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Sep 24, 2008 -- Can't afford a doctor? Try these alternatives

CLARKONOMICS: Both the National Association of Insurance Commissioners and IMS Health have reports out that suggest Americans are not filling prescriptions and not going to the doctor because they're financially stretched. When it comes to a choice between filling a prescription and filling up the gas tank, people are opting for the latter.

Medicine is going through a messy transition. Employer-provided healthcare can cost your employer a fortune. Many smaller businesses have discontinued it, while larger businesses have shifted more of the premium cost to the consumer.

So what can you do? Wal-Mart and other retailers have $4 prescriptions for a variety of generic drugs. Print out the list and take it with you to your doctor so he or she can try to write you an affordable script.

Also, you can try using a nurse-in-a-box as an alternative to a standard office visit. You'll find these "mini-offices" staffed by nurse practitioners at supermarkets, drug stores, discounters, etc. Their prices point tends to be around $59 for a visit.

Clark is a big fan of consumer-driven medical care. But consumer-driven medical care does not mean ignoring your health because you can't afford it.


Unfortunately, Clark won't be able to answer any questions submitted via commenting. If you have a question, please try posting it to our message boards.

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What others are saying

  • Cant afford to see a Dr
    Im sure this will help. Ameriplan saves people up to 75% on medical costs, medications and what not. I know a few people that use it and it works wonders.
    here is the site.
    www.mybenefitsplus.com/laughlin

    Hope this helps. Everyone should be able to see a Dr!
  • can't afford insurance or doctor
    it's easy for people to say it's only 50-60 for a visit, "consumer-driven medicalk care does not mean ignoring your health" but for some of us, who have lost everything, have no income other than enough for a place to live and eat and nothing extra and medical bills that accrued when we had insurance and they refused to cover it, now in debt with no way to pay, there is no option.
  • nurse-in-a -box
    I made the mistake of taking my daughter to a NIB. I lost my health insurance 04/08 due to job loss, and COBRA would have taken over 1/2 of my Unemployment. I chose my house instead. Anyway, my childs peditrician charges $60 for office visit. I thought the NIB would save me $$ - and it only saved $1. The mistake I made was not calling other drs. My PCP only charges me $40 with no insurance.... So call around. You may not be able to afford to see your regular dr. but there are doctors out there that will not charge an arm & a leg to see you. I hope this helps someone.
  • Health Insurance
    Why is health insurance in this country only available as an employer benefit? My car insurance isn't. My homeowner's insurance isn't. Let them open themselves up to competition i.e. you get charged based upon your personal factor. Oh wait, people would be penalized for smoking, eating too much junk food, and red meat. I can see those lobbyists now.
  • take care clinic
    Beware, I took my son because I thought he might have an ear infection. The NP checked his ears and said all clear, then she mentioned that his glads seemed swallon but said it was just a touch of the cold bug. When he didn't seem to get better went to our Dr. and he had strep! Also was over charged by 20.00 and two months later still fighting to get my money back. Make sure you check your insurance explaination of benefits against your bill. And save your reciept!!!
  • Dr. $
    how many of us can spare $65.00?
    i mean how much time will it take to get that? Now, this week, this month, so on... when we're feeling better.
  • 211
    You can call 211 but dialing 211 or you may be able to find what you need on the HRSA (Health Resources and Services Administration). Please see the information below to get better ideas of what the FQHC is all about;

    Federally-funded health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income. Health centers provide checkups when you're well
    treatment when you're sick
    complete care when you're pregnant
    immunizations and checkups for your children, dental care and prescription drugs for your family mental health and substance abuse care if you need it.

    Health centers are in most cities and many rural areas.

    For access just enter hrsa, this should bring you to the home page. Look to the right side of the page, find the yellow colored box that states "Find a Health Center". Best of luck to you!
  • 211.org
    here is the link
    http://www.211.org/
  • 211.org
    I tried www.211.org and I couldn't find the website. Is there a phone number or a bone fide web address?
  • Nurse practitioners are great!
    For most routine problems I have found nurse practitioners to be excellent. They usually have spent more time and done more thorough exams than doctors. I think it makes a lot of sense to make basic health care more affordable and available for the nurse practitioners to be involved. I also think it is important for the patient to educate himself or herself about their own body and health conditions. A well educated patient would often be able to tell whether their problem is quite routine or if it is more complicated and may require an expert. I was very happy with the care I received from my nurse practitioners, but also recently I traveled to a nearby city to visit a super-expert at a major medical center for a tricky eye condition that the doctors in my town didn't understand. There is a place for both the doctors and the nurse practitioners.
  • An FYI about NPs
    NPs in Georgia do not have prescriptive rights. To my knowledge, GA is the only state in the US where this is true. The NP in the urgent care center is backed by an MD. If you look at your prescription, you'll see that it was signed by the MD, not the NP. The physician lobby in GA has fought against NP prescriptive rights in GA for years, citing a lack of education, etc. NPs are Masters prepared nurses with years of bedside care (not just writing orders, but actual hands on care) under their belts. Imagine how much better healthcare would be if they were utilized more.
  • Healthcare experience
    Recently, I went to a NIAB for a terrible case of "contact dermatitis," an allergic reaction similar to poison ivy. I knew going in that I'd need steroids to treat the problem. As soon as the NP looked at my condition, she said I'd have to go to my dr. (don't have one) or urgent care clinic bcs she couldn't prescribe steroids for me. She didn't charge me. I went to an urgent care clinic, where I saw an NP, who prescribed me steroids. When I went in, I told her, "I have a bad case of contact dermatitis; I'll need steroids to treat it." She looked me over and said, "I agree with your assessment." The bill: $100. That was with a discount for paying the office visit up front in its entirety. I fail to see where seeing an NP in one location was any better than seeing one in another location, but there you go. Perhaps the fact that I ended up paying almost double made the treatment better. I think anything we can do to introduce a more market-driven pricing model in health care is a good thing.
  • Healthcare
    Healthcare may be available to all. However, not everyone has the information and/or the funds to even pay the $59 for Healcare in a Box or the $4 for Wal-Mart prescriptions. Many Americans are making decisions between food, children's needs, keeping their homes, and medical care. With escalating costs for everything, these choices are becoming more difficult. We should not be so self-righteous as to think that everyone has the education, information, and monetary situation that some may have. We have to do something for the 'least of these.' I recently had a cerebral aneurysm. Even with health coverage, I still have to make choices about some of my prescriptions and the co-pays for physical therapy, and specialized care(neurology & CatScans/MRI). These co-pays are very expensive for me. I really think that we need to rethink the costs.
  • Everyone has access to health care
    I am so tired of people stating they don't have access to health care. Most every community, both urban and rural has at least one FQHC/Federally Qualifying Health Center or CHC/Community Health Center. All of this care is based on your income and NO ONE can be denied care due to lack of money or health insurance. In fact many of the people that receive care here are the “working poor”. This includes families that live from check to check as well as people that just lost their job or have had a reduction in income.
    These clinics provide numerous services including health care, social services, counseling and pharmacy options. Overcrowded? Yes. Substandard care? No - the funding for the clinics is provided from grant money which is very specific on how the money is used. Designed and decorated by someone that does this for a living, not always but you may be surprised.
    Please stop complaining, get off the sofa and call 211 or go online 211.org to find a clinic in your area. If more people would utilize these clinics and focus on preventative care our emergency rooms/departments would not be filled with minor, acute illnesses.
  • Pa/np training
    I wanted to point out that Np and PA practice has been well studied by private as well as government groups. The findings have always shown that Np/PA practice is not substandard and is comparable to MD's. In fact many studies do show that patient satisfaction is higher with np/pa care than md's. It is easy for this debate to turn into a turf battle and most of us who work day in and day out as mid level practitioners have no desire to be doctors or take away any "turf" from md's. We all acknowledge that md's have more training and are considered the "team" leader. But it doesn't take away from the training, experience and desire for excellent patient care we can bring to the table. There are plenty of sick patients to go around and they deserve competent care and compassion no matter what letters are attached to the end of your name. The majority of doctors that I work with appreciate my work and even ask me to consult on cases they feel I have a particular expertise for. The best advice for patients in choosing a healthcare provider is that they listen and trust you as well as you do them.
  • priorities
    I agree with the person who said people will complain about the cost of their office visit to a dr. but will gladly plunk down money for seasons' tickets to sporting events.

    Some of these people are the same ones who can't miss that yearly winter ski vacation or cruise to St. Maarten, but balk about spending 100.00 for a doctor's visit.
    I guess it's like this: If you can eat it, drink it, wear it, ride it, read it, live in it, sit on it, lie on it, cheer for it, ski it or bet on it, then it's worth every penny. If it's someone whom you pay for a service that ultimately enables your body to do all of the above, you complain, moan and resent writing that check. There is nothing rational about this way of thinking.
  • affordable doctors
    I don't think Clark is saying he is against doctors. He is saying if you can't afford your doctor's fees - and maybe some people can't - there are alternatives. With drug prices the alternatives are there, too. You can buy your medications from Canada or take a risk and buy from overseas manufacturers (bad idea, imo).
    For the record, it's not the doctors who are the bain of our health system.
    It's evident that the pharmacy benefit management companies, pharmaceutical companies and other interested parties are the problem.
    I was married to a doctor, often going to parties hosted not by the doctors, but the drug reps. Many of them drove nicer cars and lived in bigger, fancier houses than the physicians they peddled their products to. They're only doing their jobs, just as we all are, but the pharmaceutical giants are the ones working with the Pharmacy Benefit Management Companies (PBMs) (and probably the FDA and Medicare, too) to set the outrageous formularies that determine drug price determination and reimbursement.
    Remember, the most profitable corporations and businesses in America are not medical practices: They are the pharmaceutical giants. The problem is we have the option of finding a more affordable doctor but finding affordable medication is not as easy.
  • NIAB
    I lost my job & health coverage that wasn't useful anyway due to previous conditions. I have a rare liver disease & live in a rural area. If it wasn't for the state medical system, I would be in literal torment due to the symptons of this disease until I die. My husband & I barely make the bills now but we do have some help with state medical as a result. The NPs or PACs have been my best help in the office & the $4 prescriptions when there is a waiting period for the state funded health coverage to kick in. We are tax paying citizens & want to be productive in our community & state. We look forward to the day the medical care issues are in our favor. Clark & most in government most likely have no clue how life is with NO medical coverage & no funds to pay for even 2nd rate medical attention.
  • Nurse Practioners
    I have insurance and a very really good family doctor. However if he's out of town or not available, the nurse practioners in his office are great. Their exam is actually more extensive than his is and they seem more caring. My friend says his doctor is so busy he schedules his appointments with the nurse as she is better, easier to see and a hell of a lot better to talk to.
  • NIAB
    I have no problem seeing an NP or PA for most routine problems, they are well trained. The thing you forget, it isn't the office visit that usually costs so much, it is the extra tests that need to be done. It won't matter if you see a PA or NP if you need a throat culture or a biopsy, the costs will be relatively the same as in a doctor's office.
  • Thanks, Clark!
    I currently have over $1K in medical bills that my insurance has decided not to pay. And with the price of everything going up, I'm living paycheck-to-paycheck these days. I have no idea how I'm going to pay what I owe, so ideas for saving $ in the near future are appreciated. And BTW, I'm not blowing my money on sports events or other entertainment. I'm doing "crazy" things with it like buying gas and groceries, and paying my mortgage.
  • Nurse-In-A-Box is a great idea
    I have had certain recurring problems and I already know exactly what prescription I need. If I call my doctor's office, I can't ever talk to him directly and usually I can't even talk to his nurse. When I try to make an appointment it is usually about 4-6 weeks in the future. Why should I have to go through that hassle when all I need is a simple prescription? The nurse practitioner at Walmart, Walgreens, or where-ever could easily take care of it for me and it would be cheaper.
  • escalating medical costs
    Insist that your elected representatives (state and national) immediately work on stopping (all, but emergency) medical services to illegal 'immigrants'. This will bring medical costs down in all our localities.
  • NPs and Medical Care
    I find it funny that people will complain about paying a doctor's fee yet they will jump on season tickets to a sporting event and pay high prices for being 'entertained' by athletes or entertainers. What's up with that? Our country has a twisted reality...Wake up America. Start appreciating your physicians and medical providers. Who are you going to call when you are having a medical emergency, a doctor or Brett Favre?
  • Nurse in a box better than nothing!
    I think clark is simply suggesting an alternative for people who cannot afford healthcare.
    Maybe i'm missing something, but I didnt read anywhere that clark hates doctors and doesnt want them to make any money. He is simply trying to help consumers that are not as fortunate as those who get pleasure from trashing his work on the internet. Second rate healthcare is better than no healthcare! Which is what many would have if not for listening to Clark.
  • NIAB
    As an RN who started the nurse practicioner program prior to losing my eyesight; I can tell you CNP are very well educated. Most folks do not realize it takes 6 yrs.of college to obtain your bachelor's degree in nursing; not the usual 4 bec. you have clinicals to complete along with regular classes and must finish your pre requirements prior to statting an RN program. It takes an additional 2 yrs. of college to obtain a master's level along with clinicals for an CNP. They all work for yrs. as an RN before attempting the CNP Program. So these NIAB as you call them have many yrs.of practice behind their belts as well as 8yrs. of college. Nurses look at a patient with a holistic view: medical, psychological,social and spiritual needs rather than the medical model dr's use to treat patients. My husband preferred going to the CNP to the dr. wit our ins. when we lived in NM who uses them frequently. I've worked with good caring drs. in my career and those who just treated patients as a means to an end.
    All in all, for non complicated issues; a CNP is an excellent choice and they do not hesitate to get answers from who ever the physcian they work under, if need be. Please do not hesitate to use them.
  • Nurse in the box
    My doctor only charges $65 for office visit because I have no insurance. My medincine that I will need he gives me samples so I do not have to pay. I am very thankful!!
  • Medical Care
    I find you entertaining, but oftentimes misguided.
    You at times take your CHEAPNESS a step too far.
    I would never put my families health at risk by going to a Walgeens type walkin clinic.
  • here vs. hear
    Beth,
    You're not an audiologist are you?
  • There are problems
    Docs have high insurance costs, education bills etc. If people would not sue because doc said to sneeze instead of cough. Docs are so afraid of getting it wrong so they give us 10 tests when we probably only need 1. That costs everyone!

    I think doctors should be paid more! But the insurance companys are a joke. What are they doing to earn their money? The doctors aren't rich anymore and therefore, treat their patients like a drive thru. Get the most patients in and out so they can actually earn a buck. Thus, losing the care they once provided.

    Sadly, we all are affective w/the greed disease.
  • nurse in a box care
    I usually like clark, but he is dead wrong on this whole nurse in a box thing. Nurse practiioners are ill equiped for anything but the most routine of visits (illness, that to be quite honest, will resolve on their own). Nurse practioners were never intended to practice on their own, as they do in the nurse in the box setting. Sure a doctor may review the chart, but only after the patient is long gone. Depending on a nurse for medical care is not cost effective. Unfortunately, their knowledge is too limited. Anything of significance will require referral to doctor. This leads to another charge. If you would have seen a doctor in the first place, your final costs would be much lower. Also, a nurse is very likely to miss complex diagnoses. Unfortunately Clark, you get what you pay for.
  • Been with Kaiser since 1996 -
    Mudfish - sign up for Kaiser Permanente. You pay only $25 every time you go and $10 for most prescriptions. They have WONDERFUL very experienced doctors and you are in & out in less than an hour. Much better than the "doc in the box" places with huge waiting lines.
  • Unbelievable
    I think it is completely unbelievable that people would sit hear and blame doctors on the problems this country has w/ high health costs. Wake Up! Do you honestly think they go through 10 or more years of school to come out HUNDREDS of THOUSANDS of dollars in debt only because they want to 'steal' your money?! I know there are doctors that do only care about the money, but not most. Get your facts straight before you start blaming the people that are hear to help you.
  • Free market medicine?
    In my entire life, I have never seen a hospital or doctor's office with their fees posted clearly for all to see.

    When asked, hospitals will quote some fees and charges, but those fees are far higher than those actually charged to the vast majority of patients.

    Healthcare in America is controlled by a few entreached interests. They fight against nurse pactitioners. They fight against doctors charging lower fees in a storefront setting. This is anything but a free market.
  • Frontline documentary
    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

    Visit Frontline's website and select "Sick Around the World". Maybe Clark should watch it too. Might learn something.
  • Why is the U.S. Health system 2nd rate?
    Before buying into Clark's idea that a free market medical system is the way to go - check out this short documentary from Frontline. I for one, have had the opportunity to take advantage of the superior health care system in one of the countries mentioned in this documentary. The eight years I lived in Taiwan I never had to deal with a GP - I spoke directly with a specialist. All of the doctors I visited were either trained in the U.S. or Canada. I just pray that if I ever become seriously ill in the U.S., that I can make it to Taiwan for medical treatment rather than risk my life to our current substandard HMO system. I'm also sick and tired of doctors blaming the high cost of treatment on insurance and drug companies. Stop your whining. Doctors are not part of the solution - doctors are part of the problem.
  • To Zack:
    The $450 fee you paid was for the dermatologist's expertise. If he/she was sharp enough to quickly diagnose your problem, then you got your money's worth. Would you feel better if the doc had run a bunch of tests and spent 4 hours to arrive at the same conclusion?
  • I WANTmy doctor to be rich!
    To FAMILY MEDICIN DOC WIFE & SCMBGDOC:

    Listen, I don't want doctors worrying about how they are going to buy groceries while they're examining me -- they've earned the right to high pay. The dilemma is NOT what doctors deserve; rather, it is: How do strapped families pay for a doctor's visit? Patients often ask me for (free) medical advice that I am not qualified to give. A NIAB may be their only option (other than no care at all).
  • You've been threatened!
    It's funny the Wallstreet quake has scared everyone, even almighty doctors. So much- that they have to turn off the radio when they hear about cheaper alternatives.
  • Thank you, Clark.
    I was happy that you mentioned the nurse-in-a-box because our family just can't afford medical insurance and paying for a Doctor's visit. My husband's employer won't provide his employees any health insurance so we are on our own. What I like about NIAB service is that I can take my kids for minor ailments like coughs, minor infections, or anything that is "general" for a lot less than a doctor's visit. Of course I am not saying that doctor's visit are useless. I will still take my kids to a doctor if something more serious needs to be addressed, but for minor things, a NIAB works great for people like us. So dear Doctors, pls don't be upset. We are just like you, who work hard for our money and are just trying to spend it wisely.
  • nurse practitioner services
    Thanks for suggesting these services. Everyone has a right to obtain medical services which he or she can afford. Too many people have had to place medical services costs on credit cards and then are exploited by those vendors through retroactive interest rate hikes that amount to usury.
  • Doctor Costs
    Doctors fees are sometimes way out of control and they are a protected industry. My wife and I had a very quick visit to a dermatologist last year, it took a total of 20 minutes or less for both of us. We had to pay about $450.00! No lab test just a quick look at our skin -- thats is outrageous!! If qualified foreign doctors were allowed to practice outside the AMAs oversight I'd be a lot happier with my medical bill!
  • Medical Services
    Granted I accept that doctors proceed through a very long and rigorous education and it is very expensive. Their services are highly specialized and are absolutely needed. However, competition in ANY industry is a good thing. It forces lower prices, better services and more choices. Greed in this country is ruining the telecom/broadband industry, Technology, BANKING and medicine. Isn't there more to life than just the stack of green in our wallets? Money is important and managing wisely is important. But why prevent competition? Corporations and other businesses who want regulatory protection from competition are undermining capitalism and the advantages of a free market economy and they are usually the same ones who are first to tout the advantages of such a system. Greed and hippocracy rule these days it seems.
  • Medicine
    Doctors certainly do deserve to make a living. Both of these other posts are way too defensive. Some people cannot afford insurance though and cannot afford the $125/hr to go to the doctor office. In this case the "nurse in a box" solution may just be the thing for basic healthcare needs. Or do the doctors feel entitled to all the business and the money and a monopoly on medicical services? Do I detect a tinge of entitlement here?
  • you are wrong on this one
    My husband is a family medicine doctor and owns his business. He works very hard to provide for our family and has a wonderful reputation in our community. You obviously do not know what you are saying when you prefer the "doc in the box" options/nurse practioners. Please stop speaking of things that you do not have a clue about- you are doing more harm than good- I have turned the radio off this morning after your biased comments regarding these issues in health care-get the facts from doctors like my husband who can inform you better- they have to make a living too!
  • Clark,
    Why didn't you get into politics so you could outlaw completely all doctors from practicing medicine. They all seem to be scumbags getting their seductive sandwhich and then prescribing the most expensive medications to their patients. All US doctors are swine and should not be able to make a living in this country. They should work for free like you Clark....oh wait a minute you are a multimillionaire..Clark is a multimillionaire, that is just wrong and who's sandwhich did Clark eat...GOOGLE????
    s
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