It’s beginning to look like health care consumers are going to have to take lowering health care into their own hands since no answers are coming down from above.

Here are ten tips for lowering your costs.

One, encourage your employer to offer a health savings account with a high deductible. Encourage the employer to pay half the deductible. Your premiums will be much lower, and your employer will save up to 50% over current HMOs and PPOs.

Two, investigate a company called Simplecare. The SimpleCare story has appeared is on the cover of US News & World Report, in Forbes, and on NBC News. SimpleCare, a fee-for-service organization, accepts money for medical treatment without insurance forms, co-payments, and other third-party payment related procedures. SimpleCare guides the patient to an alliance of doctors offering cash discounts. It has membership at 38,000 patient members working with 1,500 doctors nationwide. Discounts range from 15 percent to 50 percent for patients paying in cash.

Three, ask your doctor if he or she accepts cash only. About 10 percent of doctors will accept cash only. The idea is to pay for care at the time and point of care with cash, check, or credit card without the expense or trouble of going through an insurance company. Dealing with third parties creates a 50 percent to 60 percent overhead, and many doctors are finding they can charge less and make just as much or more money without going through a third party. Often the doctor’s fee is negotiable.

Four, find out if your doctor dispenses prescriptions in the office. Prescriptions dispensed in this way average 50 percent less. A company called Physicians Total Care has installed prescription systems in 30 states and is growing by 170 percent a year. For more information, Google “Physicians Total Care” or read a chapter “Physician Office Dispensing Stages Comeback” in my book Innovation-Driven Health Care.

Five, fill your prescriptions at Walmart, Target, or discount stores. Walmart has more than 300 generic drugs and 1000 over-the-counter it sells at $4 for a 30 day supply and $10 for a 90 day supply. Fifty percent of Americans live within 5 miles of a Walmart or Target.

Six, ask your primary care physician if he or she performs common procedures like skin biopsies, abscess drainage, joint injections in the office. An organization called the National Procedures Institute has trained over 15.000 primary care doctors to perform simple office procedures, and these can be done less expensively without waiting than in a surgeon or other specialist’s office.

Seven, consider visiting a retail clinic in drug store or discount outlet for minor ailments or immunizations. Nurse practitioners using protocols and electronic medical records are generally in charge of these clinics, which may have physician or hospital backups. The charges are listed and predictable. About 2,000 of these clinics are now operating. The services of these clinics cost about half as much as a visit to a physician’s office but do not have a physician’s expertise.

Eight, if you work for a larger employer, ask if they are considering setting up worksite clinics. About half of the nation’s corporations with headquarters employing more than 100 employers on site are organizing these clinics, which offer the services of a primary care physician and staff, which may include a nurse, nutritionist, and other health professionals. Employees can receive generic drugs and other treatments or advice on site, or may be referred to cost-effective networks of specialists off-site.

Nine, if you are uninsured or underinsured consider visiting a federally-qualified community health clinics. These were launched by President Bush as a Health Centers Initiative. These clinics, which are present in all 50 states, have 4,000 locations and have served 15 million people. They are administered by Health Resources and Service Administration. Services included checkup when well, treatment when sick, complete pregnancy care, immunizations, dental, and mental care. To find a clinic near you, Google “HRSA – Find a Health Center.”

Ten, in general the lowest cost and most convenience care is available at a local primary care physician. There is now a shortage of these physicians. Therefore, these physicians are now very busy, and you may have to wait for an appointment. Because of low reimbursements, some no longer accept new Medicare or Medicaid patients.

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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