Health Care Plans Quickly and Easily Explained Part 1

If you have started you your research into what the best health car plan for you and your family is then you’ve more then likely hit a few roadblocks. Don’t be alarmed, that’s actually a common occurrence for many consumers looking to find the best deal for their health care insurance needs, especially when trying to determine the best health care coverage for your loved ones. You may have noticed that some health care plans differ in the amount of coverage they provide, the amount you pay as a premium, your co-payment amounts and even your deductible amounts.

One of the major differences in many of today’s health care plans is what services and medical treatments they will cover, especially with many health insurance companies taking the high road of offering better benefits towards routine treatments and preventive health checkups in an effort to reduce illnesses, major medical emergencies and hospitalization requirements. You can expect a medical pre-screening or physical along with a lengthy health questionnaire in order to identify any current or pre-existing medical conditions that could eliminate your potential to receive health insurance.

If you do have medical issues to include diabetes, hepatitis or any other major medical condition and are still granted the right to receive health insurance coverage then be fully prepared to pay a higher premium for your health insurance. This is also true if you are labeled or identified as a smoker.

Health care plans are broken down into two different categories of coverage; the indemnity healthcare plan sometimes referred to as fee-for -service and the more common managed health care plan. Both have their pluses and minuses, as you will soon discover.

The indemnity plan offers the most flexibility because it allows you the privilege of choosing or using your own or preferred health care professional, whether they are a doctor, physician or medical specialist. You also have the right to pretty much go to any hospital or clinic to seek medical treatment and referrals are not necessary to seek out specialists in certain medical fields. However as with most things in life, the costs justify the means and an indemnity health plan is no different. The deductibles on these plans are higher then a managed health care plan and more money comes out of the patients pocket (sometimes upfront) based on letting you use a doctor that is outside the health network your health insurance provider has established.

Although most prescriptions and treatments are covered under these plans you can expect to pay for other medical procedures that seem rather mundane and routine such as a physical.

This ends part 1of our 2-part article on health care plans quickly and easily explained series of articles. Be on the lookout for our next article which will focus on the more common managed health care plans which includes Health Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Point of service Plans (POS).

Do You Make These Mistakes in Choosing Your Health Care Plans

There are a lot of details to consider when you are choosing a health care plan, whether it’s one offered through your employer or one you buy on your own. No matter what age you are, your health should be a primary concern, although young people often act as if they will live forever and sometimes postpone making health care decisions.

Here is a list of common mistakes that people make all the time when choosing a health care plan. They are in no particular order, and all are important to consider, carefully and completely. If you are not conversant with all the terminology or are finding it difficult to make the decisions, you should ask for help from a neutral third-party such as family member or friend. Don’t ask a health insurance company unless you want to hear a sales pitch!

Common mistakes
- You don’t check out your doctor, or any others – Although some healthcare plans require you to use a physician in their own network, other plans are more inviting. If you already have a physician, and are buying your own insurance, check with the doctor to see what plans he is a member of. If you do have to choose a new doctor, you should look into the health plan doctors’ credentials by contacting the AMA.

- You forget “location, location, location” – The location of your doctor or clinic, and the travel time required, are other factors you should consider when considering health care plans. Find out where the doctor is located and also look into the regular and emergency hours of the facility.

- You don’t consider specialists – If you already need specialist care, or think you may need to in the future, you need to know the health care plan’s procedures on using them. Some plans require you to contact a primary care physician, while others allow you to make specialist appointments directly.

- You don’t consider your own specialist – You should definitely find out if your current specialist is in the health care plan you are considering. If not, perhaps your specialist can refer you to one who is.

- You forget to check the policy on “pre-existing conditions” – Even though this should be a “no-brainer,” people forget to ask about the policies on pre-existing conditions. Coverage for pre-existing conditions varies widely among health plans. Some exclude them entirely, and will not even consider coverage, while others cover them fully. Many health care plans fall somewhere in the middle, offering coverage after a certain amount of time, or for a certain amount of time or expense. Rules promulgated by the Health Insurance Portability and Accountability Act guarantees you coverage for your pre-existing conditions if you join a new group plan offered by your employer after being insured the previous year. Do your research to make sure you know what your policy covers.

Less common oversights
- You don’t ask about physicals and health screenings – Again, it seems an obvious thing to ask, but if you appreciate getting regular physicals and health screenings you should ensure that they are covered. Most “managed care” plans do cover these types of procedures, usually on an annual basis, but there are some plans that do not cover them. If you have children, make sure to ask if “well baby” check-ups, physicals and immunizations are covered.

- You forget about additional services – Everything, from prescription drug coverage to mental health care, is an important consideration. You need to consider which of the various additional services that you may need are, in fact, covered when you are comparing health care plans. Other examples of these additional services that may be important to you are drug and alcohol counseling and treatment, home health care, nursing home or extended care, hospices, experimental treatments, alternative and complementary medicine, chiropractic care and physical therapy.

Bottom line considerations
- You don’t price things out correctly – Once you know what you want in your health care plan you need to compare costs, and you need to do it right, which means covering all the bases. You will need to know exactly what deductibles must be paid first before the health care plan coverage starts paying, and don’t forget to ask if the deductible needs to be met before certain services can be utilized. Find out about “out of network” charges if you anticipate having to go beyond your plan facilities or physicians. Finally, there are co-payment, cap amounts and total-care limits you need to know about. Some plans have lifetime limits, some have lifetime and annual limits, and others have mixed formulas for making this determination. Get all the facts.

- You don’t check the exclusions – If you don’t read the exclusions list, you will not know what is not covered. You need to see if any condition you currently have, or that you expect to contract in the future, is included. This is an important bottom-line consideration since, if you don’t get this settled and dealt with up front, you will likely spend a great deal of money down the line to treat excluded conditions.

It is a difficult thing to look at your health in a dispassionate, dollar-oriented way, but that’s life. As we age, more of our energy goes into thinking and planning against death and disability, but the subject need not be morbid or depressing. Do your best to get a health care plan that covers what your particular needs are, and remind yourself that you are worth the trouble – and the expense.

Medicare.com provides coverage information that is simple and straightforward. We give you the medicare basics, as well as provide practical information and tools for making informed decisions on your coverage needs.

Why the Obama Health Care Plan is Important

The Obama health care plan, whether you believe in all of it’s tenets or not, is one that at least gets us pointed in a direction. Putting it another way, the cost of inaction will drive us even further into a country that cares more about political lobbying than the real needs of our people. It’s important to really understand what Mr. Obama’s health care plan is about in order to make a fair judgment one way or the other.

I’m a small business owner without the comforts of a big company medical plan. Fortunately for me, my wife IS employed by a large company and we DO have decent, not great health care. But, what if neither of us had this luxury? I was with two of the largest technology companies in the world, Oracle and HP, but was eventually laid off some years back, like so many other unfortunate individuals.

The Obama health care plan is trying to fix some serious flaws in it’s system. I recently visited a terminally ill college friend of mine. He was initially denied even a visit to the hospital. He finally got approval and was diagnosed as having only a few weeks left to live. His family then lobbied to have insurance over his cost of home care to live out his short life in dignity and quality. Now, it has been proven over and over again that home care for the terminally ill saves money and provides for a much better quality of life than a hospital stay. Why deny someone this option?

We all recognize that employers are struggling during these tough economic times. And, costs of hospitalizations and the like have increased over 100%, but consider the options for no health care reform. It will continue to be pushed out to the next generation and then the next. The answer then would be to burden our children and our children’s children. Is this the legacy we want to leave behind?

The Obama health care plan really is about a few key tenets. Probably the most important component to me is that of preventative health care. This hot button is debated amongst so many people. On the one hand, the bloated medical systems want to care for you only after you come down with an illness. Wouldn’t it make more sense to prevent the illness in the first place? Things such as quality screening to make sure you are exercising regularly, eating properly, etc. Wouldn’t you rather stay well, rather than go to the hospital when you’re sick?

Another key component of the health care plan is around the use of technology. The US is one of the few developed countries that really are a leader in this area. How is it possible that we cannot figure out how to fix our antiquated medical reporting system? Transportable medical records would reduce errors, increase efficiency and save all of us money! Why can’t the doctor that I saw for my dislocated shoulder 10 years ago be able to easily share that information to my new doctor who’s treating me for arthritis? An efficient sharing and collaborating of medical records would allow for a better health experience for the patient.

Finally, competition in insurance coverage is a serious flaw in our system today. The Obama health care plan is target to correct this problem. Why should a few insurance companies make the bulk of the money? If there is little to no competition, there’s no way to know whether you are getting insurance at competitive rates and whether the quality of care is at its highest.

The real answer to the debate on the Obama health care plan, though, is the cost of INACTION. We all know that the health care system is severely broken. Let’s make a step forward, instead of lobbying to take two steps backward.

Health Care Planning

One of the foremost challenges faced by health care professionals is to formulate a well-devised, well-thought out plan for assisting both the patients as well as the health care givers. Care planning is an essential part of health care, but is often misunderstood or regarded as a waste of time. Without a specific document delineating the plan of care, important issues are likely to be neglected. Care planning provides a sort of ‘road map’, to guide all who are involved with the patient’s/resident’s care. The health care plan has long been associated with nursing; however, all health care professionals need to be assisted in the care giving process. In today’s world, highly expensive Health Insurance policies are not viable for most individuals. Therefore, the government needs to play a crucial part in ensuring that ‘health care’ is impartially and effectively provided to all citizens.

At the beginning of the 20th century, a new concept, the concept of ‘health promotion’ began to take shape. It was realized that public health had neglected the citizen as an individual and that the state had a direct responsibility for the health of the individual. Consequently, in addition to.disease control activities, one more goal was added to health-care planning- health promotion of individuals. It was initiated as personal health services such as mother and child health services, mental health and rehabilitation services. C.E.A.Winslow, one of the leading figures in the history of public health in 1920, defined public health care planning as: ‘the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort.’

The first step in the health care planning program is accurate and comprehensive assessment. Once the initial assessment is completed, a problem list should be generated. This may be as simple as a list of medical diagnosis. The problem list may include family/relationship problems,which are affecting the parent’s overall well-being.

Following the problem list, the health-care professional must ask,’ will I be able to solve this problem?If yes, then the goal of the health-care professional must be to solve that particular problem. Moreover, this goal should be specific, measurable and attainable. The approaches towards achieving that goal should also be measurable and realistic. An example of a problem that could improve, would be health-care deficit related to hip fracture. With rehab, this problem is likely to resolve.

In case a medical problem is irreversible- such as diabetes- the next step would be to eliminate further complications or possible health deterioration. In the case of such health problems, the goal should be to retain the level of health at an optimum level.

In case of an illness, where further health complications are inevitable, the goal should be to improve the quality of life. It is note-worthy that for all medical problems, approaches must be ordered by the physician. The health care planning process is never completed until the patient is discharged from the current care setting. Periodic schedule re-evaluation is also necessary once the patient is discharged.

In the final analysis, the ultimate purpose of the health care plan is to guide all who are involved in the care of the patient and to provide appropriate treatment.

Obama’s Health Care Plan: The Truth Is Finally Revealed on Obama Care

Recently, the mandates and explanations have begun to trickle out on president Obama’s Health Care Plan. One of the proposed mandates of the plan was the ability to keep our current health insurance plans with our employers. It was said Medicare would pretty much be left untouched. However, new figures just released show that more than four million American Medicare recipients will be forced to switch prescription drug plans under Obama care. And, that number is expected to grow much higher.

What Happened to ‘Gandfather’?

Also part of Obama’s health care plan was the proposed ‘grandfathering’ in of many current health care plans. Remember? The president himself promised us that we could keep our current coverage under Obama care. However, if you read the fine print of the bill, it turns out that more than 72 percent of employers that offer insurance expect to lose their “grandfather” status.

At the time of the writing of this article, health insurance rates are going up with no end in sight under Obama’s health care plan. One of the most absurd concepts of this government intrusion into our personal freedoms, is the redefining of ‘childhood’ age by our government.

Childhood to Age 26.

For the purposes of Obama’s health care plan, childhood is now defined as a dependent under the age of 26 years of age. This provision alone is estimated to cost tax payers in the hundreds of millions of dollars. As it is, our children may need this coverage more than ever anyway. Universities are now announcing that they can no longer offer basic health insurance to students under Obama’s health care plan rules and regulations.

As more knowledge and information comes to light about this government monstrosity, we are made even more aware of the true costs in terms of dollars and cents. This is the true cost of government intrusion into our personal affairs. It seems more and more obvious that we do not need the government to dictate to us our health care coverage.

While it may be true that health care reform is needed, it seems to me, that private industry if left to it’s own devices, could do a much better and cheaper job of it. One of the main hindrances to cheaper health insurance for individuals, for example, is the fact that insurance companies are prohibited in many cases from selling health insurance policies across state lines. This prohibits competition and therefore causes premiums to rise.

Healthcare at any cost?

As the news continues to be made more public about Obama’s health care plan, it becomes more evident that America can not afford it. Slowly, the American public has begun to see this also. Those of us who have been watching this development carefully have realised this for a long time. And, we remain hopeful that a more reasonable and affordable solution can and will be found to healthcare.

David Chenault is a Freelance writer specializing in Alternative Health & Wellness. David writes for many other Health & Wellness sites and has several works published throughout the Internet in the Alternative Health & Wellness, Nutrition, and Disease Prevention Niches.

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.