The Best Healthcare for Less: Save Money on Chronic Medical Conditions and Prescription Drugs

by David Nganele

Overview

You can afford the care you need.
If you're one of the millions who suffer from medical conditions such as cancer, heart disease, or diabetes, you know that these illnesses can, over time, cause extreme financial hardship. In this timely, thorough resource, Dr. David Nganele helps you identify the drugs, programs, hospitals, and strategies that will significantly reduce your out-of-pocket expenses. You'll discover how you can better afford your healthcare without losing out on quality of care. This reassuring guide provides hope and relief from one of the most stressful aspects of dealing with a serious illness. Whether you have health insurance or not, if you have to deal with medical costs, this book will become a significant source of financial relief.

Product Details

ISBN-13:	9780471218494
Publisher:	TURNER PUB CO
Publication date:	04/25/2003
Pages:	272
Product dimensions:	5.98(w) x 8.98(h) x 0.70(d)

About the Author

DAVID NGANELE, Ph.D., is former president of the Eden Center for Diverse Health Communications, a medical education company focused on improving access to healthcare through education. Prior to joining Eden, he founded Harmony Health Communications, where he worked with pharmaceutical companies, community organizations, and physician groups to develop award-winning and innovative disease-management programs. Previously, Dr. Nganele worked at Pfizer in various product management capacities. His work has received media coverage in such publications as the New York Times as well as being featured on radio and television.

Read an Excerpt

The Best Healthcare for Less

Save Money on Chronic Medical Conditions and Prescription Drugs

---

By David Nganele

John Wiley & Sons

ISBN: 0-471-21849-9

---

Chapter One

Healthcare Costs

Where They Come From and Who Pays for Them

The Cost of Healthcare

The cost of healthcare is now over a trillion dollars a year. The benefactors of this money transfer are:

Hospitals $420 billion Physician and clinical services $289 billion Home and nursing care $133 billion Drug Manufacturers $130 billion

The rest goes to medical equipment and other services like dental care and research.

Take a look at the diagram on the next page. I call it the "the healthcare cost pyramid." Have you heard of the food pyramid? The food pyramid is a guide to help us achieve proper nutrition. The healthcare cost pyramid should serve as a guide to help us understand and, hopefully, control the cost of healthcare. A lot of money is being spent on healthcare; and the goal here is to show how we can spend wisely on healthcare and maybe even reduce the cost of healthcare by becoming educated consumers.

Explaining the Healthcare Cost Pyramid

Primary Prevention

At the top of the pyramid is primary prevention. Primary prevention is doing the things that prevent us from getting sick. This is achieved by living a healthy lifestyle, and it includes exercising, eating properly, and getting routine physical examinations. It also includes not doing the thingsthat can get us sick, such as smoking, illegal drug use, and excess alcohol intake. As you can see from the diagram, this is the smallest section of the pyramid. Primary prevention is the least costly thing we can do in terms of healthcare cost, so we need to educate ourselves to do everything we can to stay in that section of the pyramid. While everybody should be living healthy lifestyles to avoid getting sick, there are certain individuals who are at high risk for certain diseases and they need to pay particular attention to what it takes to prevent getting sick.

It can't be repeated enough: prevention is better than cure. Prevention is less expensive, too. With primary prevention, you not only prevent diseases from starting, you might actually catch the beginning of a disease and do the things that prevent it from becoming a full-blown illness. Chapter 2 deals with primary prevention. The goal is to show how we can practice healthy living even when we think we don't have the time or we don't know what to do.

Secondary Prevention

As we move down the pyramid, we get into secondary prevention. Secondary prevention is doing the things that prevent an illness we have from becoming complicated. With primary prevention, we do the things that prevent us from getting sick. A lot of individuals can, for example, prevent getting diabetes by watching their weight through proper nutrition and exercise. Unfortunately, sometimes even with the best of efforts, we still get sick. When we do get sick, we need to understand all we can about the disease, what it is, how we got sick, what we need to do to treat it, and very important, what will happen if we do not manage it effectively. This is secondary prevention. Part 4 of this book considers secondary prevention in light of some of the major chronic diseases. I have focused on these chronic diseases because these are the ones that people have to live with for very long periods of time. So as you can expect, chronic diseases are the most costly to manage.

The most important physician in your life is you. The things you do every day to yourself will determine your state of health much more than anything any physician can ever do. Your physician can tell you all you need to know and do to stay healthy, but unless you do what's suggested, it will all amount to zero. And your negligence could cost you a bundle down the road.

So, what happens if your doctor tells you have high blood pressure, high cholesterol, or diabetes? You now fall to the middle of the pyramid. The goal here is to do everything you can in order not to fall to the bottom of the pyramid, that of institutional care. As you can see from the size of the box, institutional care is bigger than secondary prevention, meaning that it costs a lot more. We prevent falling to the bottom of the pyramid by strictly following the instructions from our doctors and other healthcare professionals. Whether we practice only conventional therapy, also known as Western medicine, or add on to that complementary or alternative medicine-in other words nonconventional medicine -the goal should be the same: to do what it takes to properly manage the disease.

Pharmaceuticals play an increasing role in helping us effectively manage diseases and keep us in the secondary prevention box. However, as the costs of medications go up, many individuals stop taking their medicines or take them inappropriately to save on the cost. While this might reduce expenses in the short run, eventually this poor disease management will result in the type of complications that will push an individual down to the bottom box of the pyramid. He or she might end up in a hospital or a nursing home, or worse, die prematurely. The key, therefore, is to find the means to get the needed medication and take it as prescribed. Because of the importance of drugs, I have devoted a whole section-part two-to prescription drugs, to show how any individual, regardless of insurance status or income level, can get medications at low or no cost.

Institutional Care

At the bottom of the pyramid is institutional care. This is where you now have to leave the comfort of your home to get taken care of, either in a hospital or a nursing home, because your condition now requires a greater level of management. This is healthcare cost at its most expensive state. Half of all direct spending on diseases goes toward institutional care. We pay that much for hospitals and other kinds of institutional care because they provide the intensive care needed to keep us alive-and for that, we truly owe them our lives. The point here is that they are expensive, and to the extent that we can do things to prevent going to an institution, to postpone going to one, to reduce the amount of time spent there, or to minimize what they have to do to us there, the less expensive the cost of healthcare will be.

Who Pays for the Cost of Healthcare?

The government pays for almost half of the cost of healthcare and private insurance pays for a third. Most of the rest comes out of our pockets. The programs that are available to help us with the cost include the different government and private insurance programs.

Government Programs

Government insurance comes mostly in the form of:

Medicare Medicaid Child Health Insurance Program Coverage for the military

Medicare

Medicare was started in 1966 as a health insurance to assist the elderly. In 2000 it spent about $230 billion to take care of the medical needs of seniors and some disabled. The program is administered by the federal government. To have Medicare, you must meet the following requirements:

You are age 65 or older. You receive Social Security or railroad retirement benefits. You or your spouse worked in a Medicare-covered employment for 10 years or more.

You are a U.S. citizen or permanent resident, residing continuously in the United States for at least five years.

If younger than age 65, you have a disability that makes you eligible for government aid, or have permanent kidney disease that requires dialysis or transplant.

There are two parts to Medicare: Part A and Part B. Part A, also called Hospital Insurance, covers the cost of hospitalizations, some nursing home cost, and some medical care at home, as well as hospice care. Most people get Part A automatically once they turn 65. There are no premiums to be paid for Part A. Part B, also called Medical Insurance, covers doctor's fees, outpatient hospital care, laboratory services, medical equipment, ambulance services, and other services that Part A does not cover. You do not get Part B automatically. You have to enroll in it, and pay a premium that is adjusted each year. For 2000, the premium was $50 a month and this amount is automatically deducted from your Social Security or retirement check.

Annual deductibles must be met for hospital stays ($800 in 2001), doctor's visits ($100 in 2001), as well as coinsurance for daily hospital stays and most other medical care. A lot of Medicare recipients buy supplemental insurance, also known as Medigap, to cover these costs.

There is a third part to Medicare called Medicare+Choice, sometimes called Part C. In Part C, a Medicare recipient who has both Parts A and B can choose to enroll in a Managed Care Plan that accepts Medicare. A lot of Medicare recipients enroll in this program because the managed care plans provide prescription drug coverage. Medicare itself does not provide prescription drug coverage, and that has caused a lot of heated debates because seniors are increasingly needing prescription drugs. In 2000, the average annual cost of a prescription for the top 50 drugs used by seniors was about $1,000. Since some seniors take up to 15 different medications, the cost of medications can become a great financial burden.

There are a number of programs, usually administered by various states, to assist Medicare recipients pay for some of their medical costs. These programs all have income eligibility; that is, you have to have an income below a certain level to qualify.

If you have questions about your eligibility to join Medicare or about the benefits, or to enroll, call the Social Security Administration at [phone].

Medicaid

Medicaid was started in 1965 to help pay for healthcare for individuals with low incomes. It is jointly funded by the federal government and the states but is administered by each individual state. The federal government sets broad national guidelines but each state does the following:

Establishes its own eligibility criteria Determines the type, amount, duration, and scope of services Sets the rate of payment for services Administers its own program

In general, for states to get federal funds, they must cover these individuals:

Those with low incomes who meet the requirement for the State's Temporary Assistance for Needy Families (TANF) program, generally referred to as welfare People who are poor enough to be receiving supplemental security income (SSI) Children under age six and pregnant women whose family incomes are below 133 percent of the federal poverty guideline Recipients of adoption or foster care assistance Special protected groups, such as persons who lose SSI due to earnings from work or increased Social Security benefits, who may keep Medicaid for a period of time Certain Medicare beneficiaries who meet asset and income criteria

Because states have a lot of leeway in designing their programs, there is a lot of variation from state to state. Sometimes even within a state there may be different Medicaid programs.

Medicaid is more generous than Medicare in what it covers. Most states have added benefits to their programs that are not required by the federal government. This includes coverage for prescription drugs and payment for nursing home care.

To learn more about your eligibility for Medicaid and what services are covered in your state, call the state's health department. The phone numbers are listed in appendix A at the back of this book.

Child Health Insurance Program (CHIP)

This program was started in 1997 as a way to expand the State's Medicaid program to cover children who do not qualify for Medicaid. These are the criteria:

Children under age 19.

Family income below 200 percent of the federal poverty level ($34,100 for a family of four in 2001). Some states cover children in families with higher incomes.

Must not be eligible for Medicaid coverage.

Parents do not have to be U.S. citizens or even legal immigrants.

CHIP is very generous and usually covers:

Well-child programs Immunizations Doctor's visits

Laboratory and diagnostic tests Hospitalizations Prescription drugs

Other medical services

States usually charge a small monthly premium that is based on income, sometimes as low as $4 per child per month. To learn more about your child's eligibility and how to enroll, call (877) KIDS NOW (877-543-7669) or your state's health office (see appendix A for the state's phone numbers).

Coverage for the Military

Present and past members of the armed forces have programs that provide them with health coverage and services. The most widely known is the Veteran Affairs (VA) Health System. There are 172 VA hospitals around the country. To be eligible for VA assistance:

You must have enlisted in the armed forces before September 7, 1980.

If enlisted after September 7, 1980, or entered active duty after October 16, 1981, you must have 24 continuous months of active duty service or have completed the full period of time for which you were called or ordered to active duty.

You must have been discharged or released from active duty under conditions other than dishonorable.

You must be recently discharged from the military for a disability determined incurred or aggravated in the line of duty.

Active duty and retired military individuals and their families can also use the various military hospitals around the country. Retirees and spouses and children of active duty, retired, and deceased members of the armed forces can be covered by an insurance program called the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). This program will pay for the use of nonmilitary medical services.

Private Insurance

Almost 100 percent of all large businesses (200-plus workers) and 60 percent of small businesses (three to nine workers) provide some type of health insurance for their employees. The health insurance coverage for employees usually moves in step with the economy. When the economy is soft, there is less coverage provided by businesses, especially small employers.

Continues...

---

Excerpted from The Best Healthcare for Less by David Nganele Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---

Table of Contents

Foreword.

Acknowledgments.

Introduction.

PART ONE: WHERE WE ARE AND WHERE WE SHOULD BE. 

1. Healthcare Costs: Where They Come From and Who Pays for Them.

2. How Not to Get Sick: Primary Prevention.

PART TWO: PRESCRIPTION DRUGS.

3. Prescription Drugs and Healthcare Cost.

4. Saving on Prescription Drugs When You Have Drug Coverage.

5. Prescription Drugs at No Cost or Low Cost: With or Without Insurance.

PART THREE: OTHER AREAS OF HEALTHCARE COST.

6. Physician Services.

7. Institutional Care:  Hospitals and Nursing Home.

8. Employment and Family Issues.

PART FOUR: MANAGING THE COST OF COMMON CHRONIC DISEASES.

9. Alzheimer's Disease.

10. Arthritis.

11. Asthma.

12. Cancer.

13. Depression and Anxiety.

14. Diabetes.

15. Heart Disease.

16. HIV and AIDS.

17. Osteoporosis.

APPENDICES.

Appendix A: Directory of State Health and Insurance Agencies.

Appendix B: Directory of Drug Companies' Patient Assistance Programs.

Appendix C: Directory of Some Internet Pharmacies.

Appendix D: Directory of Some Discount Pharmacy Programs.

Index.