Hospital emergency departments, as the name implies, are meant to be used for true emergencies. Unfortunately many trips to the ER are not life-threatening and are in fact both unnecessary and avoidable. A study published in 2013 found that only 29% of ER visits reviewed were actual emergency situations. Less than half of those visits that were not an emergency required medical attention but could have been treated in a primary care facility. One in four did not require immediate attention.

Low health literacy leads many patients to the ER when they could have received care at a less expensive setting – like at their doctor’s office or at a walk-in clinic. It’s also known that patients with low health literacy are more likely to make return visits to ERs within two weeks. Some barriers for patients with low literacy include:

• Not understanding or following doctor’s instructions for managing chronic conditions.
• Misunderstanding information they find about symptoms online.
• Not recognizing the importance of proper preventative care.

More recent research, presented at the Society for Academic Emergency Medicine Annual Meeting in Orlando, explored how low health literacy was related to preventable ER visits. The study looked at over 1,200 participants and a total of 4,444 ER visits. Over 10% of the visits were found to have been preventable.

Of the preventable visits, over 60% led to hospital admission. (The average cost of a hospital stay is estimated to be close to $10,000.) When researchers looked at the health literacy of the participants, those with lower health literacy were over twice as likely to have made a preventable ER visit. Having below an eighth-grade reading level was the definition used for low literacy.

The most common preventable conditions leading to ER visits included chronic obstructive pulmonary disease (COPD), urinary tract infections and long-term complications from diabetes.

While not surprising, the study illustrates that patients with low literacy are more likely to make preventable visits to ER and other emergency services. And increasing the literacy of patients can help dramatically decrease unnecessary healthcare costs.

My wife and I are generally pretty savvy shoppers. Well, she is – and I get the benefits. She clips coupons, looks for bargains, and buys certain items only when they’re BOGO (buy one, get one free). Why pay full price when you don’t have to?

In healthcare, we’ve rarely had that option. For a long time, the cost of a healthcare treatment or test didn’t even come up until after the bill came. For most of us, health insurance covered the majority of the cost, and our responsibility was limited to a small co-pay.

That’s changing now as the trend toward consumer-directed health plans (CDHPs) grows, and many of us are spending more out of pocket. In 2016, nearly one-third of all employer-sponsored health plans were CDHPs.

As a result, patients are getting choosier. And as the healthcare system continues to evolve, we need to be more proactive. We need to get smart about where to go for care, how to pay, and how to prepare. These tips can help:

How to Save

Your primary care physician is likely your go-to source for most of your healthcare needs. But there are times you may want to consider these alternatives:

• Some health plans offer telemedicine, which can give follow-ups, help manage chronic conditions, monitor medications, and provide other clinical services all through electronic communication. Depending on your condition, telemedicine can save you both time and money.
• For problems that are serious but not life-threatening, such as a sprained ankle, bad cough, or fever, urgent care centers can be a good alternative to the emergency room. Be sure the center is in network for your insurance plan. Co-pays for visits should be listed on your insurance ID card or on the plan’s web portal or mobile app.
• Websites like FAIR Health may help you figure out the costs of some medical care.
• Teaching hospitals in some communities may offer discounts for certain medical needs.
• For prescription drugs, ask your doctor or pharmacist if generic versions are available. They’re often a fraction of the cost of a brand-name medication.

How to Pay

Using credit cards to pay off big medical bills may be tempting, but it can add up to mountains of debt. Make sure you know your options:

• If you have a high-deductible health plan (HDHP), you can open and put money in a Health Savings Account (HSA) with pre-tax dollars. Many employers will contribute to your HSA as well. HSAs can be used for a wide range of healthcare expenses – from sunscreen to X-rays – and the balance carries over year to year.
• With Flexible Spending Accounts (FSAs), you can use pre-tax dollars to pay for most healthcare-related products and services. Some FSAs operate on the “use it or lose it” rule, meaning you must spend all the money in your account by the end of each year or lose any remaining balance. There are exceptions, though, so check with your employer.
• Hospitals and certain providers may consider payment plans for larger expenses. Be sure to ask about them if you anticipate big bills or find yourself with higher-than-expected costs.
• Finally, keep in mind that most healthcare organizations will take into account your ability to pay. You may be able to negotiate some expenses, or they can suggest programs that can help out.

How to Prepare

Here’s the key to saving on healthcare: Do your homework. Costs for tests, procedures, and treatments can vary widely, regardless of where you live or what plan you use, so take these steps:

• Choose the right plan based on your age, health history, and the care you expect you’ll need.
• Be sure your provider is in-network.
• Talk to others who’ve been through similar medical issues or procedures, and learn from their experiences.
• Ask questions – not only about what to expect from the service, but about how much it will cost. Healthcare is one of the most expensive services we purchase, so don’t be shy about asking questions whenever your doctor recommends tests or procedures, or prescribes medications.
• Be proactive: Practice good health habits, eat smart, exercise, and take advantage of free screenings, flu shots, and other preventive steps.

Paying for healthcare will never be like shopping for groceries. But as things continue to change, there will likely be more and more similarities – and in time, smart shoppers will get better deals.