Through blogs and comments, patients and experts explore what it takes to find good health care and make the most of it.

How Can We Pay Less for our Health Care?


I just completed a series of radio and TV interviews about the extent to which people participate in their health care you know, those three-questions-in-90 seconds blips that currently constitute news for the viewing/listening public.

The question about how individuals can get a handle on their health care costs came up again and again. And so I had a lot of practice coming up with a useful 50 word answer.

My primary aim was to make the case for increasing the value of the care we have access to-- that we each have to participate knowledgeably and actively if we are to get safe, decent care. So sometimes I urged people to respond to prevention and health promotion guidance. Sometimes earlier questions set me up to direct people to make uses of community and online assistance in deciding whether, when and where to seek care. Sometimes it was more to the point to talk about using good judgment about using informal and clinical resources.

But other times the correspondent asked the question in such a way that it was clear that this was a shopping problem: How do I get the best care for the least amount of money?

Heck if I know. Should I have replied: Know your health plan? Ask the price before you make an appointment, get a test or accept a prescription from your doctor? Talk about the specific costs of your care with your physician?  Or simply You can't'?

A recent article in the Business section of the NYTimes addressed this problem obliquely.  While mistakenly attributing the ballooning cost of health care primarily to our lack of access to such information, it reiterated just how inaccessible cost information is to us.

I am glum about my inability to respond elegantly and usefully to a question that reflects the concerns of millions of Americans. Perhaps I am forgetting something?

How would you answer this question?  Give it your best shot: 50 words or less.

More Blog Posts by Jessie Gruman

author bio

Jessie C. Gruman, PhD, was founder and president of the Center for Advancing Health from 1992 until her death in July 2014. Her experiences as a patient — having been diagnosed with five life-threatening illnesses — informed her perspective as an author, advocate and lead contributor to the Prepared Patient Blog. Her book, AfterShock, helps patients and caregivers navigate their way through the health care system following a serious or life-threatening diagnosis. The free app, AfterShock: Facing a Serious Diagnosis, offers a pocket guide based on the book. | More about Jessie Gruman

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Health Care Cost   Pay for your Health Care   Jessie Gruman  

Comments on this post
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Trudy Lieberman says
June 25, 2010 at 10:52 AM

Health care is the only place where the doctor is both the seller and purchaser of services. This unique position makes it difficult, if not impossible for the patient/ consumer to bargain for the best price. Then there's the matter of trust. If you don't trust your doctor, who do you trust when you're sick? What patient is going to dicker over price and risk undermining that trust?

Shoshanna Sofaer says
June 25, 2010 at 11:09 AM

Right now, it is very difficult to be a prudent purchaser of health care/insurance. Useful, accurate cost information is not available. Until it is:
- DonĂ¢??t assume that more expensive is better; it often is not.
- Ask the price of everything; ask for less expensive alternatives, and especially for generic versions of medications.
- Get a second opinion before any major expenditure.

kgrigsby says
June 28, 2010 at 2:06 PM

Once, when we were between health plans, I took my son to a new pediatrician. At the begining of the appointment, I told the clerk at the desk that I wasn't sure about our new health plan benefits, they'd just kicked in and I didn't have our ID cards. I asked if I could leave information about coverage off and pay cash for the visit. The staff looked at me like I was from Mars.

We were there for a routine appointment- a well baby check- and so I asked how much the service would cost. It took the hour I was in the office for the staff to tell me that they still had no price for the visit. They sent me a bill later. I was shocked- no where in that office was there a price menu- not even for routine services they provide everyday.

I've heard in situations like these, you can negotiate with the office to pay the fees that health plans reimburse providers- their negotiated rates. But, do the staff even have those at their fingertips?

Dale Shaller says
June 29, 2010 at 4:12 PM

Ironically we seem to know more about how to measure quality (at least with measures of clinical process and patient experience) than cost. There is some price information beginning to emerge in selected markets, such as Minnesota. For example, here is a link to the MN Health Scores site that reports cost information for selected procedures: