The Health Reform Law Provides New Career Opportunities in the Health Services Sector!

The Health Reform Law signed March 23, 2010, will increase demand in all areas of health care in America. The intent of the law was to create a virtual universal health care system in America that could accommodate all the people. Few people are able to pay cash for medical services; most of us rely on health insurance to cover our medical expenses. Prior to the signing of the Health Reform bill, health care insurance hasn’t been widely available to all Americans and this has caused many of us to put off early treatment until the ailment assumes critical proportions. When it does, we must then go to emergency rooms, with our then advanced disease. The emergency room is the most expensive type of medical care, and one of the chief reasons Americans are spending a stunning $2 trillion a year on medical services. Making health insurance accessible and affordable to all Americans is the answer to this problem.

Being insured, people will be able to seek early treatment, and preventative medicine can thus curtail the more expensive procedures that are the root cause of the uncontrolled growth of medical care cost. The law has already taken effect and the ramifications, in terms of numbers of patients, are about to descend on a health services industry that is ill prepared to handle the increased volume.

Currently, health services in the U.S. are barely able to keep up with the 150 million employer-insured and the 40 million elderly citizens receiving Medicare. By 2019, the ranks of the employer-insured are expected to increase by 9 million, and Medicare will take on another 12 million people. Exchanges, a vehicle that will provide low cost insurance to small businesses and individuals, will add an additional 25 million to the rolls. From 2010 to 2019, approximately 46 million new people will be added to the health care load. Does our current health services industry have what’s needed to accommodate this relatively sudden growth?

Most of the burden of this increase will fall on the primary care component of the health services industry. According to the Academy of Family Physicians, by 2020, the demand will far outweigh the supply of these professionals. 40,000 new primary care professionals is what the demand will require. At that time, we’ll have a situation in which nearly everyone can afford medical treatment, while yet fewer professionals are available to provide it.

To meet the expected increase in medical services demands, the new Health Law has allocated billions to the education of new health care professionals. Even if they were to get started immediately, most would not be fully trained until from four to six years hence. To get the ball rolling, the law has provided funds for education in the health services field, has made scholarships and grants available, and is set to support professionals in whatever continuing studies they may need to handle the new demand. Demand over supply will also inevitably increase monetary compensation for available health care professionals. For those considering health services as a career, a wide open field awaits them with all the help they will need to establish their new careers.

Attention is also being focused on how and where health care may be delivered. The law is allocating $11 billion for the creation of new health centers in our communities. Work is underway to promote nurse-operated clinics. Nurse practitioners and physician’s assistants will take on new roles, having increased responsibilities. Expect to see new and different medical facilities working in coordination, in order to optimize the use of health service personnel.

Thanks to the Health Reform Law, the health services industry is about to become the most promising career path available. If you’re considering what career choice to follow, now is the time to look into the health services industry. Now is your chance to be in demand, for a lifetime!

The Many Community Mental Health Services Available to You

Well developed and well managed community mental health services are actually associated with low suicide rates. Hence, mental health services for the masses can be improved by focusing on the community based and specialized mental health services.

If ever you are in need of mental health services, you can contact your local affiliates of the national self help organizations or the local mental health center. Most of these agencies have the relevant information on the various services designed to meet the different needs of those who are suffering from different types of disorders such as anxiety conditions, panic disorders, schizophrenia, etc. Apart from these, they also provide information related to community mental health services designed specifically for children, refugees, HIV infected patients, the elderly, etc. Here are a list of various community health services available for your use.

Mental health act has provided a great opportunity in rendering different kinds of community care based upon individual needs. The provision of good residential accommodation for various groups of mentally disordered or patients with disorders who need constant care by the government aided agencies is a step towards enhancing the community health services.

Generally community health services treat or support people suffering with mental disorders in a domiciliary setting instead of placing them in a hospital or a psychiatric asylum. The various services offered by these community services usually differ from country to country. Most of the community services consist of psychiatric wards similar to that of a hospital. These services are mostly rendered by professionals and government organizations. According to the world health organization, community services are very easy to access by a wide range of people and are quite effective and even aid in reducing social exclusion.

When compared to private mental hospital, community services are less likely to have possibilities for the violation and neglect of human rights which are rarely encountered in few of the mental hospitals. These community services also play an important role in educating the people about the various common disorders and their corresponding symptoms. This way, people gain knowledge on various disorders and can easily recognize individuals who may be suffering from these disorders but might not really be aware of them. Aged and older people who require constant attention, can get benefited by these community services, instead of paying huge bills at private hospitals, they can get good care at the community services.

With the population in the older age group on the rise, there is need for the development of community mental health services in various localities. Also, with many specialists willing to volunteer at the community services, clients can gain a lot of benefits. Since, most of the mental health disorders occurrence do not have a clear reason behind them, the treatment usually is a long term one and for people who cannot afford highly expensive treatments and consultations, community mental health services is the best place to choose. With government pitching in to provide funds for them, it is time people think of visiting them when needed.

The Development of Multi-Professional Occupational Health Services

During the last fifty years a need to reduce the rate of occupational accidents and diseases, and to address the economic burden that arises from workplace accidents and diseases onto the tax payer through the externalization of costs, has forced the organization of the national infrastructure to support employers to fulfill their legal obligation in health and safety at work. This was to a large extent guided by the International Labour Organization (ILO) conventions. The ILO Occupational Safety and Health Convention, No 155 (13) and its Recommendation, No 164 (14), provide for the adoption of a national occupational safety and health policy and prescribe the actions needed at the national and at the individual company levels to promote occupational safety and health and to improve the working environment. The ILO OH Services Convention, No. 161 and its Recommendation, No. 171 (33), provide for the establishment of occupational health services, which will contribute to the implementation of the occupational safety and health policy and will perform their functions at the company level.

EU legislation on the introduction of measures to encourage improvement in the safety and health of workers at work defines the employer’s responsibilities for providing all of the necessary information concerning safety and health risks, and the protective and preventive measures required, obligation for consultation with and the participation of workers in health and safety, the employer’s responsibility for providing training and health surveillance. The framework Directive also states that the employer shall enlist competent external services or persons if appropriate services cannot be organized for lack of competent personnel within the company.

Therefore, the framework Directive greatly strengthens the concept of addressing the issue of health and safety at work by using multi-professional occupational health services, and in encouraging the active participation of employers and employees in improving working conditions and environments.

The organization and scope of occupational health (OH) is constantly changing to meet new demands from industry and society, therefore the infrastructures which have been created for occupational health are also undergoing continuous improvement. OH is primarily a prevention-orientated activity, involved in risk assessment, risk management and pro-active strategies aimed at promoting the health of the working population. Therefore the range of skills needed to identify, accurately assess and devise strategies to control workplace hazards, including physical, chemical, biological or psychosocial hazards, and promote the health of the working population is enormous. No one professional group has all of the necessary skills to achieve this goal and so co-operation between professionals is required. OH is not simply about identifying and treating individuals who have become ill, it is about taking all of the steps which can be taken to prevent cases of work related ill-health occurring. In some cases the work of the occupational hygienist, engineer and safety consultant may be more effective in tackling a workplace health problem than the occupational health nurse or physician.

The multi-professional OH team can draw on a wide range of professional experience and areas of expertise when developing strategies, which are effective in protecting and promoting the health of the working population. Because ‘OH largely evolved out of what was industrial medicine there is often confusion between the terms ‘OH and ‘Occupational Medicine’. The distinction between the two has recently been clarified in the WHO publication Occupational Medicine in Europe: Scope and Competencies.

In this document it states that “Occupational medicine is a specialty of physicians; occupational health covers a broader spectrum of different health protective and promotional activities.” It is clear that the medical examination, diagnosis and treatment of occupational disease are the sole preserve of the occupational physician. It is only the physicians who have the necessary skills and clinical experience to perform this function in the being paid to the prevention of hazardous exposure and improved risk management there should be less need for extensive routine medical examinations and hopefully fewer occupational diseases to diagnose in the future. Therefore, it is likely that more occupational physicians will want to move into the broader modern field of preventative occupational health than in the past.

However, at this point, where the physician stops using the skills learnt in medical school and starts to enter the workplace to examine working conditions, there is a much greater overlap between the core areas of knowledge and competence between occupational physicians, now practicing OH, and other OH experts, such as occupational hygienists, safety engineers and an increasing number of occupational health nurses.

The occupational physicians, in their scope and competencies acknowledge that there is no longer any requirement for the physician to be automatically chosen to manage the occupational health team. The person, from whatever discipline, with the best management skills should manage the multi-professional occupational health team in order to ensure that the skills of all of the professionals are valued and fully utilized.

Next in this series “The Occupational Health Team”.

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Are Mental Health Services Covered By Health Insurance?

Does Major Medical Health Insurance Cover Mental Health Services?

Many people are concerned about paying for mental health services. They know that they get these services from health professionals, or sometimes by medical doctors, and so they want to know if their health plan will help cover them. The answer to the question for any particular individual is, of course, it depends.

Group Major Medical From A Job

Many group major medical policies do provide employees with comprehensive coverage. This may include mental health coverage. Other employers may provide these services under another benefit program. If you get your medical benefits at work, you need to consult your policy or ask the human resources department. Some companies will post free, confidential phone numbers for employees who would like to seek help.

If it is not an emergency, it is safer to get an treatment pre-approved. This way you will know how much the group health plan will pay and how much you have to pay out of pocket.

Individual Health Insurance

People with individual or family policies my not have comprehensive mental health benefits. Even though private insurers cannot cancel a policy because a covered person develops a condition, many will refuse an initial application because of mental illness. The new health reform bill should make it so people cannot be refused a policy for pre-existing conditions in the future, but this part has not been implemented yet.

How To Get Low Cost Mental Health Treatment Without Insurance And A Lot Of Money

Mental health services can be very expensive, especially if you need to pay for private treatment. Many people who need help need to return for repeated therapy, treatment, or prescriptions too. But there are many resources to help people get free or reduced cost treatment. The problem is that a lot of people who need treatment may not know how to look for help! One other problem is that many people who need help may fear they lack the funds to pay for expensive therapists or doctors.

Online Mental Health Treatment Lookups

You can find a couple of very good free and low cost clinic finders online. These services can help you find all sorts of medical centers, and this includes mental health centers. Both the Partnership for Prescription Assistance (PPARX.org) and the US Department of Health and Human Services provide handy zip code searches.

You enter your zip code, and then a maximum distance you would like to travel. The online system will display any free or reduced fee clinics in your area. If you cannot find the right service very close to home, you may have to expand your search a bit.

Get Help On The Phone

If you do not have access to the internet, or if you are trying to get help for another person, there is also a toll free number that can provide help for people who need help. This is the national suicide and emotional distress hot line. This number is: 1-800-273-TALK

This phone number can put you in touch with 24/7, free, confidential phone help. They can also direct you to one of hundreds of crisis centers in the US.

Community Resources

On other place to look for help is at local community centers or charities. Some have social workers on staff or can direct you to other local resources where you can get help. Your local pastor should also have this information, and maybe he or she can draw upon resources from a congregation.

Understanding the Importance of Australian Certified Health Services Assistance Courses

A career in the health sector in Australia is regarded as rewarding, stable and interesting, with each week being completely different from the last- there will be a different set of patients, health professionals, client profiles and patient care requirements. If this is a profession you may be interested in, then you could start your career in the healthcare industry with entry-level work as a Health Services assistant.

You can develop a wonderful career caring for patients in hospitals as an assistant to professional health staff. You will train to work directly with patients under supervision. There are many varied duties that may be expected of you in this role.

As a Nursing Assistant you will need to provide assistance to clients according to their care plan- but only under the supervision of a qualified health professional. You can learn how to perform patient observations and how to work effectively with culturally diverse clients as well as co-workers. You will need to learn the rudiments of medical terminology. Besides this, you will also have to undertake a range of routine tasks and gain knowledge of transporting patients, preparing and maintaining beds, following basic food safety practice and infection control.

Your role, in short, will be to provide support to care providers, ensuring the health service functions effectively. You do not need to provide direct care support to patients. You can undergo the necessary training through the Certificate III in Health Services Assistance HLT32512 – this is a nationally recognised qualification and could enable you to find entry-level work as an Assistant in Nursing or Nursing Support Worker. Having completed this course, you could work with competence in aged care facilities, hospitals, clinics, private medical practices and home and community care services.

In such facilities, some of the areas where you could work are administration support, food service, maintenance, stores assistant or orderly, or on a pathway towards nursing assistant, operating theatre technician, patient support assistant and ward support. The Certificate III course content covers electives in specialised work functions such as operating theatre support or nursing work in acute care. You will also gain a broad range of skills necessary for working in remote or regional areas.

Common occupational titles may include Wards-person, Orderly, Patient Services Assistant (PSA) and Health Support Worker. You may also undertake additional tasks that may include cleaning, portering, waste handling and serving clients/patients with meals.

Potential career outcomes, once you have gained the required skills and competencies, may include work as an Assistant in Nursing, Nursing Support Worker, or Nursing assistant. If working in the theatre fascinates you, then you may opt to be a Theatre Support Worker or Operating Theatre Technician. Others can choose to work on the wards as Wards assistants or ward support workers. Patient service or Patient care are other services that you may try out as well.

All About Affordable Health Insurance Plans

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can’t land on an affordable health plan that could cater to the medical care needs.

Let’s discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits.

• Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer’s group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer’s group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman’s Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas

While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can’t have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children’s Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent’s health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.

A Prescription For the Health Care Crisis

With all the shouting going on about America’s health care crisis, many are probably finding it difficult to concentrate, much less understand the cause of the problems confronting us. I find myself dismayed at the tone of the discussion (though I understand it—people are scared) as well as bemused that anyone would presume themselves sufficiently qualified to know how to best improve our health care system simply because they’ve encountered it, when people who’ve spent entire careers studying it (and I don’t mean politicians) aren’t sure what to do themselves.

Albert Einstein is reputed to have said that if he had an hour to save the world he’d spend 55 minutes defining the problem and only 5 minutes solving it. Our health care system is far more complex than most who are offering solutions admit or recognize, and unless we focus most of our efforts on defining its problems and thoroughly understanding their causes, any changes we make are just likely to make them worse as they are better.

Though I’ve worked in the American health care system as a physician since 1992 and have seven year’s worth of experience as an administrative director of primary care, I don’t consider myself qualified to thoroughly evaluate the viability of most of the suggestions I’ve heard for improving our health care system. I do think, however, I can at least contribute to the discussion by describing some of its troubles, taking reasonable guesses at their causes, and outlining some general principles that should be applied in attempting to solve them.

THE PROBLEM OF COST

No one disputes that health care spending in the U.S. has been rising dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is projected to reach $8,160 per person per year by the end of 2009 compared to the $356 per person per year it was in 1970. This increase occurred roughly 2.4% faster than the increase in GDP over the same period. Though GDP varies from year-to-year and is therefore an imperfect way to assess a rise in health care costs in comparison to other expenditures from one year to the next, we can still conclude from this data that over the last 40 years the percentage of our national income (personal, business, and governmental) we’ve spent on health care has been rising.

Despite what most assume, this may or may not be bad. It all depends on two things: the reasons why spending on health care has been increasing relative to our GDP and how much value we’ve been getting for each dollar we spend.

WHY HAS HEALTH CARE BECOME SO COSTLY?

This is a harder question to answer than many would believe. The rise in the cost of health care (on average 8.1% per year from 1970 to 2009, calculated from the data above) has exceeded the rise in inflation (4.4% on average over that same period), so we can’t attribute the increased cost to inflation alone. Health care expenditures are known to be closely associated with a country’s GDP (the wealthier the nation, the more it spends on health care), yet even in this the United States remains an outlier (figure 3).

Is it because of spending on health care for people over the age of 75 (five times what we spend on people between the ages of 25 and 34)? In a word, no. Studies show this demographic trend explains only a small percentage of health expenditure growth.

Is it because of monstrous profits the health insurance companies are raking in? Probably not. It’s admittedly difficult to know for certain as not all insurance companies are publicly traded and therefore have balance sheets available for public review. But Aetna, one of the largest publicly traded health insurance companies in North America, reported a 2009 second quarter profit of $346.7 million, which, if projected out, predicts a yearly profit of around $1.3 billion from the approximately 19 million people they insure. If we assume their profit margin is average for their industry (even if untrue, it’s unlikely to be orders of magnitude different from the average), the total profit for all private health insurance companies in America, which insured 202 million people (2nd bullet point) in 2007, would come to approximately $13 billion per year. Total health care expenditures in 2007 were $2.2 trillion (see Table 1, page 3), which yields a private health care industry profit approximately 0.6% of total health care costs (though this analysis mixes data from different years, it can perhaps be permitted as the numbers aren’t likely different by any order of magnitude).

Is it because of health care fraud? Estimates of losses due to fraud range as high as 10% of all health care expenditures, but it’s hard to find hard data to back this up. Though some percentage of fraud almost certainly goes undetected, perhaps the best way to estimate how much money is lost due to fraud is by looking at how much the government actually recovers. In 2006, this was $2.2 billion, only 0.1% of $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year.

Is it due to pharmaceutical costs? In 2006, total expenditures on prescription drugs was approximately $216 billion (see Table 2, page 4). Though this amounted to 10% of the $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year and must therefore be considered significant, it still remains only a small percentage of total health care costs.

Is it from administrative costs? In 1999, total administrative costs were estimated to be $294 billion, a full 25% of the $1.2 trillion (Table 1) in total health care expenditures that year. This was a significant percentage in 1999 and it’s hard to imagine it’s shrunk to any significant degree since then.

In the end, though, what probably has contributed the greatest amount to the increase in health care spending in the U.S. are two things:

1. Technological innovation.

2. Overutilization of health care resources by both patients and health care providers themselves.

Technological innovation. Data that proves increasing health care costs are due mostly to technological innovation is surprisingly difficult to obtain, but estimates of the contribution to the rise in health care costs due to technological innovation range anywhere from 40% to 65% (Table 2, page 8). Though we mostly only have empirical data for this, several examples illustrate the principle. Heart attacks used to be treated with aspirin and prayer. Now they’re treated with drugs to control shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty or stenting, and coronary artery bypass grafting. You don’t have to be an economist to figure out which scenario ends up being more expensive. We may learn to perform these same procedures more cheaply over time (the same way we’ve figured out how to make computers cheaper) but as the cost per procedure decreases, the total amount spent on each procedure goes up because the number of procedures performed goes up. Laparoscopic cholecystectomy is 25% less than the price of an open cholecystectomy, but the rates of both have increased by 60%. As technological advances become more widely available they become more widely used, and one thing we’re great at doing in the United States is making technology available.

Overutilization of health care resources by both patients and health care providers themselves. We can easily define overutilization as the unnecessary consumption of health care resources. What’s not so easy is recognizing it. Every year from October through February the majority of patients who come into the Urgent Care Clinic at my hospital are, in my view, doing so unnecessarily. What are they coming in for? Colds. I can offer support, reassurance that nothing is seriously wrong, and advice about over-the-counter remedies—but none of these things will make them better faster (though I often am able to reduce their level of concern). Further, patients have a hard time believing the key to arriving at a correct diagnosis lies in history gathering and careful physical examination rather than technologically-based testing (not that the latter isn’t important—just less so than most patients believe). Just how much patient-driven overutilization costs the health care system is hard to pin down as we have mostly only anecdotal evidence as above.

Further, doctors often disagree among themselves about what constitutes unnecessary health care consumption. In his excellent article, “The Cost Conundrum,” Atul Gawande argues that regional variation in overutilization of health care resources by doctors best accounts for the regional variation in Medicare spending per person. He goes on to argue that if doctors could be motivated to rein in their overutilization in high-cost areas of the country, it would save Medicare enough money to keep it solvent for 50 years.

A reasonable approach. To get that to happen, however, we need to understand why doctors are overutilizing health care resources in the first place:

1. Judgment varies in cases where the medical literature is vague or unhelpful. When faced with diagnostic dilemmas or diseases for which standard treatments haven’t been established, a variation in practice invariably occurs. If a primary care doctor suspects her patient has an ulcer, does she treat herself empirically or refer to a gastroenterologist for an endoscopy? If certain “red flag” symptoms are present, most doctors would refer. If not, some would and some wouldn’t depending on their training and the intangible exercise of judgment.

2. Inexperience or poor judgment. More experienced physicians tend to rely on histories and physicals more than less experienced physicians and consequently order fewer and less expensive tests. Studies suggest primary care physicians spend less money on tests and procedures than their sub-specialty colleagues but obtain similar and sometimes even better outcomes.

3. Fear of being sued. This is especially common in Emergency Room settings, but extends to almost every area of medicine.

4. Patients tend to demand more testing rather than less. As noted above. And physicians often have difficulty refusing patient requests for many reasons (eg, wanting to please them, fear of missing a diagnosis and being sued, etc).

5. In many settings, overutilization makes doctors more money. There exists no reliable incentive for doctors to limit their spending unless their pay is capitated or they’re receiving a straight salary.

Gawande’s article implies there exists some level of utilization of health care resources that’s optimal: use too little and you get mistakes and missed diagnoses; use too much and excess money gets spent without improving outcomes, paradoxically sometimes resulting in outcomes that are actually worse (likely as a result of complications from all the extra testing and treatments).

How then can we get doctors to employ uniformly good judgment to order the right number of tests and treatments for each patient—the “sweet spot”—in order to yield the best outcomes with the lowest risk of complications? Not easily. There is, fortunately or unfortunately, an art to good health care resource utilization. Some doctors are more gifted at it than others. Some are more diligent about keeping current. Some care more about their patients. An explosion of studies of medical tests and treatments has occurred in the last several decades to help guide doctors in choosing the most effective, safest, and even cheapest ways to practice medicine, but the diffusion of this evidence-based medicine is a tricky business. Just because beta blockers, for example, have been shown to improve survival after heart attacks doesn’t mean every physician knows it or provides them. Data clearly show many don’t. How information spreads from the medical literature into medical practice is a subject worthy of an entire post unto itself. Getting it to happen uniformly has proven extremely difficult.

In summary, then, most of the increase in spending on health care seems to have come from technological innovation coupled with its overuse by doctors working in systems that motivate them to practice more medicine rather than better medicine, as well as patients who demand the former thinking it yields the latter.

But even if we could snap our fingers and magically eliminate all overutilization today, health care in the U.S. would still remain among the most expensive in the world, requiring us to ask next—

WHAT VALUE ARE WE GETTING FOR THE DOLLARS WE SPEND?

According to an article in the New England Journal of Medicine titled The Burden of Health Care Costs for Working Families—Implications for Reform, growth in health care spending “can be defined as affordable as long as the rising percentage of income devoted to health care does not reduce standards of living. When absolute increases in income cannot keep up with absolute increases in health care spending, health care growth can be paid for only by sacrificing consumption of goods and services not related to health care.” When would this ever be an acceptable state of affairs? Only when the incremental cost of health care buys equal or greater incremental value. If, for example, you were told that in the near future you’d be spending 60% of your income on health care but that as a result you’d enjoy, say, a 30% chance of living to the age of 250, perhaps you’d judge that 60% a small price to pay.

This, it seems to me, is what the debate on health care spending really needs to be about. Certainly we should work on ways to eliminate overutilization. But the real question isn’t what absolute amount of money is too much to spend on health care. The real question is what are we getting for the money we spend and is it worth what we have to give up?

People alarmed by the notion that as health care costs increase policymakers may decide to ration health care don’t realize that we’re already rationing at least some of it. It just doesn’t appear as if we are because we’re rationing it on a first-come-first-serve basis—leaving it at least partially up to chance rather than to policy, which we’re uncomfortable defining and enforcing. Thus we don’t realize the reason our 90 year-old father in Illinois can’t have the liver he needs is because a 14 year-old girl in Alaska got in line first (or maybe our father was in line first and gets it while the 14 year-old girl doesn’t). Given that most of us remain uncomfortable with the notion of rationing health care based on criteria like age or utility to society, as technological innovation continues to drive up health care spending, we very well may at some point have to make critical judgments about which medical innovations are worth our entire society sacrificing access to other goods and services (unless we’re so foolish as to repeat the critical mistake of believing we can keep borrowing money forever without ever having to pay it back).

So what value are we getting? It varies. The risk of dying from a heart attack has declined by 66% since 1950 as a result of technological innovation. Because cardiovascular disease ranks as the number one cause of death in the U.S. this would seem to rank high on the scale of value as it benefits a huge proportion of the population in an important way. As a result of advances in pharmacology, we can now treat depression, anxiety, and even psychosis far better than anyone could have imagined even as recently as the mid-1980′s (when Prozac was first released). Clearly, then, some increases in health care costs have yielded enormous value we wouldn’t want to give up.

But how do we decide whether we’re getting good value from new innovations? Scientific studies must prove the innovation (whether a new test or treatment) actually provides clinically significant benefit (Aricept is a good example of a drug that works but doesn’t provide great clinical benefit—demented patients score higher on tests of cognitive ability while on it but probably aren’t significantly more functional or significantly better able to remember their children compared to when they’re not). But comparative effectiveness studies are extremely costly, take a long time to complete, and can never be perfectly applied to every individual patient, all of which means some health care provider always has to apply good medical judgment to every patient problem.

Who’s best positioned to judge the value to society of the benefit of an innovation—that is, to decide if an innovation’s benefit justifies its cost? I would argue the group that ultimately pays for it: the American public. How the public’s views could be reconciled and then effectively communicated to policy makers efficiently enough to affect actual policy, however, lies far beyond the scope of this post (and perhaps anyone’s imagination).

THE PROBLEM OF ACCESS

A significant proportion of the population is uninsured or underinsured, limiting or eliminating their access to health care. As a result, this group finds the path of least (and cheapest) resistance—emergency rooms—which has significantly impaired the ability of our nation’s ER physicians to actually render timely emergency care. In addition, surveys suggest a looming primary care physician shortage relative to the demand for their services. In my view, this imbalance between supply and demand explains most of the poor customer service patients face in our system every day: long wait times for doctors’ appointments, long wait times in doctors’ offices once their appointment day arrives, then short times spent with doctors inside exam rooms, followed by difficulty reaching their doctors in between office visits, and finally delays in getting test results. This imbalance would likely only partially be alleviated by less health care overutilization by patients.

GUIDELINES FOR SOLUTIONS

As Freaknomics authors Steven Levitt and Stephen Dubner state, “If morality represents how people would like the world to work, then economics represents how it actually does work.” Capitalism is based on the principle of enlightened self-interest, a system that creates incentives to yield behavior that benefits both suppliers and consumers and thus society as a whole. But when incentives get out of whack, people begin to behave in ways that continue to benefit them often at the expense of others or even at their own expense down the road. Whatever changes we make to our health care system (and there’s always more than one way to skin a cat), we must be sure to align incentives so that the behavior that results in each part of the system contributes to its sustainability rather than its ruin.

Here then is a summary of what I consider the best recommendations I’ve come across to address the problems I’ve outlined above:

1. Change the way insurance companies think about doing business. Insurance companies have the same goal as all other businesses: maximize profits. And if a health insurance company is publicly traded and in your 401k portfolio, you want them to maximize profits, too. Unfortunately, the best way for them to do this is to deny their services to the very customers who pay for them. It’s harder for them to spread risk (the function of any insurance company) relative to say, a car insurance company, because far more people make health insurance claims than car insurance claims. It would seem, therefore, from a consumer perspective, the private health insurance model is fundamentally flawed. We need to create a disincentive for health insurance companies to deny claims (or, conversely, an extra incentive for them to pay them). Allowing and encouraging aross-state insurance competition would at least partially engage free market forces to drive down insurance premiums as well as open up new markets to local insurance companies, benefiting both insurance consumers and providers. With their customers now armed with the all-important power to go elsewhere, health insurance companies might come to view the quality with which they actually provide service to their customers (ie, the paying out of claims) as a way to retain and grow their business. For this to work, monopolies or near-monopolies must be disbanded or at the very least discouraged. Even if it does work, however, government will probably still have to tighten regulation of the health insurance industry to ensure some of the heinous abuses that are going on now stop (for example, insurance companies shouldn’t be allowed to stratify consumers into sub-groups based on age and increase premiums based on an older group’s higher average risk of illness because healthy older consumers then end up being penalized for their age rather than their behaviors). Karl Denninger suggests some intriguing ideas in a post on his blog about requiring insurance companies to offer identical rates to businesses and individuals as well as creating a mandatory “open enrollment” period in which participants could only opt in or out of a plan on a yearly basis. This would prevent individuals from only buying insurance when they got sick, eliminating the adverse selection problem that’s driven insurance companies to deny payment for pre-existing conditions. I would add that, however reimbursement rates to health care providers are determined in the future (again, an entire post unto itself), all health insurance plans, whether private or public, must reimburse health care providers by an equal percentage to eliminate the existence of “good” and “bad” insurance that’s currently responsible for motivating hospitals and doctors to limit or even deny service to the poor and which may be responsible for the same thing occurring to the elderly in the future (Medicare reimburses only slightly better than Medicaid). Finally, regarding the idea of a “public option” insurance plan open to all, I worry that if it’s significantly cheaper than private options while providing near-equal benefits the entire country will rush to it en masse, driving private insurance companies out of business and forcing us all to subsidize one another’s health care with higher taxes and fewer choices; yet at the same time if the cost to the consumer of a “public option” remains comparable to private options, the very people it’s meant to help won’t be able to afford it.

2. Motivate the population to engage in healthier lifestyles that have been proven to prevent disease. Prevention of disease probably saves money, though some have argued that living longer increases the likelihood of developing diseases that wouldn’t have otherwise occurred, leading to the overall consumption of more health care dollars (though even if that’s true, those extra years of life would be judged by most valuable enough to justify the extra cost. After all, the whole purpose of health care is to improve the quality and quantity of life, not save society money. Let’s not put the cart before the horse). However, the idea of preventing a potentially bad outcome sometime in the future is only weakly motivating psychologically, explaining why so many people have so much trouble getting themselves to exercise, eat right, lose weight, stop smoking, etc. The idea of financially rewarding desirable behavior and/or financially punishing undesirable behavior is highly controversial. Though I worry this kind of strategy risks the enacting of policies that may impinge on basic freedoms if taken too far, I’m not against thinking creatively about how we could leverage stronger motivational forces to help people achieve health goals they themselves want to achieve. After all, most obese people want to lose weight. Most smokers want to quit. They might be more successful if they could find more powerful motivation.

3. Decrease overutilization of health care resources by doctors. I’m in agreement with Gawande that finding ways to get doctors to stop overutilizing health care resources is a worthy goal that will significantly rein in costs, that it will require a willingness to experiment, and that it will take time. Further, I agree that focusing only on who pays for our health care (whether the public or private sectors) will fail to address the issue adequately. But how exactly can we motivate doctors, whose pens are responsible for most of the money spent on health care in this country, to focus on what’s truly best for their patients? The idea that external bodies—whether insurance companies or government panels—could be used to set standards of care doctors must follow in order to control costs strikes me as ludicrous. Such bodies have neither the training nor overriding concern for patients’ welfare to be trusted to make those judgments. Why else do we have doctors if not to employ their expertise to apply nuanced approaches to complex situations? As long as they work in a system free of incentives that compete with their duty to their patients, they remain in the best position to make decisions about what tests and treatments are worth a given patient’s consideration, as long as they’re careful to avoid overconfident paternalism (refusing to obtain a head CT for a headache might be overconfidently paternalistic; refusing to offer chemotherapy for a cold isn’t). So perhaps we should eliminate any financial incentive doctors have to care about anything but their patients’ welfare, meaning doctors’ salaries should be disconnected from the number of surgeries they perform and the number of tests they order, and should instead be set by market forces. This model already exists in academic health care centers and hasn’t seemed to promote shoddy care when doctors feel they’re being paid fairly. Doctors need to earn a good living to compensate for the years of training and massive amounts of debt they amass, but no financial incentive for practicing more medicine should be allowed to attach itself to that good living.

4. Decrease overutilization of health care resources by patients. This, it seems to me, requires at least three interventions:

* Making available the right resources for the right problems (so that patients aren’t going to the ER for colds, for example, but rather to their primary care physicians). This would require hitting the “sweet spot” with respect to the number of primary care physicians, best at front-line gatekeeping, not of health care spending as in the old HMO model, but of triage and treatment. It would also require a recalculating of reimbursement levels for primary care services relative to specialty services to encourage more medical students to go into primary care (the reverse of the alarming trend we’ve been seeing for the last decade).

* A massive effort to increase the health literacy of the general public to improve its ability to triage its own complaints (so patients don’t actually go anywhere for colds or demand MRIs of their backs when their trusted physicians tells them it’s just a strain). This might be best accomplished through a series of educational programs (though given that no one in the private sector has an incentive to fund such programs, it might actually be one of the few things the government should—we’d just need to study and compare different educational programs and methods to see which, if any, reduce unnecessary patient utilization without worsening outcomes and result in more health care savings than they cost).

* Redesigning insurance plans to make patients in some way more financially liable for their health care choices. We can’t have people going bankrupt due to illness, nor do we want people to underutilize health care resources (avoiding the ER when they have chest pain, for example), but neither can we continue to support a system in which patients are actually motivated to overutilize resources, as the current “pre-pay for everything” model does.

Florida Health Insurance Rate Hikes and Quotes

Florida Health Insurance Rate Hike

Florida Health insurance premiums have touched new heights! Every Floridian has the common knowledge that most annual health insurance contracts will endure a rate increase at the end of the year. This trend is not new and should be expected. Every time this issue pops up it seems as though the blame game starts. Floridians blame Health insurance companies; Health insurance companies blame Hospitals, Doctors and other medical care providers, Medical care providers blame inflation and politicians, well, we really don’t know what they do to help the issue… No one seems to be interested in finding the real cause of the health insurance premium rate increase. Most individuals, self employed, and small business owners have taken Florida Health Insurance Rate Hikes as the inevitable evil.

Hard Facts

What are various reports telling us? Why do Health insurance premium have annual rate increases?

Rate of inflation and heath insurance premium rate increase.

America’s health expenditure in the year 2004 has increased dramatically, it has increased more than three time the inflation rate. In this year the inflation rate was around 2.5% while the national health expenses were around 7.9%. The employer health insurance or group health insurance premium had increased approximately 7.8% in the year 2006, which is almost double the rate of inflation. In short, last year in 2006, the annual premiums of group health plan sponsored by an employer was around $4,250 for a single premium plan, while the average family premium was around $ 11,250 per year. This indicates that in the year 2006 the employer sponsored health insurance premium increased 7.7 percent. Taking the biggest hit were small businesses that had 0-24 employees. There health insurance premiums increased by nearly 10.4%

Employees are also not spared, in the year 2006 the employee also had to pay around $ 3,000 more in their contribution to employer’s sponsored health insurance plan in comparison to the previous year, 2005. Rate hikes have been in existence since the “Florida Health Insurance” plan started. In covering an entire family of four, a person will experience an increase in premium rate at every annual renewal. If they would have kept the record of their health insurance premium payments they will find that they are now paying around $ 1,100 more than they paid in the year 2000 for the same coverage and with the same company. The same item was found by the Health Research Educational Trust and the Kaiser Family Foundation in their survey report of the year 2000. They found out that the premiums of health insurance that is sponsored by the employer increases by around 4 times than the employee’s salary. This report also stated that since 2000 the contribution of employees in group health insurance sponsored by employer was increased by more than 143 percent.

One business man predicts that if nothing is done and the Health insurance premiums keep increasing that in the year 2008, the amount of health premium contribution to employer will surpass their profit. Professionals within and outside the field of Florida health insurance, think that the reason for increase in Florida health insurance premium rates are due to many factors, such as high administration expenditure, inflation, poor or bad management, increase in the cost of medical care, waste etc.

Florida health insurance rate hikes affect whom?

Rising rates of Florida health insurance generally affects most of the Floridians who live in our beautiful state. The highest affected individudals are the minimum wage and low wage workers. Recent drops in the renewal of health insurance are mostly from this low income group. They just can’t afford the high premiums of Florida health insurance. They are in the situation where they can not afford the medical care and they can not afford the medical insurance premiums that are assosiated with adequate coverage. Almost half of all Americans are of the opinion that they are more worried about the high health insurance rate and high cost of health care, over any other bill they have on a monthly basis. A survey also finds that around 42% of Americans can not afford the high cost of health care services. There is one very interesting study conducted by Harvard University researchers. They found out that 68% of people who filed bankruptcy covered themselves and their family by health insurance. Average out-of-pocket deductibles for people filed bankruptcy were around $ 12,000 per year. They also found some co-relation between medical expenditure and bankruptcy. A national survey also reports that main reason for people not to take health insurance is the high premium rate of health insurance.

How to reduce Florida’s high health insurance cost? Nobody knows for sure. There are different opinions and experts are not agreeing with each other. Health professionals believe that if we can raise the number of healthy people by improving the lifestyle and regular exercise, good diets etc. than naturally they will need less medical care services which decreases the demands of health care and hence the cost.( This year in Florida the smoking rate has increased by 21.7 percent) One Floridian sarcastically suggested that there are ‘highs’ and ‘lows’ in health care that are needed to reversed. That the state of Florida is to ‘high’ in cost of medical care compare to other States and ‘low’ in the quality of health care.

Florida Health insurance rate hike has attracted many frauds. These frauds float many bogus insurance companies and offer cheap health insurance rate which attract many people to them. These companies usually through assosiations that are based in other states.

Meanwhile reputable Florida health insurance companies provide different types of health insurance like employer sponsored group health insurance, small business health insurance, individual health insurance etc. to vast number of employees and their families. Still there are many people in Florida that lack any health coverage. Today the employer also has found it challenging to decide how to offer employer sponsored group health insurance to their employees, so that both of them arrive at some point of agreement.

Community Needs Health Assessment

In 2012 the Internal Revenue Service mandated that all non-profit hospitals undertake a community health needs assessment (CHNA) that year and every three years thereafter. Further, these hospitals need to file a report every year thereafter detailing the progress that the community is making towards meeting the indicated needs. This type of assessment is a prime example of primary prevention strategy in population health management. Primary prevention strategies focus on preventing the occurrence of diseases or strengthen the resistance to diseases by focusing on environmental factors generally.

I believe that it is very fortunate that non-profit hospitals are carrying out this activity in their communities. By assessing the needs of the community and by working with community groups to improve the health of the community great strides can be made in improving public health, a key determinant of one’s overall health. As stated on the Institute for Healthcare Improvement’s Blue Shirt Blog (CHNAs and Beyond: Hospitals and Community Health Improvement), “There is growing recognition that the social determinants of health – where we live, work, and play, the food we eat, the opportunities we have to work and exercise and live in safety – drive health outcomes. Of course, there is a large role for health care to play in delivering health care services, but it is indisputable that the foundation of a healthy life lies within the community. To manage true population health – that is, the health of a community – hospitals and health systems must partner with a broad spectrum of stakeholders who share ownership for improving health in our communities.” I believe that these types of community involvement will become increasingly important as reimbursement is driven by value.

Historically, healthcare providers have managed the health of individuals and local health departments have managed the community environment to promote healthy lives. Now, with the IRS requirement, the work of the two are beginning to overlap. Added to the recent connection of the two are local coalitions and community organizations, such as religious organizations.

The community in which I live provides an excellent example of the new interconnections of various organizations to collectively improve the health of the community. In 2014 nine non-profits, including three hospitals, in Kent County, Michigan conducted a CHNA of the county to assess the strengths and weaknesses of health in the county and to assess the community’s perceptions of the pressing health needs. The assessment concluded that the key areas of focus for improving the health of the community are:

· Mental health issues

· Poor nutrition and obesity

· Substance abuse

· Violence and safety

At this time the Kent County Health Department has begun developing a strategic plan for the community to address these issues. A wide variety of community groups have begun meeting monthly to form this strategic plan. There are four work groups, one for each of the key areas of focus. I am involved in the Substance Abuse workgroup as a representative of one of my clients, Kent Intermediate School District. Other members include a substance abuse prevention coalition, a Federally qualified health center, a substance abuse treatment center and the local YMCA, among others. The local hospitals are involved in other workgroups. One of the treatment group representatives is a co-chair of our group. The health department wants to be sure that the strategic plan is community driven.

At the first meeting the health department leadership stated that the strategic plan must be community driven. This is so in order that the various agencies in the community will buy into the strategic plan and will work cooperatively to provide the most effective prevention and treatment services without overlap. The dollars spent on services will be more effective if the various agencies work to enhance each others’ work, to the extent possible.

At this time the Substance Abuse work group is examining relevant data from the 2014 CHNA survey and from other local resources. The epidemiologist at the health department is reviewing relevant data with the group so that any decisions about the goals of the strategic plan will be data driven. Using data to make decisions is one of the keystones of the group’s operating principles. All objectives in the strategic plan will be specific, measurable, achievable, realistic and time-bound (SMART).

Once the strategic plan is finished, the groups will continue with implementation of the plan, evaluating the outcomes of the implementation and adjusting the plan as needed in light of evaluation. As one can see, the workgroups of the CHNA are following the classic Plan-Do-Check-Act process. This process has been shown time and again in many settings-healthcare, business, manufacturing, et al-to produce excellent outcomes when properly followed.

As noted above I recommend that healthcare providers become involved with community groups to apply population level health management strategies to improve the overall health of the community. One good area of involvement is the Community Health Needs Assessment project being implemented through the local health department and non-profit hospitals.

Optimum Health Nutrition is the Pathway to a Healthy Life

Whether you are overweight or not, it is important to know about health nutrition. It is true that the problems resulting from overweight abound in the country and that these problems are connected in one way or other to nutritional deficiencies and improper diets. While obese people need to correct their diets, it is best even for those who are not overweight to follow the rules of optimum health nutrition to ensure that they are able to maintain the weight and remain healthy.

In this connection child health nutrition is also equally important. As they are in the growing phase, children need sufficient nutrition and it is also important that they understand the value of right nutrition early enough so that they will make it a habit all through their lives.

The primary rule of optimum health nutrition is that you should be aware of what you are eating. Sometimes the calories in what you eat may be high, sometimes your meal timings may be wrong, or sometimes there could be too much of harmful things like caffeine in what you take. This eating pattern has to be changed both in the case of adults and children, to manage the best possible child health nutrition. It may be a bit difficult in the beginning but will become a habit very soon.

The fundamentals of optimum health nutrition is having plenty of liquids in the diet, eating lots of fresh fruits and vegetables, and taking some dietary supplements to compensate for what could be lacking in the diet. The benefits of this balanced nutrition will be better immunity for the body, more energy, freedom from many common ailments, and an overall feeling of well being. Nutritional supplements are considered a part of this nutrition as well as child health nutrition because human body can often lack in minerals like iron or calcium and taking of supplements becomes mandatory to rectify the imbalance.

Consulting your personal doctor will help you to get some guidance on how to manage optimum health nutrition. He will be able to provide you with detailed information on the matter and will also give you tips and tricks to manage it on a day to day basis. Nutritionists and dietitians can also be helpful in giving advice on the matter. Once a person develops an interest in physical fitness, it is best for him to consult an expert in the field and get the necessary direction to move ahead fast in the chosen path.