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Some are skipping much-needed care to save money

Ginger Rough

PHOENIX — Karla Collier knows what it’s like to be sick. And to have no money. Or health insurance.

A few years ago, she ran out of cash and stopped taking her diabetes medication.

It was a bad decision, one that landed the 33-year-old Phoenix resident in the emergency room with dangerously high blood-sugar levels and a slew of other grave health problems.

“Oh, I was sick, sick, sick,” Collier said of the experience.

Emergency room doctors are seeing more patients like Collier these days, as a sluggish economy puts more Arizonans out of work and continues to wreak havoc on household budgets.

Experts say there are many ways to safely save on medical expenses. But a lot of patients are doing all the wrong things and putting their health in jeopardy in the process.

“There are worse things than being unemployed,” said Richard Watts, director of emergency and trauma services at Banner Good Samaritan Medical Center. “And not properly managing your health is right up there.”

A survey released last month by the Kaiser Family Foundation, a California-based nonprofit that tracks health care issues, found that more than half of Americans polled said someone in their family had skimped on medical care in the past year. Commonly reported cost-cutting measures included not visiting the doctor for a chronic problem, not filling a prescription or eliminating dental care.

Not one of those is an appropriate solution to minimizing health care expenses, experts say.

When it comes to managing day-to-day health care needs, there is one generally golden rule: If you’re sick, especially with a chronic problem, such as hypertension or respiratory illness, you have to visit the doctor, and you have to keep your follow-up appointments.

It’s the only way to avoid making a bad situation worse.

“We have definitely seen a decrease in patients coming in because they can’t afford their co-pay, or they are simply postponing or not coming in for their follow-up visits,” said Dr. Emily Zaragoza Lao, a family-medicine practitioner at St. Joseph’s Hospital in Phoenix. “They figure, ‘If something happens, I’ll go to the ER.’ That’s not a good way to go.”

The elderly and children in particular need to visit a physician if they are not feeling well, not eating or seem lethargic.

If you’re generally healthy, there is much you can do to minimize costs.

The first, and easiest, thing is to communicate with your physician about routine needs without an office visit. Call and see if your symptoms warrant an in-person consult. You can also use e-mail for day-to-day matters.

Next, always be honest with your doctor about your financial situation. If your doctor recommends an expensive test or treatment, ask if it’s really necessary or if there are less costly options you can try first.

Dentists, for example, say some patients are choosing to simply have abscessed teeth removed rather than pay for more expensive oral-surgery fixes, such as root canals, crowns or bridgework.

“Right now, we’re just seeing people being much more conservative,” said Dr. Gary Jones, a Mesa-area dentist. “There are a lot of those decisions being made. It’s usually an issue of, ‘There’s a right way, and then there’s something we can do to get by until we can do it the right way.’”

Doctors say effectively controlling the cost of medications is one of the best ways to have a positive impact on your health care budget.

There are several ways to do this without causing yourself harm.

The first, and most obvious, is to speak with your doctor or pharmacist about the use of generic medications. A variety of retailers now offer hundreds of medications in generic form for as little as $4 for a 30-day supply or $10 for a 90-day supply.

“I would recommend that you simply not use brand names unless your doctor says there is a specific reason for you to take one,” said John Cerni, a pharmacy supervisor for CVS in Chandler.

If your medication doesn’t come in a generic form, there are still other ways to save.

For example, if you have insurance, check your provider’s formulary, which is the list of drugs covered by your plan.

Many insurance companies have different “tiers” of medication. Co-pays for some might run as high as $45, whereas a similar medication in a different tier could cost as little as $10 or $20, Cerni said. Check with your doctor or pharmacist about the less expensive option.

In many cases, a physician can prescribe a double-strength dose of an existing medication, which allows the patient to cut the pills in half and stretch them twice as long.

“The most important thing is to stay in touch with your provider,” said Kim Leight, a Tempe-based mental health nurse practitioner. “We don’t cut people off. We have samples, we don’t have as much as we used to, but we really want to continue helping.”

Doctors warn that patients should never stop taking a prescription without consulting with a doctor. They also say people should not skip doses of a prescription or take only half a pill in an attempt to make the medication last longer.

Physicians say that this tactic, which basically gives you half a dose, undermines the medication’s ability to work properly. The results can be deadly, doctors say.

“I had a patient in ICU over the weekend because she decided to stop taking her anti-psychotic. She couldn’t afford it and had a breakdown,” Leight said.

Doctors say that in trying economic times such as these, stress levels skyrocket. That can have a very negative effect on the immune system.

As hard — and even simplistic — as it may sound, physicians say getting adequate amounts of sleep and proper nutrition are among the most important things patients can do to help keep their stress levels in check and their immune system healthy.

The best prevention efforts tend to cost very little.

“I truly believe in preventative care,” Lao said. “It’s so fundamental, but we tend to ignore the basics. And then our immunity goes down, and we get sick.”

(The Arizona Republic)