There have been many proposals for reducing the cost of health care, but none are nearly as effective as the few simple measures that are presented here.

The first, often overlooked, is to use receptionists who each have the ability to speak at least two languages. That way, whenever a caller uses, say, English to try to make an appointment, the receptionist can reply in, for example, Spanish. In the case where a caller is bilingual in Spanish and English, then the call is quickly transferred to the receptionist who speaks Swahili and Navajo. That stops most calls right there.

In a smaller clinic, where multiphonic linguists are not affordable, it is helpful to choose personnel who have poor verbal skills, who are cognitively unable to operate a switchboard, and to hire a seven-year-old with a 16-ounce hammer to maintain the phones. Teach cost-saving phone techniques so that the receptionists can operate efficiently. Here are some sample conversations that were recorded at one well-run and profitable clinic.

"Hello, I'd like to make an appointment with Dr. Pathek."

"Thank you for calling, please hold."...

This next conversation can be faulted on its excessive length, nonetheless, the receptionist was able to succeed in the end.

"Hello, please don't put me on hold. I'd like to make an appointment with Dr. Smith."

"Thank you for calling. Dr. Robinson has an opening next Tuesday at 3:00 PM"

"No, I want to see Dr. Smith."

"Oh, Dr. Smith, why didn't you say so? Please hold while I check her schedule."

[22 minutes of elevator music]

"I'm sorry, you were calling for an appointment with the physical therapist?"

"No, I want an appointment with Dr. Smith."

"No problem. What is your name, please"

"Henry Jones"

"Could you spell that please?"

"H-E-N-R-Y J-O-N-E-S"

"I'm sorry, sir, I am trying to write it down, could you spell it a bit more slowly."

"Henry, H---E---N---R---Y, Jones, J---O---N---E---S"

"Thank you, Mr. Rones."

"No, it with a 'J'!"

"I'm sorry. Is that Jenny with an 'ie' or a 'y' at the end."

"No, it's not 'Jenny' it's 'Henry.'"

"Then why did you say it's 'J'?"

"That's my last name."

"Thank you. Do you spell that J-A-Y?"

"No, my last name is 'Jones.'"

"Thank you Mr. Jay. The physical therapist is available on Wednesdays, can I set you up for a 10:15 appointment?" [caller hangs up]

It is very important to handle emergencies with dispatch. With careful training any office staff can learn to speed the transaction. Here is a transcript of a recording of one of the best receptionists observed in a nationwide study. We deal here with an incoming call:

"Hello, this is an emergency." [click, dial tone]

However, it takes years of training to reach this level of operational expertise.

Cost savings are available through an associated pharmacy. Underfilling orders is effective, and brings the customer back time and again. A few patients can count pills, and compare them to the prescriptions, but most patients won't notice if the dosage rather than the pill count is smaller than that prescribed. For example, supply 10 mg. antibiotic where 50 mg. is called for. Be sure to charge for the 50 mg. pills so that you can show that you thought you were providing the correct product. Of course, if patients do notice that the dosage or count is wrong, then the problem may not be with the pharmacy, but with the physician whose handwriting has been allowed to deteriorate to the point of legibility.