be unaffordable. What to do!? Drug company sponsored coupons that help cover the copayment can help rescue the situation.

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But are those coupons a good thing? The may increase the use of expensive drugs and cause drug prices to be higher than they would be if patients had more responsibility for paying the cost of care.

We explore this issue with Wells Wilkinson, Director of Prescription Access Litigation Project and staff attorney at Community Catalyst, a national consumer organization that works for access to quality, affordable care. Wilkinson explains that drug coupons may encourage overuse of costly medications when lower priced generic medications could work equally well. He also expresses concerns about the privacy implications of using these coupons.

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In contrast to much of the rest of the U.S. economy, our health care system is a cobbled, poorly coordinated system. Health insurance is provided largely by government and by employers. Do employers, who have lots of experience with well working markets, have market-based solutions for health care problems?

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Our guest today is Helen Darling from the National Business Group on Health. The National Committee on Quality Assurance recently honored her for her leadership promoting health care quality as an issue of commercial competitiveness. She has helped American businesses become better purchasers of health care and has helped government and industry leaders understand the economic importance of health care quality.

Dramatic increases in health care costs have been major problems for U.S. employers hurting growth and competition. Despite the high costs, the quality of care is uneven. Too often, Americans get care that is either less than optimal or that makes things worse. No one solution may solve this. There are dozens of potential solutions that can help. Large employers can help identify key targets, can provide onsite health support, and can encourage employees to participate in condition management.

The lack of personal responsibility for health care costs is a central problem in the US health care system. Our system literally provides a blank check for health care coverage with little to no incentive for patients or their doctors to consider cost. This results in utilization that is off the chart. The Choosing Wise Initiative identified five overused interventions that don’t add health. People should realize that some preventive tests and procedures may not be helpful and that a healthy lifestyle is.

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There are a lot of doctors out there. How do you find a great one? Do you rely on word of mouth? This week, we talk with William Liss-Levinson, Ph.D. about top doctors. Bill is Vice President and Chief Strategy & Operations Officer for Castle Connolly Medical Ltd. Castle Connolly helps people find and access great medical care. It researches doctors’ credentials and surveys doctors to find “America’s Top Doctors.”

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The public can get access to the list of over 30,000 top doctors through the Castle Connolly website. The information is also available in the America’s Top Doctors book, regional magazines and U.S. News.

Castle Connolly is hosting its 7th annual Physician of the Year awards. These awards celebrate physicians’ dedication, not just for the 5 ward winners but in recognition that no one goes into medicine without dedication. Too often physicians are seen in a less than wonderful light. People should have even broader recognition of doctors’ commitment to patients

Bill’s critical message is that there are good, mediocre, and excellent doctors, that top doctors matter, and that better outcomes can be expected when seeing a top doctor. His final message is that these are confusing times for health care, and that politization gets in the way. We are blessed with being able to access awesome medical care. Be a good consumer!

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On last week’s program, Tom Hubbard, Senior Program Director at NEHI, a national health policy institute and think tank, based in Cambridge, Massachusetts, spoke about some of the practical ways to reform our health care system. This week, we continue the discussion, focusing on how poorly some patients use their medications and what can be done to improve medication use. Improving adherence to treatment is critical because it would improve outcomes and lower costs but there is no one solution. Research shows that patients are non-adherent for lots of reasons. Their total list of medications may not be right, doses may not be right, and review by a physician and/or pharmacist could help. Other barriers include side effects, complicated dosing, and very personal factors, such as costs, beliefs about medication effects, and cultural factors. Strategies to improve adherence will need to be customized to patients’ specific needs. Doctors, insurers and drug companies may all play a role.

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One key to improving outcomes may be to tie payment to successful treatment, putting more at stake for physicians. This is a contentious and exciting time in medicine!

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On today’s program, Tom Hubbard, Senior Program Director at NEHI, a national health policy institute and think tank, based in Cambridge, Massachusetts, joins us. NEHI has a diverse membership of 80 member organizations, including patient groups, doctors, health insurers and drug companies. These organizations have a shared interest in better patient outcomes and a shared interest in greater use of evidenced based medicine.

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A basic principle of health care reform efforts should be to maintain innovation. Health care represents a huge segment of the economy. Healthy workers are essential to our economy. Strides need to be made to promote better diet and fitness and reduce the problems of obesity and diabetes.

There is massive documentation on wasteful use of health care resources. Some 30-40% of health care is wasted. The fragmented medical system results in needless repetition of tests. In order to “bend down the curve” of health care spending, there are about half a dozen things crying out for attention, including avoidable hospital readmissions, coordination of care and improved faithfulness to use of medicine. New organization models including medical homes and accountable care organizations may help.

Next week, Tom continues the discussion, speaking on how well (or not well) patients use their medications. Improving adherence to treatment is critical, but there is no one solution. Research shows that patients are non-adherent for lots of reasons. Their total list of medications may not be right, doses may not be right, and review by a physician and/or pharmacist could help. Other barriers include side effects, complicated dosing, and very personal factors, such as costs and beliefs about medication effects. Strategies to improve adherence will need to be customized to patients’ specific needs. Doctors, insurers and drug companies may play a role.

One key to improving outcomes may be to tie payment to successful treatment, putting more at stake for physicians. This is a contentious and exciting time in medicine!

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Poor use of medication, also called poor adherence, is responsible for medications not working nearly as well as they could. Patients don’t take their medications for a variety of reason, including forgetfulness, fears, side effects, costs, complexity (especially for older folks) and non-belief in efficacy. Our guest today is Rebecca Burkholder, Vice President of Health Policy for the National Consumers League; the National Consumers League is a nonprofit organization that has represented consumers and workers since 1899. The organization is preparing a national campaign to promote better adherence

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The goals of the League’s adherence initiative are based on focus groups that showed what was needed. The key issue was for patients was understanding medication better. There’s a lack of knowledge about the relationship between poor adherence and poor medical outcomes. Patients should speak to their doctors to make sure that the reason for the medication and the expectations of it are understood. The campaign will work to promote better adherence. It has over 100 public and private partners and will focus initially on 6 regions across the United States. There will be publicity, a website, many tools, and a pledge for better adherence.

Listeners should consider assessing their own adherence and consider using the campaign tools if needed. A great resource is scriptyourfuture.org.

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