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Open wallet and say "ah'

(ran PT, HT, CI editions)

Resolve to use the P-word throughout the year and start talking with your doctors and other health care providers about an oh-so-unmentionable topic: price.

Medical inflation is exploding after years of relative calm thanks to managed care and other factors. In 2002, the average cost of medical and dental benefits for active employees rose 14.7 percent, from $4,924 per employee to $5,646, according to a study by Mercer Human Resource Consulting. General inflation in 2002 was barely 2 percent.

Mercer expects a similar rise when the 2003 count is in, and more of the same in 2004. The rises are forcing employers to cut health care benefits, increase co-payments and shift other costs to workers. Most consumers will be paying a bigger share of medical bills out of their own pocket than ever.

Price may be the final taboo in a revolution in health care consumerism that has removed doctors from their pedestals. The revolution is making patients partners in medical decisions and changing the medical establishment's image from a holy temple to a profit-driven industry that sells services.

In almost every other area of the economy, consumers expect to see goods and services clearly priced. They usually check the price before they buy. They consider less costly alternatives. They walk away when the price seems exorbitant and look elsewhere.

One of the first studies on this issue found that both patients and doctors recognize the need to talk price. It was headed by Dr. Caleb Alexander of the University of Chicago and published in November in the Journal of the American Medical Association. Researchers surveyed 133 doctors and 484 patients in big Chicago-area internal medicine practices.

About 63 percent of the patients wanted to discuss costs before agreeing to tests or treatments, but only 15 percent did it. About 80 percent of the doctors thought their patients wanted to talk about costs, but only 35 percent of the doctors raised the topic.

Those lapses can affect patients' health, as well as their pocketbooks _ especially for prescription drugs, which account for a big share of a family's out-of-pocket medical expenses.

A doctor often can pick among several different prescription drugs to treat a disease. Newer brand-name drugs with high price tags may work only a little better than older drugs that cost a fraction as much. Patients who don't have the money may go without treatment and never fill an expensive prescription.