12 Ways to Shrink Your Health Care Footprint

Our carbon footprints are calculations of the greenhouse gases we're individually responsible for. Reduce yours, and you can take some satisfaction in having done something, however small, to reduce emissions and slow global warming. Now might be a good time to start thinking about our health care footprints.

Serious reform and belt tightening can't happen without new policies from Washington, but individual responsibility and action can both set an example and make a contribution.

It all adds up. Besides, even people with good health coverage are paying a larger fraction of their health care bills these days, in the form of co-pays, deductibles and other out-of-pocket expenses. There's a direct personal interest in reining in costs, not just a societal one.

Here are a dozen suggestions for making your health care footprint a bit smaller:

1. Develop a good working relationship with a primary care physician. A primary care doctor who knows you, your medical history and your circumstances stands a much better chance than a relative stranger of making decisions and giving you advice that will keep you healthy, out of the hospital and in no need of specialized medical care. She or he can take care of you in context.

The catch is that primary care physicians are in short supply. And primary care may be evolving into more of an ensemble approach, with the physician being the head of a large supporting cast.

In a few years, the relationship you have with the physician may be less primary than, say, the one you have with the health coach -- someone who works with the physician and whose job it is to cajole, remind and motivate people to take better care of themselves.

2. Dont use the emergency department unless absolutely necessary. Call your doctor or his service and try to get some advice over the phone or, better yet, in person. Emergency care is fantastically expensive partly because the doctors and nurses often need to order a lot of tests so they can make diagnostic and treatment decisions quickly.

3. Get and stick with the program. Most of American health care these days is devoted to treating chronic conditions like arthritis, diabetes, heart disease and high blood pressure, and to care at the end of life. Taking medications as prescribed, getting regular checkups (regular eye examinations if you have diabetes, for example), and adhering to lifestyle changes can keep those diseases under control at relatively (we stress relatively) modest cost.