Nicholas Lyon, 29, of Southwest Miami-Dade has serious heart problems, and his doctor tells him he should get flu and pneumonia shots to spare his body the stress of those illnesses. But he thinks he might put it off.
"It depends on what they cost," he says. "Every time I go to the clinic it's $90. I'm only working part-time in computer repair. I have to see if I can do it right away or budget it for later."
He's not alone.
Strapped for cash by the economic downturn, their health insurance at risk amid soaring layoffs, Americans are using a variety of strategies -- some good, some bad -- to handle healthcare costs.
Some turn to generic drugs; others skip medicine doses or put off doctor visits, according to an October survey by the AARP. The first idea's good; the others court disaster, doctors say.
"This can be a life-or-death situation," says Dr. Kathy Hebert, who sees heart patients at county-subsidized clinics at Jackson Memorial Medical Center.
Patients who skip doses or take half-doses often end up with a sub-therapeutic level of the drug in their bloodstream all the time, she says.
"When you stop for a day, the level declines; the next time you take the drug it doesn't get you back to the therapeutic level. So you have half the expense of the drug but none of the benefit," says Hebert, who also is medical director of disease management at the University of Miami Miller School of Medicine.
"You may put a couple of dollars in your pocket today, but you may pay the piper in five or 10 years," says Dr. Mark Caruso, a primary care physician at Baptist Hospital.
It's a bad time to get sick. Or hurt. Or have a baby. Healthcare costs rose by 6.9 percent last year, twice the overall inflation rate. At the same time, incomes stagnated as economic hard times cut working hours, and layoffs cost tens of thousands their company-paid health insurance.
Nineteen percent of Florida residents under age 65 -- nearly one in five -- have no health insurance, up from 16.9 percent in 1999, according to a mid-2008 survey by the University of Florida College of Public Health. That's 3 million people.
Even those with insurance struggle to pay costs. Insurance companies last year charged employers an average of $12,100 to cover a family of four, with the workers contributing $3,300 of it, according to the National Coalition on Health Care.
Here, then, are the actions people are taking, based on the AARP survey, and the consequences to be mindful of, doctors say:
Taking over-the-counter or generic drugs instead of prescription drugs.
OTC drugs such as aspirin or Tylenol for minor aches and pains are fine, says Dr. Laurence Gardner, executive dean for education and policy at the UM medical school. Others may not be.
"The standards of efficacy and safety of OTC drugs is much lower than for prescription drugs. Cold remedies have limited long-term benefits. Herbal remedies, some vitamins and those so-called prostate remedies in drugstores, there's not much science that says they work."
Generic drugs, on the other hand, are one of the best ways to save money staying well, Gardner says. They can be up to 80 percent cheaper than brand-name drugs because the companies making generics do not face the considerable expenses of research, development and advertising born by brand-name makers.
Overall, U.S. prescription drug sales hit $286.5 billion in 2007. Generic drugs make up 66 percent of all prescriptions, but account for less than 15 percent of the money spent on them, according to the Generic Pharmaceutical Association.
The FDA requires that generics be the same chemical formula, and be as fast, safe and effective as brand-name drugs.
"With a couple of exceptions, using generic drugs is a blinding example of the obvious," says Gardner.
Some doctors have questioned whether some of the 9,000 existing generic drugs might have different effects or side effects than the brand-name originals.
"Some anti-arrhythmia drugs against sudden cardiac death are in a special category," says Hebert. "Some studies say that if you switch to generics, the therapeutic level falls, and the patient is at higher risk."
She recommends that patients ask their doctors about each drug before switching.
But a study published Dec. 2 in the Journal of the American Medical Association backed the quaity of generics. Doctors at Harvard Medical School and Brigham and Women's Hospital compiled results of 30 studies since 1984 covering dozens of common cardiovascular drugs and found generics medically equal to brand-name drugs.
Putting off seeing a doctor.
Bad idea, says Gardner.
"One of the best places to invest your healthcare dollars is in visiting a quality primary care physician," he says. "A visit might be $80 to $120 with most of it paid by insurance, if there is insurance. In an annual exam, the important thing is to talk to your doctor about how you feel. He can listen and sometimes pick up problems that have not occurred to the patient."
If you're without insurance, it's perfectly OK to negotiate with your doctor for a lower fee, says Caruso.
'If somebody's been a patient of mine, and comes in and says, 'Doc, I'm between jobs,' we will bend over backward to help." This applies even to high-priced specialists, he says.
Cutting back on preventive care such as vaccinations and screening tests.
"No way I can advocate that," says Caruso. "I'm a primary care doctor. My thing is prevention. I'm the guy who reminds you to have your flu shot, have your colon exam. An ounce of prevention can save a lot of heartache down the road."
Something you can do, he says, is talk to your doctor about individual tests you might put off. A chest X-ray or EKG if you're young and healthy, for example.
Skipping medicine, cutting the dose or leaving prescriptions unfilled.
"That's not good," Gardner says. "Prescription medicines are prescribed in doses and intervals that are necessary for high blood pressure, diabetes, heart failure."
Seeking prescription assistance from the pharmacy or manufacturer.
Excellent idea, experts say. Many pharmacies have cut-rate programs for patients of all ages and income levels. Drug makers have programs giving free or reduced-rate drugs to those who can't afford the full price. Mass-market retailers such as Wal-Mart and Target have programs, too.
Splitting pills (not included in survey).
With many medications, a good way to save on prescription prices is splitting pills, doctors say. A 40-milligram pill typically costs less than twice as much as a 20-milligram pill. Customers can cut the pills in half and save money.
Be aware that some pills cannot be safely split; check with your doctor to make sure yours can. And it's important to split the pills precisely so you get the full dose every day, says Walgreen's spokesman Michael Polzin. A plastic-and-steel pill-splitter is about $5 at most drugstores. To see more of The Miami Herald or to subscribe to the newspaper, go to http://www.herald.com. Copyright (c) 2009, The Miami Herald Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
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