Health Interview: Dr. Matthew Ajluni of the American Osteopathic Association Discusses the Startling Results of the AOA 2012 Health Care Expenditure Survey

American Osteopathic Association spokesperson and osteopathic family physician Dr. Matthew Ajluni, DO of Swedish Covenant Hospital in Chicago, Illinois joined me recently to discuss the results of the 2012 Health Care Expenditure survey the AOA (American Osteopathic Association) recently conducted and share how patients, physicians and insurance companies are affected by it and how it can be remedied.


  Dr. Matthew AjluniAmerican Osteopathic Association Spokesperson and Osteopathic Family Physician Dr. Matthew Ajluni. Image courtesy of American Osteopathic Association 



Candace Rose: Can you tell us about the 2012 Health Care Expenditure survey the AOA recently conducted?

Dr. Matthew Ajluni: Sure. The AOA did a survey of over 1,000 to gauge how the recession was affecting patients and their access to health care and unfortunately there was some startling results which suggested that a large percentage of patients were cutting back on their health care spending or skipping annual visits and followup visits in an effort to save money. As many as 15 to 20% suggested the recession was negatively affecting their health and it really was illuminating for us after we got these results that we needed to try and encourage patients to continue to seek health care in spite of how it's affecting their pocketbook and give them tools and tips to help them still get health care, but to do it in a cost effective manner."


Candace Rose: As a physician what surprised you the most about the results?

Dr. Matthew Ajluni: "I guess that as many as one in three were actually skipping their annual visits. I have definitely seen patients in my practice that are reluctant to come in. I didn't think the numbers were that high. I was surprised that as many as one in five patients were actually just skipping medicines altogether- that was documented in the survey. 57% stated that budget was a primary consideration when they were trying to make health care related decisions. It was no surprise to me that patients want to save money in any possible way they can but it is surprising that as many of them were actually skipping visits and skipping or reducing imaging tests such as mammograms, x-rays, things like that."


Candace Rose: I was surprised that the survey stated that women were more likely than men to skip or reduce imaging tests. Why do you think this is?

Dr. Matthew Ajluni: "It's difficult to know, but the best thing I could guess is that women are unfortunately saddled with more preventative health care items on their list including mammograms and bone density scans and pap smears, and they have more to worry about in terms of prevention. So if you're just adding all those up I would imagine women are trying to save just like men are, but again they have a higher number of things to do so perhaps that was speaking to that."


Candace Rose: According to the survey "one in four respondents indicated skipping or reducing specialist visits as recommended by a primary care physician or health care provider to save money. What would you tell patients who are skipping on exams and what can they do?

Dr. Matthew Ajluni: "Well, this is for me really the meat of the study and the most interesting in illuminating part of it is that we have to strongly encourage patients to not skip in particular their visits with their primary care physicians. I'm an osteopathic family physician and I put prevention really first in my arsenal of treatment for patients and trying to make my patients understand the importance of these preventative visits. Really when we put prevention first we can keep people from getting sick in the first place hopefully or staving off the complications of hypertension and diabetes, high cholesterol. If we're able to control these illnesses in the beginning and don't allow them to become more problematic, then ultimately we'll be keeping our patients healthier and in the long run saving them money. I sort of have used an analogy with patients (a crude analogy) but look at the way we take care of our automobiles. Even if we're in tough times most people will still get their oil changed, do tire care, do their filter changes because otherwise if you don't do those things to your car your car's going to ultimately break down. Well, the body is not that dissimilar. You've got to do regular maintenance to keep yourself healthy and down the road eventually there's going to be cost savings to if you prevent these more serious complications."


American Osteopathic AssociationAmerican Osteopathic Association. Image courtesy of the American Osteopathic Association


Candace Rose: What should patients ask their physicians at their annual appointments? 

Dr. Matthew Ajluni: "Well, beyond the normal in the context of saving money and having cost effective medicine, I think patients should engage their doctors and let them know that cost is an issue, especially if they're out of work, they don't have health insurance. So I would suggest letting their physician know upfront that they want to be as cost conscious as possible and specifically though, asking about the medicines you're going to prescribe- is their a generic alternative to this medicine? A vast majority of medical problems- high blood pressure, high cholesterol, diabetes have very good inexpensive generic medicines that can be used but sometimes doctors are more (for whatever reason) potentially prescribing the newer branded medicines that cost far more. Some people suggest you can save as much as 30 to 80% with generic medicines but if you tell your doctor that 'I want a generic' that can make a significant impact on your savings. Asking your doctor to prescribe a 90-day supply versus a 30-day supply can also save you money on your co-pay and the medicines tend to be cheaper if you buy them in a three month supply. It saves you a trip to the pharmacy if you're only going there every three months versus every month and you'll save on gas as well. Sometimes there's rebates or coupons for medicines, so that's something else you can ask your physician. And then occasionally asking your doctor 'are these tests absolutely necessary'? Sometimes doctors are prescribing a lot of tests because they think patients want the tests or they're being extra cautious in ordering certain tests. It's not to say doctors are over-ordering tests, but it's important to really have a frank discussion with your doctor about the necessity of certain tests that might be ordered and a patients willingness maybe to wait two or three months and see if things get better and things like that. So those are a few things to discuss with your doctor."


Candace Rose: What type of lifestyle changes can we make so we don't have to visit the doctor as often?

Dr. Matthew Ajluni: "Great question. There are many and ultimately the better you take care of yourself (of course) hopefully the less frequency you'll need to see your doctor and hopefully the less frequent significant health complications will arise. So the things that we can do is eat as healthy a diet as possible- a diet rich in fruits and vegetables; low in saturated fats; low in simple carbohydrates like cake, cookies, candies, muffins and things of that nature. And definitely avoiding soda pop; juice also has a significant amount of sugars, so minimizing our intake of these kind of simple carbohydrates and really focusing on raw fruits and vegetables as a significant cornerstone of our diet. Exercising and staying active- I recommend that my patients get 150 minutes of cardiovascular exercise per week which would translate roughly to 5 days of 30 minute exercise per day and trying to do something that gets your heart rate up for a sustained period of time. Avoiding cigarettes; avoiding excessive alcohol- if you are going to drink, drinking in moderation which is considered not more than one to two drinks per day. These are some things we can do to try and stay as healthy as possible."


Candace Rose: You mentioned saturated fat, and coconut oil (which is a saturated fat) is everywhere these days, and many don't know what to make of it. Is it healthy or is it not?

Dr. Matthew Ajluni: "Again, there are some benefits of coconut oil in the form of antioxidants and other good nutrients but it is heavy in fat and you definitely want to use that in moderation."


Candace Rose: Do you have any additional tips or information you'd like to share?

Dr. Matthew Ajluni: "Yes, I do. There are a few other things to help save money beyond having that discussion that we talked about, with having that discussion with your physician, but also making sure that you contact your insurance company. Many times there's prescription or pharmacy benefits if you use their preferred pharmacies or home delivery pharmacies. I've had patients that can save money that way. Sometimes your insurance company will have wellness programs or discounted gym memberships, and these are other ways to cut costs. And then having a discussion with your employer if health care insurance is offered with your employer about the different plans they offer and which ones may be cheaper – HMO plans can potentially offer savings, also flexible spending accounts are another way to save money. And also lastly I'd like to refer patients to the where if they click on About Your Health there's the Savvy Patient Checklist that has some of these things that I've discussed and there's other links to healthy eating websites and there are other recommendations for good preventative health measures."


For more information on the American Osteopathic Association visit

The Savvy Patient Checklist





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