HIV Economics 101

As the health care system in the United States continues its relentless deterioration under managed care, most patients are feeling the pain. People living with HIV probably are feeling more discomfort than their HIV-negative peers, since they must rely on doctors, daily medications, and frequent lab testing to keep them alive and healthy. No longer can you count on your health plan to adequately pay for such basic things as doctor visits, diagnostic exams, or lifesaving medications. As the June 9 cover story of Time magazine reports, embattled doctors who can no longer afford the double whammy of declining insurance reimbursements along with skyrocketing malpractice insurance premiums are making gut-wrenching choices. Many are leaving their home states to practice in more 'insurance-friendly' environments or are quitting medicine altogether. The more stubborn physicians among us who choose to stay put in our chosen profession are being forced to see more patients every hour or face being forced out of practice because of economics. A combination of ever-more-expensive medical technology, failed governmental planning, political gridlock, the stock market decline, and the greed of malpractice lawyers and their unwitting patient coconspirators (who hope to win the 'malpractice lottery') are at the epicenter of this crisis. The end result is that you lose out both financially and medically as your personal budget is strained and your doctor becomes less effective under the weight of overwhelming patient loads. So what's a person caught in this hostile health care environment to do? ' Take really good care of yourself: Try to avoid costly and preventable illnesses like sexually transmitted diseases, obesity, and the ravages of smoking. Stack the cards in favor of your health by eating right, exercising, and learning to cope appropriately with everyday stressors. Above all, stay away from party drugs. ' Choose your health plan carefully: Get the best insurance coverage that you can afford. Those health maintenance organization plans might look appealing financially but may not allow you access to HIV-specializing doctors. In fact, they may not even cover your basic medication or diagnostic testing needs. ' Budget your personal spending to include more health care'related costs: The financially devastated federal- and state-government-sponsored health plans are not going to bail you out anytime soon regarding paying for your medical care. AIDS Drug Assistance Programs across the country are cutting drugs from their formularies in an effort to ration scarce resources, and many plan to begin charging copayments for drugs that were formerly provided free of charge. ' Select your doctor very carefully: Make sure that your primary care provider is board-certified, has a medical license in good standing, and is an HIV specialist [See the 'Is Your Physician Up to Speed on HIV Care?' link below]. It has been proved in multiple research studies that the best HIV care providers save you the most money, since they tend to keep you healthier than their less-well-trained counterparts. If you are going to spend your hard-earned money, don't settle for second-rate care. Doctor-specific information is readily available on the Internet via various state medical board and HIV specialty organization Web sites. ' Keep your medication costs down: Unfortunately, most of the medications that are needed to treat HIV have no inexpensive generic equivalents'with the exception of prophylactic drugs like Bactrim. You should research your health plan to see if it has an option to get a 60-day or 90-day supply of your daily medications for a lower copayment if you mail prescriptions to a central pharmacy. You may be shocked by how much you can save each month. Finally, discuss with your doctor each and every prescription that you have been taking to determine if they are all still necessary. ' Act up: If ever there was a time to get off your butt, become politically active, lobby, march, scream, or boycott the offenders to fight rising health care costs and runaway insurance company rules, it's now. Cohan is an attending physician and vice president with Pacific Oaks Medical Group, one of the nation's largest practices devoted to HIV care, located in Beverly Hills, Calif. He serves on the board of AIDS Project Los Angeles and has expertise in nutrition, anabolics, and exercise.