Matters in Healthcare: How your choices affect healthcare costs

FRIDAY, AUGUST 31:

Everyone says health costs are high in Bermuda… did I have anything to do with it?

Health costs are affected by a number of factors and, although rarely discussed, the way each of us uses healthcare also has a significant impact. But let’s be frank – the general public are not solely responsible for healthcare costs, nor should the public be solely blamed for the pace of increase. However, if we are going to try to curb costs, everyone with a role to play should know how they can assist.

Here are some commonly asked questions or misconceptions about health costs and ‘You’:

Why does my health insurance premium keep going up? Don’t insurers make enough money already?

Premiums go up every year to keep pace with the fees of local and overseas healthcare providers, the ever-increasing availability and use of health services, and the cost of administration – a necessary feature of any service, whether health insurance or anything else. As health fees increase, premiums have to keep up. Likewise, the more we use health services and request new tests, procedures and drugs, the more insurers have to pay out, and the more premiums have to rise.

While we all enjoy having unrestricted access to the latest technology, no one likes the premiums needed to finance this. We can help curb premiums and health costs by using health services appropriately.

Is it really true that my private actions and behaviours can affect health costs?

Yes, it really is true. Drunk-driving accidents can have huge price tags – we all pay for those through insurance premiums. Every smoker with health problems, every overweight-related health issue, every sexually transmitted infection and, basically, every preventable health problem is a cost that could have been avoided. Each one adds dollars on your health premium. And before you start throwing stones, take a look closer to home to consider not only health behaviours, but use of health services too.

Is it better to see a specialist than a general practitioner?

Depends on your health and condition, but for most people, most of the time a general practitioner (GP) will be best placed to address your health needs and help you assess your options to determine the best course of action based on your circumstances. Whether it’s an annual check, a well-woman check or a well-baby check, your GP is there for you and this can help your pocket book and insurance premiums too.

When a doctor doesn’t refer me for the tests I want, should I go to another doctor?

Your relationship with your physician, dentist or other healthcare professional is vital. You have to work together in your best interest and this requires trust and confidence. Without it, you won’t feel safe in their hands, and you’ll likely not be the most amenable patient to them. When you have that relationship of trust with your doctor (or other health professional), it’s a good idea to heed their judgment regarding tests and procedures – that’s what they’re there for. Sometimes you may want a second opinion, and that’s understandable. If you have that trust, you’ll be able to discuss seeking a second opinion with your health professional and agree on a course of action you are comfortable with. If you don’t have that trust, you may want to consider a new healthcare provider.

If I want a particular health test I should be entitled to it since I’ve paid my premiums. Isn’t more healthcare better health care?

Not quite. Medically unnecessary procedures, tests and drugs don’t improve your health; they just increase health costs and premiums. Quality healthcare is about giving you the right care, at the right time in a responsive and respectful manner.

Do preventive tests just add unnecessary costs to the health system?

No – standard preventive screenings and tests are medically appropriate and there are clear clinical guidelines for these. Extensive studies and international experience have shown that regular screenings can pick up problems before they become serious health conditions, and therefore can be treated more cost-effectively. Preventive measures like health checks and immunizations really keep adults and children healthier and they are cheaper than treating advanced health problems.

Why do I have to pay my doctor to write a prescription when I phone in for it without a visit?

When you call in a prescription this may seem like it’s no work at all to you, but that’s not quite the case. For the doctor who will review your health record to ensure you get the prescription you need, it involves time, clinical judgment and administration. Just because you’re not in the doctor’s office, it doesn’t mean the doctor isn’t working on your behalf. Calling in for a prescription is certainly less expensive to you and to the health system than an unnecessary visit.

Is going to the emergency room cheaper than my GP because my insurer pays the whole thing?

Because the ER has to run 24 hours a day and be equipped for all sorts of emergencies, it is more costly than a visit to your doctor. Going to the ER will save you the co-pay but it will add much more to your premium next year. In addition, the law allows the hospital to charge patients for medically unnecessary visits to the ER. This is to prevent people from blocking services needed for genuine emergencies. So if you go to the ER for a non-emergency, you could later receive a significant bill for the service.

Jennifer Attride-Stirling is the CEO of the Bermuda Health Council.