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.

CONCLUSION

Given the enormous complexity of the health care system, no single post could possibly address every problem that needs to be fixed. Significant issues not raised in this article include the challenges associated with rising drug costs, direct-to-consumer marketing of drugs, end-of-life care, sky-rocketing malpractice insurance costs, the lack of cost transparency that enables hospitals to paradoxically charge the uninsured more than the insured for the same care, extending health care insurance coverage to those who still don’t have it, improving administrative efficiency to reduce costs, the implementation of electronic medical records to reduce medical error, the financial burden of businesses being required to provide their employees with health insurance, and tort reform. All are profoundly interdependent, standing together like the proverbial house of cards. To attend to any one is to affect them all, which is why rushing through health care reform without careful contemplation risks unintended and potentially devastating consequences. Change does need to come, but if we don’t allow ourselves time to think through the problems clearly and cleverly and to implement solutions in a measured fashion, we risk bringing down that house of cards rather than cementing it.

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Importance of Health and Media Literacy

Although research suggests that children’s eating habits are formed even before they enter the classroom – children as young as two may already have dietary preferences based on their parents’ food choices – health education can play a vital role in helping establish lifelong healthy patterns early.

Research shows that health education has a positive impact on health behaviors as well as academic achievement, and that the most effective means of improving health literacy is ensuring that health education is included in curriculum at all levels of education.

U.S. schools educate 54 million students daily, and can provide not only an outlet to promote healthy behaviors for children and adolescents, but a place for them to engage in these behaviors, including eating healthy and participating in physical activity.

The U.S. is in great need of an improvement in health literacy. In a 2007 UNICEF study, our country ranked last out of 21 industrialized countries in overall child health and safety. Approximately one in five of our high school students are smokers, 80 percent of students do not eat the recommended five servings of vegetables and fruits per day, and more than 830,000 adolescents become pregnant each year. Approximately two thirds of the American population is estimated to be overweight or obese.

Furthermore, our understandings of health and health-related behaviors are often highly influenced by the media and media images – which can lead to inaccurate assumptions and negative health behaviors and attitudes.

The importance of media literacy as applies to health education

Self-esteem patterns also develop in early childhood, although they fluctuate as kids gain new experiences and perceptions. Because media messages can influence unhealthy behaviors, especially in adolescents, a comprehensive health education program must include not only health knowledge, but media literacy as it relates to psychological and physical health behaviors as well.

“To a large degree, our images of how to be comes from the media. They are [a] crucial shaper of the young lives we are striving to direct,” writes resource teacher Neil Andersen, editor of Mediacy, the Association for Media Literacy newsletter.

Media awareness, Andersen explains, can help teach students techniques to counter marketing programs that prey on their insecurities to promote negative behavior, can explode stereotypes and misconceptions, can facilitate positive attitudes and can help students learn how to absorb and question media-conveyed information.

Because our perceptions of ourselves and others develop early, and because we live in such a media-inundated world, it is important that we address the conflicts inherent in media values versus our own values with our children and adolescents first, in a factual, positive, and coherent way.

A comprehensive (age-appropriate) health program would therefore teach about these various issues at different stages of development. Pre-adolescence and adolescence are especially pertinent stages in an individual’s growth for discovering themselves and their place in the world, and it is during this vital time that media literacy is absolutely key to an influential and positive health program. Issues must be addressed that affect positive health behavior and attitudes, especially in teen girls, including:

• Digital manipulation of the body in advertisement – Almost all of what we see in media has been altered or digitally manipulated to some extent.

• Objectification of the body in media – Since the 1960s, sexualized images of men in the media have increased 55 percent, while sexualized images of women increased 89 percent, according to a University of Buffalo study. There are also 10 times more hypersexualized images of women than men and 11 times more non-sexualized images of men than of women.

• Average women versus models – Models today are 23 percent skinnier than the average woman, versus 9 percent skinnier in the 80s.

We live in a pop-culture that not only promotes a hyper-skinny-is-best attitude, but also discourages average or healthy body ideals and individuals from feeling good about simply pursuing healthy dietary choices – they feel they must resort instead to drastic (and quick) weight loss measures that put unhealthy stress on the body.

For example, a study released in 2006 by the University of Minnesota showed that 20 percent of females had used diet pills by the time they were 20 years old. The researchers also found that 62.7 percent of teenage females used “unhealthy weight control behaviors,” including the use of diet pills, laxatives, vomiting or skipping meals. The rates for teenage boys were half that of girls.

“These numbers are startling, and they tell us we need to do a better job of helping our daughters feel better about themselves and avoid unhealthy weight control behaviors,” concluded Professor Dianne Neumark-Sztainer. Over the five-year period that the study was conducted, moreover, researchers found that high school-aged females’ use of diet pills nearly doubled from 7.5 percent to 14.2 percent.

What teaching health and media literacy can do

When a colleague asked Doctor Caren Cooper, a Research Associate at the Cornell Lab of Ornithology, what the opposite of media was, she paused only briefly before answering, “Reality, of course.”

“We each need logic tools to realize that all media is a representation of reality – if we don’t bring this realization into our consciousness, we are apt to forget and let our own reality become distorted: fostering a culture of over-consumption, eating disorders, sexual violence, and climate change deniers,” she explained.

Teaching health education comprehensively in today’s rapidly changing world is important for fostering skills that students will carry with them for the rest of their lives, including:

• Developing positive body affirmations – Accepting their bodies, accepting other’s bodies, and showing respect for one another. A good exercise would be to have them write down good things about each other – without the words beautiful, or descriptions of size, as well as what they love about themselves – both physical and character traits.

• Understanding the importance of eating right – And that it’s not about “dieting.” Perhaps the biggest misconception is that as long as a person loses weight, it doesn’t matter what they eat. But it does, and being thin and being healthy are not the same thing. What you eat affects which diseases you may develop, regardless of your size, and diets that may help you lose weight (especially quickly) can be very harmful to your health over time.

• Understanding the importance of exercise – People who eat right but don’t exercise, for example, may technically be at a healthy weight, but their fitness level doesn’t match. This means that they may carry too much visceral (internal) fat and not enough muscle.

“Given the growing concern about obesity, it is important to let young people know that dieting and disordered eating behaviors can be counterproductive to weight management,” said researcher Dianne Neumark-Sztainer, a professor in the School of Public Health at the University of Minnesota. “Young people concerned about their weight should be provided support for healthful eating and physical activity behaviors that can be implemented on a long-term basis, and should be steered away from the use of unhealthy weight control practices.”

We must also teach them:

• How to reduce stress by engaging in activities and other outlets.

• The importance of sleep.

• The importance of vitamins.

• The importance of not always being “plugged in” – The natural environment has great health benefits, and too much technology may even be hazardous to our health.

“We’re surrounded by media images for such a large portion of our daily lives, it’s almost impossible to escape from it,” explained IFN representative Collete during an interview with EduCoup. “We get the majority of our information today through media, be it music, TV, the internet, advertising or magazines, so it really is incredibly important for us as a society to think about the messages we receive from the media critically.”

Decoding the overload of overbearing messages, then, is pertinent to the health of our minds and bodies, and teaching these skills early will help kids to practice and maintain life-lengthening and positive behaviors for the rest of their lives.

Seven Principles of Health for a Happy Long Life

We are very excited to impart to you the seven principles of health. We are looking at what can allow you to live a vibrant, happy, fulfilling, and healthy life. Of course, any of the information we will share with you is purely information, not medical advice. You are however, most welcome to go and seek your own medical advice, specifically from your own health professional. But this information tells about proven methods against the test of time.

So you’ve heard a lot of talk about my health and living as well as the seven principles of health. There are a lot of different thoughts about these principles. In general, we are talking about the health principles that really matter. Sure, there might be a couple which you could apply in your life, but these are certainly the most essential ones, those that you should definitely have to include in your lifestyle. In fact, the whole aim of this article is so that you can get a good appreciation of them, so that you too can live a healthy life for yourself.

We don’t want people to be sick, and we certainly don’t want people to be taking mostly prescription drugs when they don’t have to. Now, is there any reason why we think that way? Because there are a lot of natural health measures that you can do to prevent ailments in the first place. You can certainly take alternative health measures. For instance, you can take a look at your diet, consider what you really partake of everyday. Is it really toxic to your body, or is it good for you? Are you, unknowingly building things, or destroying things in your body? These are what the seven principles of health really build upon. It really gives you an idea that you can move forward in a positive way for your body, not in a negative way. If you stifle your own growth and the cleansing processes of your body that’s naturally set up, then you’re really preventing yourself from being healthy. We’re only going to touch the surface, only looking the concept in a general point of view because there is a vast information available out there for this topic, and there’s only so much that we could share. But we’re certainly excited to talk about these things, which you can apply in your everyday life. That’s the beauty of it. Helping you take care of yourself everyday using health principles.

WHOLE FOODS

Now let’s have a look at the first one, Whole Foods. These include natural whole foods, such as fruits, vegetables, grains, nuts, herbs, and other things which are naturally-grown and unprocessed. You can just literally grab them off the tray or consume them without any preparation at all. So how is it that for several millennia, people have looked after themselves and have not gotten themselves into the same troubles that we are into now? It seems like we’ve gotten a lot sicker and a lot more frail. That is because of the processed foods that we have been consuming nowadays. We’ve upset our balance of the natural foods that we should be partaking. If you take a look at the Western diet of today, we can see that we’re having way too much sugar, saturated fats, and we substitute water for sodas or colas. It’s just not right because our whole body is being thrown out of what it’s used to. Our bodies are expecting some sort of natural foods or sustenance to build and repair itself, and it’s not getting it most of the time. So if our bodies are getting something different from whole foods, we would be expecting different results of course. That is why people get a lot sicker nowadays, as opposed to those who lived many centuries ago. The processed food revolution of the last hundred years have really changed our health and brought it downhill. If we go back and embrace the principle of natural health food the way they used to do many, many years ago, where the people did not experience the health problems that we are experiencing today because they haven’t been laden with chemicals or impurities in their bodies, we could look at whole foods as real eye-openers. This is one of the basic principles of good health. Just like in taking fruits alone, with its healing properties and its ability to provide energy and vitality to our bodies. It is just a matter of taking in fruits, which will really help boost our energy to keep us healthy and stable. We won’t have to worry that much about viruses, bacteria, and other harmful agents that will enter our body, because they will be removed fairly quickly. Vegetables are also good food sources for they will strengthen our bodies and keep us strong and healthy. That’s especially true if you consume the ones with low GI, such as sweet potatoes, brown rice, beet roots, carrots, and the like. They will really help strengthen our bodies.

You know, it’s funny talking about whole foods, herbs, and spices. Take a look at the ancient methods that the Chinese used, or the old civilizations that used herbs to heal and help cure things. These are the reasons why they work. Certain herbs target specific parts of the body and there’s no reason why you can’t incorporate them into your diet as well. Any sort of research or understanding on Chinese medicine and the old ancient ways might reveal some of these herbs to you. It is most exciting that you can apply these in your life today, just as they did thousands of years ago, to treat the ailments that they had. Nuts and seeds, and other berries are really, really good for you. You can include them in your diets as whole foods to allow you to move forward as a healthy being.

Another of these which are really mentioned quite a lot is milk. There’s nothing wrong with milk. If it’s raw milk, it’s got all the nutrients which will be really good for your body. It’s full of protein, essential fats, and gives you strength.

The other food which I would like to mention is natural, raw honey. It is full of enzymes which can really boost immunity and it is antibacterial as well. It really stands out in giving good health and vitality, and you can even apply it to your external wound. If you ever get a cut or a lesion, honey is very good in healing the wound and keeping it clean as well. So, as you have read, there are heaps of natural and whole foods which can help you to build and maintain a healthy state. And, as they say, it is never too late to introduce them into your diet as well. That is, if you have been lacking them in the past. There’s no reason why you can’t introduce them now to help boost and change your lifestyle, allow it to be a healthy one instead.

WATER

Another principle of health is Water. Now as you know, we are all made up of more than 70% percent water, which is applied a lot in the building of new cells in our bodies. Water is an essential part of us and we should allow it to work with us. By not drinking water, you are allowing yourself a disservice and depriving your body of its proper health and nutrition. On a cellular level, you’ve got to consider that each cell needs the delivery as well as removal of certain nutrients. If you look at one cell, it might have a building block, which may need a certain nutrient to complete its function. However, it can only get there with enough water in the system. Now, electrically-charged water is certainly good for us because we are electrically-loaded beings. We survive on the electricity that’s running through our bodies. There are pulses inside us that run here and there in order to send electrical signals to and from the brain and the other parts of our bodies, such as cells, muscle groups, and others. So, in order for this to happen, water has to be an essential part of this process. Salted water is also very good. If you have the right amount of salt in your diet, then the delivery of nutrients and energy between the cells will be easier because you have the right charge.

Now, the secret to any good weight-loss or fitness program is that you drink sufficient amounts of water. The reason for this is because water can remove and flush out toxins and excess fat cells that are not needed by the body. Without the sufficient amount of water, your body won’t be able to carry out this process properly. So, as you can see, water is an essential part of the body’s system. Let’s maintain it and work towards building it up in the future. And we should drink at least eight glasses of water per day. If you’re a larger person carrying excess weight, however, then you might have to increase that to, say, 10-12 glasses per day. It depends on your body’s structure too. If you feel thirsty, your body is already starved of water, it’s already dehydrated. The idea, then, is to keep your water levels at a sufficient amount. A good indicator of this is the amount of sweat you produce and urine color. If your urine color is cloudy yellow, drink more water so it would be clearer and lighter in color. It’s a matter of maintaining that as well. So, water is an essential part.

AIR

Next is Air. It is very important to us, for the obvious reason that we need it when we breathe. But as you know, every cell in our bodies survive on oxygen, and we need to allow our bodies to breathe, every cell has to breathe. So with insufficient oxygen flowing through us, we will slowly get asphyxiated, and toxins won’t be released. So breathing sufficiently is very important. If you go outside, you can get electrically-charged air as well. It is very important. If you ever go to the beach, or if you’re around lightning strikes, you might find some ozone in the air. You can actually smell the ozone, especially if the lightning cracks around you. It is the same sort of smell when you go to the beach; it’s the ocean’s smell. That is extremely good for you, that is O3. It basically gives life and vitality, heightens your senses and energy levels, and it’s just really good for you. In fact, if you take five deep breaths for multiple times per day, it will allow your whole body to get rejuvenated. Deep breathing is great because it opens up your airways and it brings your oxygen levels up.

SUNSHINE

Next on the principles of health is Sunshine. Getting enough sunshine is crucial for health and vitality. Now I’m not saying that you should go get sunburned. What I’m saying is that you should spend about 20 to 30 minutes out in the sun every day. Now you should do that during the “safe-sun” hours, which is usually before ten in the morning and after two in the afternoon, if possible, because the sunlight between ten in the morning and two in the afternoon will probably get you burned a bit easier. So getting enough sunlight is very important. If you allow the sunshine to penetrate or to be absorbed more by your body, and expose more of your skin to the sun, then you will get energy a lot quicker.

Now we all know that we get Vitamin D from the sun, and it is very important for your health and the recognition of your nutrients to break down and be accepted into your body. It’s almost like a gateway, wherein Vitamin D allows your minerals to be absorbed properly into your body. So if you don’t have Vitamin D, then this process can’t work properly. You will find that you’ve got a lot of deficiencies as well. You might also be worried about skin cancer. Well, we’ve got different thoughts on that. I don’t believe we could get skin cancer from the sun itself, I believe it’s more on the toxins and the impurities in your skin which are actually burned and which turn against you. So, how come we haven’t got problems on melanoma and skin cancer before, and then all of a sudden, within the last 50 years, we’re now having melanomas? Does that mean that the sun has changed? Or is it because we, and our diets, have changed? I would think it’s probably more so because of the latter. Our diets have certainly changed. The amount of chemicals and radiation inside of our bodies are the problem. The sunlight actually reacts to these chemicals and impurities in the body, under the skin, which actually turned against us. So, a little bit of sunlight every day, in the safe-sun periods, away from being sunburned, will actually do more good than harm. It is very important that everyone will recognize that sunshine is a vital part of health.

If you’re not feeling very well, if you’re feeling ill and off-color, well, go for a walk in the sun. Expose your body to the sun and get 20-30 minutes of sunshine. You will feel the energy levels radiating out of you, you’ll feel a lot better afterwards, and it is amazing to see that it actually does you good. If it can make plants grow, make living things flourish, then it is bound to do you good as well. So, don’t just listen to those who are saying that the sun will do you a lot of damage, when it can actually do you a lot of good. It is a matter of managing and doing it properly. Sunlight is very important for health.

EXERCISE and MOVEMENT

Another principle is exercise and movement. This is number five out of the seven principles. You need to move; you need to exercise. When I say exercise, I’m not saying you need to be running a marathon. I’m saying you can get out and do some walking, some stretching of your body, and doing some general movements through your whole body. This will do you more good than harm. In fact, we’ve got these things called lymph nodes right through our whole body, and they are not circulated from the heart. The lymph nodes’ fluids are not circulated because they are being pumped by the heart. Instead, they are circulated because of your movements and exercise, as well as through massage. So it is very important that you keep this happening always. Otherwise, they’ll build up, which will cause problems in your lymph glands. It is also important that you keep flushing them and moving them about because they will be stagnant and clogged with toxins.

I’m sure everyone can move, walk around, do some stretching, and just generally get up and about. This means that you could get out for 20-30 minutes each day, and it will be a lot easier if you’ve got a routine related to this. If you haven’t got one, well, anytime you get out, you could stretch and move your whole body. It will do you a lot good. So, once again, if you’re feeling under the weather, it’s important that you actually do move. It is important that you do stretch and get the fluids within your body moving so you will be cleansed and the toxins will be removed from your body. Some areas of your body need movement to flush the toxins out and if you’re not moving, they’ll be just sitting there and become stagnant. If you see people with a lot of fluid in their legs, especially elderly people, they’re just sitting there, the fluid builds up in their legs. Now if you want to keep your body parts vital and alive, it’s important that you move about certain parts so that new blood can circulate through your body and through the parts that aren’t moving much. So, to flush out the toxins in your body, movement and exercise is very important.

REGENERATION

Number six on the principles of health is regeneration. This encompasses rest, relaxation, recuperation, and regeneration. That means that everyone needs to rest. Everyone needs to lay flat and lay their heads down, parallel to the earth’s surface. This is so that you can rest, regenerate, and recuperate. Our bodies are designed so that the magnetism and the electrical charge can actually flow properly. To do this, you need to be lying down. Have you ever worked too hard and think you just need to lie down? That is the feeling you get when your body’s saying, enough is enough, and that it needs to regenerate. It’s like a good battery: it can only go for so long before it depletes. If it’s lost, you can’t function properly. And that’s why regeneration is important.

Now part of regeneration means that when you do lie down and close your eyes, it does not mean that you get some smartphone or iPhone app or other electronic device and try and fiddle with that because your brain is another organ that needs rest and recuperation as well. And that means shutting down the conscious and allowing it to go into regeneration mode. When you lay down and you rest, that means resting your brain as well. And it’s very important that you do have periods to rest every day, wherein you do not do anything except sit and reflect. Rest and recuperate. That means mentally as well. Otherwise, you will suffer from some sort of burnout later on, and we don’t want that. If you’re feeling ill, then rest and relaxation will surely bring you back to health. When you’re feeling overtired, rest and sleep will allow your body to regenerate and your brain to kick back into gear and reset itself every night. And it’s important that you get at least six hours of sleep every day. If you’re not, then you’re really cheating yourself, and later on you’re going to pay the price and you’re going to really suffer mentally about this. So it’s important that you get about six to eight hours of sleep per day. Rest and recuperate, lie flat down, and allow your body to kick-start itself and regenerate. That’s what the cells need: regeneration.

RELATIONSHIPS and PASSION

The last of the seven principles of health is the Relationship and Passion. Everyone needs to have good relationships, whether it’s with a passerby, you treat them very well, as you would want to be treated. This is also for the long-term relationships with your friends and loved ones as well. You want to have great relationships with positive people to uplift and build. You don’t want bad relationships that would tear down and destroy you. And that also pertains to your general health as well. Positive relationships build, while bad relationships destroy and tear down. It is important that you recognize this, because if you are around toxic people, who constantly batter and bring you down, then it would bring your health down as well. So, it’s a matter of minimizing the time and exposure to toxic people, and building up and allowing positive people to give you more influence instead.

The other point there is passion. If you are passionate about something, then you will want to spend more time doing what you are passionate about. That includes your favorite hobby, sport, friends and family. You would want to spend time with these people or these passions. There is a saying that, without hope, we have nothing. Now, we have to have something in our lives which we would want to strive for, get up every day for, move forward for, and that is our passion. Whether it’s strictly for a relationship, for building ourselves up, some sort of hobby, or sport that we really enjoy, it’s important that we have hope in our lives. After all, if we don’t have a passion, then what are we here for? What are we really doing?

In the passion, in the relationship, it is also a passion towards your Creator. God is a great avenue to rely on. You might think I am getting a bit spiritual, but it is true. Everyone needs a relationship with the Creator. Everyone needs a relationship with spiritualism in their own life. You need to reach out and realize it. It’s not all about you. You are part of the greater creation and you are part of a greater being and a greater purpose. To have a great relationship with your family and friends is great, but to have a relationship with the Creator is even better. To have a passion, a drive about these things, an inner drive wherein you know where you are going and what you are doing, that’s very important. Spiritualism is very important. Being passionate about something else other than yourself is also very important.

Okay, so we’ve discussed on Whole Foods, Water, Air, Sunshine, Exercise and Movement, Regeneration, Relationships and Passion. If you tie all of these things together, and you live by these, and you use them as a driving force that you want to include in your life, then you will have a great and healthy life. And that’s what this is all about, health and living, to do things the right way. You will certainly function properly and healthfully as well. So, are you including all of these in your life? I hope so.

I hope you’ve got the opportunity to actually reach out and allow others to help you as well. By helping others and allowing others to help you, by embracing these seven principles of health, you will live a much richer life. It is all about reaching out and helping others through these as well, not just yourself. So if you’ve got the opportunity to help, whether it is just for yourself or for others, this is what it’s all about.

It’s very exciting to talk about these principles of health, for you will realize which one of them is lacking in your life. And then it’ll be up to you to go work on these things. If you’re not eating enough whole foods, or drinking enough water, if you’re not getting out and enjoying enough fresh air in your life, open your house up and let the air just breeze right through your house. Get out in the sunshine and enjoy that. Go for a walk, enjoy your rest time, allow your brain to regenerate and recuperate. Put enough effort into relationships and passion and you’ll feel the fulfilment of life right through your whole being.

A Quick And Easy Method To Get A Cheap Health Insurance Quote

Healthcare charges are through the roof, and consequently so are health care insurance rates. So how can you get a low cost health insurance plan? The following article demonstrates how to get an inexpensive health plan with a top-rated company the easy way…

Major Medical Plans

Major medical health plans, also referred to as catastrophic health plans, are the lowest cost non-comprehensive health plans. These plans have a high insurance deductible (the total amount you pay toward your claim before your insurance kicks in), plus affordable premiums.

Major medical plans only cover hospital fees like surgical treatments, hospital stays, X-rays, and diagnostic tests. They don’t cover visits to your physician or prescription drug costs.

If you are relatively young, in good health, hardly ever visit your physician, do not use high-priced prescription drugs, and are on a tight budget, these plans could be just the ticket for you.

Comprehensive Medical Plans

The lowest priced comprehensive health insurance plans are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service plans (POSs).

HMOs

HMOs are the lowest priced of the comprehensive health insurance plans. They supply health care via a network of doctors and medical facilities picked by the HMO.

When you visit your physician you are required to pay a small copayment, commonly $10 to $15. The upside of these plans is there are no deductibles to pay for, and you do not need to spend your time filling in health insurance forms like you will with conventional medical plans.

Your primary care doctor is going to either treat you or else refer you to a specialist whenever you need medical help. You are not covered if you decide to see a doctor who isn’t a part of your network.

Preferred Provider Organizations

PPOs cost slightly more than HMOs, and they are the most popular health care insurance plans because they allow for more flexibility than HMOs. Like an HMO, you will need to select your health care provider from an approved directory of doctors.

Your copayment for every doctor visit is about the same as an HMO’s, there are no forms to fill in, and no deductibles to pay. However there are no gatekeepers with a PPO so you can go to a medical specialist without first seeing your primary care doctor.

Point of Service Plans

POS plans are more expensive than HMOs and PPOs, but deliver the greatest flexibility of the three medical insurance plans. They supply heath care treatment by way of a health provider network, but you also have the option of seeing a physician of your choosing.

Copayments for doctor visits within the network tend to be about the same as they are for HMOs and PPOs, and you will be reimbursed up to 80% for your out-of-network visits to the doctor after you pay the deductible.

Low-cost Health Insurance Quotes

The simplest way to get inexpensive health insurance quotes is to pay a visit to an insurance comparison internet site. At these sites you’ll receive price quotes from health insurance companies competing for your business.

When you visit one of these sites you will be asked to complete an easy questionnaire with details about yourself and your health. After you submit the questionnaire you will begin to receive quotes from several top-rated companies. You may then examine your quotes in the privacy of your home, and choose the plan with the cheapest quote which fits your needs.

Do Patient CoPayments Produce Better Health Outcomes?

Rising healthcare expenses in developed nations have made it difficult for many people to seek the medical care they need. From 2011 to 2012, healthcare costs in the United States increased 3.7 percent, costing consumers $2.8 trillion, or $8,915 each person. Some analysts estimated the latest figures to be closer to $3.8 trillion with government spending at a whopping 17.9% of GDP.

Australians spent $132.4 billion on healthcare, while people in the UK spent £24.85 billion. Government expenditure in both these countries sit at between 9-10% of GDP, which may seem more manageable compared to the US, however healthcare leaders in both these countries are taking a firm view of preventing any escalation of these percentages.

With the high costs of health care around the world, many stakeholders wonder if introducing or adjusting copayments will produce better health outcomes.

The topic is being hotly debated in Australia, where co-payments for General Practitioner visits have been proposed by the Liberal government in its most recent Federal Budget announcement. However, while healthcare stakeholders seem obsessed with costs, the question is do copayments actually improve health outcomes for these nations?

Copayments and Health Outcomes: Is There a Correlation?

Researchers have studied the effects copayments have on health outcomes for many years. The RAND experiment was conducted in the 1970s, but a recent report was prepared for the Kaiser Family Foundation. Jonathan Gruber, Ph.D., from Massachusetts Institute of Technology, examined the RAND experiment and brought to light that high copayments may reduce public health care utilisation, but may not affect their health outcomes. The study followed a broad cross section of people who were rich, poor, sick, healthy, adults, and children.

In a 2010 study published in The New England Journal of Medicine, researchers found the opposite was true for senior citizens. Those that had higher copayments reduced their number of doctor visits. This worsened their illnesses, which resulted in costly hospital care. This was especially true for those who had a low income, lower education, and chronic disease.

Whilst intuitively we may feel that copayments in healthcare may make us value our own health more, these two studies signal that this is not necessarily the case. In fact, higher copays can lead to additional healthcare costs to the health system due to indirectly increasing hospital stays for the elderly.

Those that are not senior citizens may be able to avoid hospital care because they don’t have a high medical risk and hence be less adversely affected by such copayments. In making any conclusions about introducing copayment, we could also take learnings from the relationship of health outcomes and which is another consideration when studying the effects of copayments.

Copayments for Medication: Does It Affect Medication Adherence and Health Outcomes?

A study funded by the Commonwealth Fund, found that when US based insurance company Pitney Bowes eliminated copayments for people with diabetes and vascular disease, medication adherence improved by 2.8%. Another study examining the effects of reducing or eliminating medication copayments found that adherence increased by 3.8% for people taking medications for diabetes, high blood pressure, high cholesterol, and congestive heart failure.

Considering medication adherence is important when trying to determine if copayments affect health outcomes. When people take medications as prescribed to prevent or treat illness and disease, they have better health outcomes. A literature review published in the U.S. National Institutes of Health’s National Library of Medicine (MIH/NLM) explains that many patients with high cost sharing ended up with a decline in medication adherence, and in turn, poorer health outcomes.

The correlation of medication adherence and health outcomes is found in other parts of the world as well. According to the Australian Prescriber, increasing copayments affects patients who have a low income and chronic medical conditions requiring multiple medications. When they can’t afford their medications, they either reduce or stop many of their medications, which can lead to serious health problems. These patients then need more doctor visits and in severe cases, hospital care.

Medication copayments effects on health outcomes were also found in a Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial. Nonwhite heart attack patients were more likely to take their medications following a heart attack if copayments were eliminated, which decreased their readmission rates significantly.

Health Outcomes Based on Medication vs. Medical Care?

Is it possible that expensive copayments may only affect health outcomes for people who are on multiple medications? The research seems to reflect that may be the case. People seem to go to the doctor less when copayments are high, but it seems that senior citizens are the ones that end up suffering the poorer health outcomes due to the lack of regular medical supervision and possibly poor medication adherence. The decreased medication adherence seems to have the biggest effect on health outcomes, especially when the prescription drugs are for the treatment of an illness or disease. It seems as though the elderly and people needing multiple medications will benefit the most from lower copayments in terms of better health outcomes.

Should copayments for visiting doctors be introduced in countries like Australia?

My thoughts are therefore, if copayments are going to be introduced for visiting a doctor, we should provide exemptions for those that cannot afford it, e.g. senior citizens and pensioners. We also need to look at putting a cap on copayments, so that those with chronic conditions genuinely requiring multiple medical visits are not ridiculously out-of-pocket.

Human nature is such that when we receive something for free, it is often not valued appropriately. I do think that placing a nominal price on our healthcare is a good thing in Australia, as I do believe that the vast majority of people will appreciate the generally good quality of care we receive in this country.

Copayments are appropriate for those that can afford it, and should not be at the expense of those who cannot. This supports the premise of egalitarian healthcare systems that Australia aspires to continue.

Here is where we need to be careful about how we debate the issue, and not place the issue in one generalised basket. I am very much in favour of healthcare system that is adaptive and customised to individual needs, and this is what we should aspire to do in our discussions about copayments.

What do you think?

Energesse is a specialist consulting firm for the Healthcare & Wellness industry. We consult to hospitals, biotech, pharmaceutical, health insurance companies, not-for-profits, wellness businesses and governments on solving their big challenges through strategizing, introducing cutting-edge solutions and technologies as well as delivering improved health and economic outcomes.

Significance of Public Health for the Health Sector of Pakistan

Pakistan, as we all know is a developing country and we are currently going through lots of challenges and issues. These issues vary from terrorism, energy crisis and poverty to poorly developed education and health systems.

Health, which is the basic human right, has unfortunately not been our priority. This statement is supported by the fact that according to the World Health Organization 2013 statistics, the health system of our country is currently ranked as 122 out of 190 countries. This is a very alarming figure especially considering the fact that one of our neighboring countries Iran is ranked as 93 in the same list. This particular figure definitely draws our attention towards issues in the health sector which we are currently facing.

Firstly, we need to understand what is meant by health system. The health system does not only include hospitals and clinicians. It rather involves anything and everything which directly or indirectly affects the health of populations. The health system is composed of hospitals, environment, urban planning, food, nutrition and numerous other sectors which are directly or indirectly involved in determining the health of populations. What this means is the fact that by merely building new hospitals and producing more clinicians, we cannot make our health systems better. There has to be a multi-sectoral approach which needs to involve all the components of the health system.

The next and the most important factor to consider is that we need to reshape our current health system model. If we want to improve the health status of our population, we have to base our health system on the preventive approach rather than the curative approach, that is, we need to promote public health. The time has now come where we must come out of the downstream (clinician) approach and move towards upstream (public health) approach. This is the only way by which we can survive and can make the health status of our population better. We should reconsider and amend our current health policy and we will have to develop it on the model of public health. This is the need of the time and if we want to survive and compete with the world, we must follow the public health model instead of the clinician’s model.

At present, there are only a handful of institutes all across the country which offer professional studies in the field of preventive medicine. In order to produce skilled public health specialists, we need to have many academic institutes whose focus is solely on preventive medicine. The government should also support such institutes and provide appropriate funding to them, so that they can eventually become stable and sustainable. Thus the only way to make our health sector prosper is by working on public health. If this is not done on a priority basis and we are not able to shift our focus from clinicians model to public health model, it is feared that we will lag far behind as far as the health sector is concerned.

Health and Your Inner Teacher

When you travel the halls of your memory, who do you remember as your most influential teachers? How did these teachers influence your life and change it for the better? Great teachers spark more than math, literature, or science in your life. They spark something else as well, something deeper and long-lasting that stays with you. As an individual living your life, you have another teacher you may not have touched on in your memory. That teacher is you! When you’re trying to get healthy and support your body and mind better, your inner teacher is key toward achieving what you want.

Health involves learning. You learn about your body and which lifestyle habits foster balanced health, versus which habits derail health. But you also learn something else. You learn about yourself as a person, how you face challenges, and which obstacles are blocking your road to health. The journey toward health involves more than regimens for diet, exercise, and sleep. The journey is unique to who you are and where you’re at in life too.

Bringing out your inner teacher to learn about your health isn’t always easy. Everyone wants to believe they are perfectly healthy, and sometimes facing the reality that your health needs more support can be challenging. It means admitting that you’re not perfect and that you still have more to learn. It takes knowing that supplements, medications, or doctor’s visits alone can’t keep you healthy. You as a person are an essential part of your health, and acknowledging this fact takes honesty and courage.

When you call forth your inner teacher in an open and honest way, you can explore your physical and mental-emotional health through a unique lens. You can ask yourself if there are societal and personal expectations that are burdening you and blocking your health. You can explore whether some part of your past unfairly has a hold on your health and who you are today. You can explore your relationships with yourself and other people to see whether they are supporting or hindering health. You can also notice how you manage stress and emotions and whether your current approach could use some adjustment for better health.

Good teachers both challenge you out of your comfort zone and patiently support you through the discomfort that can result. Getting healthier can feel strange and uncomfortable at times. The body and mind are used to doing what they always do—in other words, homeostasis or equilibrium. They will maintain states of health, but they also maintain states of unbalanced health. To get healthy, your inner teacher has to push you beyond comfortably unhealthy habits. On the other hand, your inner teacher also has to patiently help you through these potentially awkward transition periods and regularly remind you: “I can do this!”

What steps have you taken lately to bring out your inner teacher on the road to better health? If you feel that it’s been a while since you’ve listened to your inner teacher, that’s okay. He or she is always there and you can turn to that side of yourself when your health feels neglected or stuck. Remember to give your inner teacher the same respect that you would any other great teacher in your life.

As you head into the autumn season, a period of time that is infused with transition in the air around you, encourage your inner teacher by asking yourself the following questions:

1) What are current strengths in my health?

2) What are some weaker points of my health that require more attention and learning?

3) Without focusing too much on the past or the future, what steps can I take today toward better health?

4) What are my obstacles to health in the present moment?

5) How can I create space in my life for my inner teacher to express itself and help me with health?

As you ask yourself these questions, you’ll find that your body and mind naturally know which direction to go in—if you listen to them. By paying attention to your inner teacher, you’ll learn new things about your health and how better to support it. And you’ll enter your own hall of fame of great teachers.

What Can You Do With A Health Promotion Degree?

Health promotion aims to enrich the health of individuals through awareness in environmental factors, education, and behavior. Health promotion can be described as a way to positively guide the psychological, environmental, biological, and physical health of individuals and communities. Health promotion can include behavior, skills, attitudes, and health knowledge. By being educated on this topic, individuals can help prevent disease and increase their quality of life through behavior changes. Through education and prevention, individuals may reduce financial costs for themselves, employers, and what insurance companies might spend for medical treatment.

Individuals working in the health field may be responsible to administer the following tasks: construct social marketing and mass media campaigns, organize community action, conduct research for scholarly articles, and assess, develop and implement health education programs. Workers may also be responsible for writing grants and advocating for community needs.

Those considering earning a degree in health promotion should be interested in issues in fitness and wellness and the health of others. They should want to advocate for healthy living and come up with creative ideas for healthy lifestyle changes. A career in promoting healthy living could include helping individuals manage and treat stress, physical inactivity, substance and alcohol abuse, insufficient nutrition, and unsafe sexual activity. In this field, workers may be responsible for offering behavior change suggestions, and setting realistic goals for their clients, and following up on medical screenings and appointments. Students may be suited for careers in hospital programs, fitness programs, government and nonprofit health agencies, hospitals, and schools. Those with a degree in health promotion may also be qualified to be a personal health coach, work in a health and wellness center, or in a pregnancy facility or program.

Promoting health goes a step beyond health education by requiring intensive-specific study. Students may take classes in stress management, anatomy and physiology, and health management. Those in this field may be employed through schools by teaching a health class, or working in health services to promote a healthy lifestyle for students. Colleges may hire individuals with a degree in health promotion to teach a course, promote community organizing, or train peers in disease prevention. Individuals deciding to pursue a health degree may take foundational courses such as nutrition, psychology, biology, and statistics. Through studying health education and promotion, participants should be able to help other improve their own wellness in order to live a longer and more satisfying life.

Government-Run Health Care Cannot Work!

It would be GREAT if our government could successfully manage American’s Health Care needs. I would be all in if the government guaranteed good health for everyone, and they were even remotely qualified to make such a guarantee. The truth is we all face different health issues at different ages. The recent health issues I faced were handled by doctors, hospitals, and nurses. I had made poor food and exercise choices and suffered a stroke because of those poor choices. Health professionals guided my recovery and no person from the government or from the health insurance company ever visited me while I was hospitalized or in recovery. The task of defining what a health care system looks should be determined by you and your doctor, not the health insurance companies, government, and lawyers that are currently the face of our health system.

The government, i.e. politicians, claim we all need health insurance, but who will pay for the premiums, co-pays, and not-covered illnesses and accidents? Will everyone enjoy good health because they a health insurance policy? Will everyone’s health insurance be free since the ACA has mandated everyone own a policy regardless of their individual health needs or financial position? Basically, at gun-point, ‘rhetorically speaking,’ the government is forcing everyone to purchase health insurance? If legal, where will the money come from to pay the health insurance premiums, or the health professionals who diagnose our illnesses? Where will the money come from to finance the equipment needed to diagnose and/or treat our health needs? Where will the money come from for the buildings needed to house the equipment and the facilities for the infirmed? These are just a few of the questions I have for those who profess the government should be responsible for our individual health needs. The last time I checked the government didn’t have any money to pay for anything unless they taxed you and me to get it.

What, you mean we already have a government-run health care system? Is that why my taxes are so high? Is that why I read in the newspaper recently that the government is paying millions of dollars every year for fraudulent health care claims? Is that why doctors are leaving the government-run health system for the more efficient private practices? Is that why the government is making criminals out of Americans who would rather not purchase health insurance policies? Golly, I hope the government does a better job of running Obamacare than they did managing health needs for our veterans through the Veterans Administration.

Health Savings Accounts – An American Innovation in Health Insurance

INTRODUCTON – The term “health insurance” is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government. Synonyms for this usage include “health coverage,” “health care coverage” and “health benefits” and “medical insurance.” In a more technical sense, the term is used to describe any form of insurance that provides protection against injury or illness.

In America, the health insurance industry has changed rapidly during the last few decades. In the 1970’s most people who had health insurance had indemnity insurance. Indemnity insurance is often called fee-forservice. It is the traditional health insurance in which the medical provider (usually a doctor or hospital) is paid a fee for each service provided to the patient covered under the policy. An important category associated with the indemnity plans is that of consumer driven health care (CDHC). Consumer-directed health plans allow individuals and families to have greater control over their health care, including when and how they access care, what types of care they receive and how much they spend on health care services.

These plans are however associated with higher deductibles that the insured have to pay from their pocket before they can claim insurance money. Consumer driven health care plans include Health Reimbursement Plans (HRAs), Flexible Spending Accounts (FSAs), high deductible health plans (HDHps), Archer Medical Savings Accounts (MSAs) and Health Savings Accounts (HSAs). Of these, the Health Savings Accounts are the most recent and they have witnessed rapid growth during the last decade.

WHAT IS A HEALTH SAVINGS ACCOUNT?

A Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States. The funds contributed to the account are not subject to federal income tax at the time of deposit. These may be used to pay for qualified medical expenses at any time without federal tax liability.

Another feature is that the funds contributed to Health Savings Account roll over and accumulate year over year if not spent. These can be withdrawn by the employees at the time of retirement without any tax liabilities. Withdrawals for qualified expenses and interest earned are also not subject to federal income taxes. According to the U.S. Treasury Office, ‘A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care.

HSA’s enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.’ Thus the Health Savings Account is an effort to increase the efficiency of the American health care system and to encourage people to be more responsible and prudent towards their health care needs. It falls in the category of consumer driven health care plans.

Origin of Health Savings Account

The Health Savings Account was established under the Medicare Prescription Drug, Improvement, and Modernization Act passed by the U.S. Congress in June 2003, by the Senate in July 2003 and signed by President Bush on December 8, 2003.

Eligibility –

The following individuals are eligible to open a Health Savings Account –

– Those who are covered by a High Deductible Health Plan (HDHP).
– Those not covered by other health insurance plans.
– Those not enrolled in Medicare4.

Also there are no income limits on who may contribute to an HAS and there is no requirement of having earned income to contribute to an HAS. However HAS’s can’t be set up by those who are dependent on someone else’s tax return. Also HSA’s cannot be set up independently by children.

What is a High Deductible Health plan (HDHP)?

Enrollment in a High Deductible Health Plan (HDHP) is a necessary qualification for anyone wishing to open a Health Savings Account. In fact the HDHPs got a boost by the Medicare Modernization Act which introduced the HSAs. A High Deductible Health Plan is a health insurance plan which has a certain deductible threshold. This limit must be crossed before the insured person can claim insurance money. It does not cover first dollar medical expenses. So an individual has to himself pay the initial expenses that are called out-of-pocket costs.

In a number of HDHPs costs of immunization and preventive health care are excluded from the deductible which means that the individual is reimbursed for them. HDHPs can be taken both by individuals (self employed as well as employed) and employers. In 2008, HDHPs are being offered by insurance companies in America with deductibles ranging from a minimum of $1,100 for Self and $2,200 for Self and Family coverage. The maximum amount out-of-pocket limits for HDHPs is $5,600 for self and $11,200 for Self and Family enrollment. These deductible limits are called IRS limits as they are set by the Internal Revenue Service (IRS). In HDHPs the relation between the deductibles and the premium paid by the insured is inversely propotional i.e. higher the deductible, lower the premium and vice versa. The major purported advantages of HDHPs are that they will a) lower health care costs by causing patients to be more cost-conscious, and b) make insurance premiums more affordable for the uninsured. The logic is that when the patients are fully covered (i.e. have health plans with low deductibles), they tend to be less health conscious and also less cost conscious when going for treatment.

Opening a Health Savings Account

An individual can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. However not all insurance companies offer HSAqualified health insurance plans so it is important to use an insurance company that offers this type of qualified insurance plan. The employer may also set up a plan for the employees. However, the account is always owned by the individual. Direct online enrollment in HSA-qualified health insurance is available in all states except Hawaii, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Vermont and Washington.

Contributions to the Health Savings Account

Contributions to HSAs can be made by an individual who owns the account, by an employer or by any other person. When made by the employer, the contribution is not included in the income of the employee. When made by an employee, it is treated as exempted from federal tax. For 2008, the maximum amount that can be contributed (and deducted) to an HSA from all sources is:
$2,900 (self-only coverage)
$5,800 (family coverage)

These limits are set by the U.S. Congress through statutes and they are indexed annually for inflation. For individuals above 55 years of age, there is a special catch up provision that allows them to deposit additional $800 for 2008 and $900 for 2009. The actual maximum amount an individual can contribute also depends on the number of months he is covered by an HDHP (pro-rated basis) as of the first day of a month. For eg If you have family HDHP coverage from January 1,2008 until June 30, 2008, then cease having HDHP coverage, you are allowed an HSA contribution of 6/12 of $5,800, or $2,900 for 2008. If you have family HDHP coverage from January 1,2008 until June 30, 2008, and have self-only HDHP coverage from July 1, 2008 to December 31, 2008, you are allowed an HSA contribution of 6/12 x $5,800 plus 6/12 of $2,900, or $4,350 for 2008. If an individual opens an HDHP on the first day of a month, then he can contribute to HSA on the first day itself. However, if he/she opens an account on any other day than the first, then he can contribute to the HSA from the next month onwards. Contributions can be made as late as April 15 of the following year. Contributions to the HSA in excess of the contribution limits must be withdrawn by the individual or be subject to an excise tax. The individual must pay income tax on the excess withdrawn amount.

Contributions by the Employer

The employer can make contributions to the employee’s HAS account under a salary reduction plan known as Section 125 plan. It is also called a cafeteria plan. The contributions made under the cafeteria plan are made on a pre-tax basis i.e. they are excluded from the employee’s income. The employer must make the contribution on a comparable basis. Comparable contributions are contributions to all HSAs of an employer which are 1) the same amount or 2) the same percentage of the annual deductible. However, part time employees who work for less than 30 hours a week can be treated separately. The employer can also categorize employees into those who opt for self coverage only and those who opt for a family coverage. The employer can automatically make contributions to the HSAs on the behalf of the employee unless the employee specifically chooses not to have such contributions by the employer.

Withdrawals from the HSAs

The HSA is owned by the employee and he/she can make qualified expenses from it whenever required. He/She also decides how much to contribute to it, how much to withdraw for qualified expenses, which company will hold the account and what type of investments will be made to grow the account. Another feature is that the funds remain in the account and role over from year to year. There are no use it or lose it rules. The HSA participants do not have to obtain advance approval from their HSA trustee or their medical insurer to withdraw funds, and the funds are not subject to income taxation if made for ‘qualified medical expenses’. Qualified medical expenses include costs for services and items covered by the health plan but subject to cost sharing such as a deductible and coinsurance, or co-payments, as well as many other expenses not covered under medical plans, such as dental, vision and chiropractic care; durable medical equipment such as eyeglasses and hearing aids; and transportation expenses related to medical care. Nonprescription, over-the-counter medications are also eligible. However, qualified medical expense must be incurred on or after the HSA was established.

Tax free distributions can be taken from the HSA for the qualified medical expenses of the person covered by the HDHP, the spouse (even if not covered) of the individual and any dependent (even if not covered) of the individual.12 The HSA account can also be used to pay previous year’s qualified expenses subject to the condition that those expenses were incurred after the HSA was set up. The individual must preserve the receipts for expenses met from the HSA as they may be needed to prove that the withdrawals from the HSA were made for qualified medical expenses and not otherwise used. Also the individual may have to produce the receipts before the insurance company to prove that the deductible limit was met. If a withdrawal is made for unqualified medical expenses, then the amount withdrawn is considered taxable (it is added to the individuals income) and is also subject to an additional 10 percent penalty. Normally the money also cannot be used for paying medical insurance premiums. However, in certain circumstances, exceptions are allowed.

These are –

1) to pay for any health plan coverage while receiving federal or state unemployment benefits.
2) COBRA continuation coverage after leaving employment with a company that offers health insurance coverage.
3) Qualified long-term care insurance.
4) Medicare premiums and out-of-pocket expenses, including deductibles, co-pays, and coinsurance for: Part A (hospital and inpatient services), Part B (physician and outpatient services), Part C (Medicare HMO and PPO plans) and Part D (prescription drugs).

However, if an individual dies, becomes disabled or reaches the age of 65, then withdrawals from the Health Savings Account are considered exempted from income tax and additional 10 percent penalty irrespective of the purpose for which those withdrawals are made. There are different methods through which funds can be withdrawn from the HSAs. Some HSAs provide account holders with debit cards, some with cheques and some have options for a reimbursement process similar to medical insurance.

Growth of HSAs

Ever since the Health Savings Accounts came into being in January 2004, there has been a phenomenal growth in their numbers. From around 1 million enrollees in March 2005, the number has grown to 6.1 million enrollees in January 2008.14 This represents an increase of 1.6 million since January 2007, 2.9 million since January 2006 and 5.1 million since March 2005. This growth has been visible across all segments. However, the growth in large groups and small groups has been much higher than in the individual category. According to the projections made by the U.S. Treasury Department, the number of HSA policy holders will increase to 14 million by 2010. These 14 million policies will provide cover to 25 to 30 million U.S. citizens.

In the Individual Market, 1.5 million people were covered by HSA/HDHPs purchased as on January 2008. Based on the number of covered lives, 27 percent of newly purchased individual policies (defined as those purchased during the most recent full month or quarter) were enrolled in HSA/HDHP coverage. In the small group market, enrollment stood at 1.8 million as of January 2008. In this group 31 percent of all new enrollments were in the HSA/HDHP category. The large group category had the largest enrollment with 2.8 million enrollees as of January 2008. In this category, six percent of all new enrollments were in the HSA/HDHP category.

Benefits of HSAs

The proponents of HSAs envisage a number of benefits from them. First and foremost it is believed that as they have a high deductible threshold, the insured will be more health conscious. Also they will be more cost conscious. The high deductibles will encourage people to be more careful about their health and health care expenses and will make them shop for bargains and be more vigilant against excesses in the health care industry. This, it is believed, will reduce the growing cost of health care and increase the efficiency of the health care system in the United States. HSA-eligible plans typically provide enrollee decision support tools that include, to some extent, information on the cost of health care services and the quality of health care providers. Experts suggest that reliable information about the cost of particular health care services and the quality of specific health care providers would help enrollees become more actively engaged in making health care purchasing decisions. These tools may be provided by health insurance carriers to all health insurance plan enrollees, but are likely to be more important to enrollees of HSA-eligible plans who have a greater financial incentive to make informed decisions about the quality and costs of health care providers and services.

It is believed that lower premiums associated with HSAs/HDHPs will enable more people to enroll for medical insurance. This will mean that lower income groups who do not have access to medicare will be able to open HSAs. No doubt higher deductibles are associated with HSA eligible HDHPs, but it is estimated that tax savings under HSAs and lower premiums will make them less expensive than other insurance plans. The funds put in the HSA can be rolled over from year to year. There are no use it or lose it rules. This leads to a growth in savings of the account holder. The funds can be accumulated tax free for future medical expenses if the holder so desires. Also the savings in the HSA can be grown through investments.

The nature of such investments is decided by the insured. The earnings on savings in the HSA are also exempt from income tax. The holder can withdraw his savings in the HSA after turning 65 years old without paying any taxes or penalties. The account holder has complete control over his/her account. He/She is the owner of the account right from its inception. A person can withdraw money as and when required without any gatekeeper. Also the owner decides how much to put in his/her account, how much to spend and how much to save for the future. The HSAs are portable in nature. This means that if the holder changes his/her job, becomes unemployed or moves to another location, he/she can still retain the account.

Also if the account holder so desires he can transfer his Health Saving Account from one managing agency to another. Thus portability is an advantage of HSAs. Another advantage is that most HSA plans provide first-dollar coverage for preventive care. This is true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. It was also true of over half (59%) of the plans which were purchased by individuals.

All of the plans offering first-dollar preventive care benefits included annual physicals, immunizations, well-baby and wellchild care, mammograms and Pap tests; 90% included prostate cancer screenings and 80% included colon cancer screenings. Some analysts believe that HSAs are more beneficial for the young and healthy as they do not have to pay frequent out of pocket costs. On the other hand, they have to pay lower premiums for HDHPs which help them meet unforeseen contingencies.

Health Savings Accounts are also advantageous for the employers. The benefits of choosing a health Savings Account over a traditional health insurance plan can directly affect the bottom line of an employer’s benefit budget. For instance Health Savings Accounts are dependent on a high deductible insurance policy, which lowers the premiums of the employee’s plan. Also all contributions to the Health Savings Account are pre-tax, thus lowering the gross payroll and reducing the amount of taxes the employer must pay.

Criticism of HSAs

The opponents of Health Savings Accounts contend that they would do more harm than good to America’s health insurance system. Some consumer organizations, such as Consumers Union, and many medical organizations, such as the American Public Health Association, have rejected HSAs because, in their opinion, they benefit only healthy, younger people and make the health care system more expensive for everyone else. According to Stanford economist Victor Fuchs, “The main effect of putting more of it on the consumer is to reduce the social redistributive element of insurance.

Some others believe that HSAs remove healthy people from the insurance pool and it makes premiums rise for everyone left. HSAs encourage people to look out for themselves more and spread the risk around less. Another concern is that the money people save in HSAs will be inadequate. Some people believe that HSAs do not allow for enough savings to cover costs. Even the person who contributes the maximum and never takes any money out would not be able to cover health care costs in retirement if inflation continues in the health care industry.

Opponents of HSAs, also include distinguished figures like state Insurance Commissioner John Garamendi, who called them a “dangerous prescription” that will destabilize the health insurance marketplace and make things even worse for the uninsured. Another criticism is that they benefit the rich more than the poor. Those who earn more will be able to get bigger tax breaks than those who earn less. Critics point out that higher deductibles along with insurance premiums will take away a large share of the earnings of the low income groups. Also lower income groups will not benefit substantially from tax breaks as they are already paying little or no taxes. On the other hand tax breaks on savings in HSAs and on further income from those HSA savings will cost billions of dollars of tax money to the exchequer.

The Treasury Department has estimated HSAs would cost the government $156 billion over a decade. Critics say that this could rise substantially. Several surveys have been conducted regarding the efficacy of the HSAs and some have found that the account holders are not particularly satisfied with the HSA scheme and many are even ignorant about the working of the HSAs. One such survey conducted in 2007 of American employees by the human resources consulting firm Towers Perrin showed satisfaction with account based health plans (ABHPs) was low. People were not happy with them in general compared with people with more traditional health care. Respondants said they were not comfortable with the risk and did not understand how it works.

According to the Commonwealth Fund, early experience with HAS eligible high-deductible health plans reveals low satisfaction, high out of- pocket costs, and cost-related access problems. Another survey conducted with the Employee Benefits Research Institute found that people enrolled in HSA-eligible high-deductible health plans were much less satisfied with many aspects of their health care than adults in more comprehensive plans People in these plans allocate substantial amounts of income to their health care, especially those who have poorer health or lower incomes. The survey also found that adults in high-deductible health plans are far more likely to delay or avoid getting needed care, or to skip medications, because of the cost. Problems are particularly pronounced among those with poorer health or lower incomes.

Political leaders have also been vocal about their criticism of the HSAs. Congressman John Conyers, Jr. issued the following statement criticizing the HSAs “The President’s health care plan is not about covering the uninsured, making health insurance affordable, or even driving down the cost of health care. Its real purpose is to make it easier for businesses to dump their health insurance burden onto workers, give tax breaks to the wealthy, and boost the profits of banks and financial brokers. The health care policies concocted at the behest of special interests do nothing to help the average American. In many cases, they can make health care even more inaccessible.” In fact a report of the U.S. governments Accountability office, published on April 1, 2008 says that the rate of enrollment in the HSAs is greater for higher income individuals than for lower income ones.

A study titled “Health Savings Accounts and High Deductible Health Plans: Are They an Option for Low-Income Families? By Catherine Hoffman and Jennifer Tolbert which was sponsored by the Kaiser Family Foundation reported the following key findings regarding the HSAs:

a) Premiums for HSA-qualified health plans may be lower than for traditional insurance, but these plans shift more of the financial risk to individuals and families through higher deductibles.
b) Premiums and out-of-pocket costs for HSA-qualified health plans would consume a substantial portion of a low-income family’s budget.
c) Most low-income individuals and families do not face high enough tax liability to benefit in a significant way from tax deductions associated with HSAs.
d) People with chronic conditions, disabilities, and others with high cost medical needs may face even greater out-of-pocket costs under HSA-qualified health plans.
e) Cost-sharing reduces the use of health care, especially primary and preventive services, and low-income individuals and those who are sicker are particularly sensitive to cost-sharing increases.
f) Health savings accounts and high deductible plans are unlikely to substantially increase health insurance coverage among the uninsured.

Choosing a Health Plan

Despite the advantages offered by the HSA, it may not be suitable for everyone. While choosing an insurance plan, an individual must consider the following factors:

1. The premiums to be paid.
2. Coverage/benefits available under the scheme.
3. Various exclusions and limitations.
4. Portability.
5. Out-of-pocket costs like coinsurance, co-pays, and deductibles.
6. Access to doctors, hospitals, and other providers.
7. How much and sometimes how one pays for care.
8. Any existing health issue or physical disability.
9. Type of tax savings available.

The plan you choose should according to your requirements and financial ability.

BIBLIOGRAPHY

1 Questions and Answers about Health Insurance- A Consumer Guide’ published jointly by the Agency for Healthcare Research and Quality (AHRQ)and America’s Health Insurance Plans (AHIP)
2 http://www.en.wikipedia.org/wiki/Health_savings_account
3 2002 AHIP Survey of Health Insurance Plans
4 “How High Is Too High? Implications of High-Deductible Health Plans” Davis, Karen; Michelle Doty and Alice Ho. The Commonwealth Fund, April 2005
5 http://www.fdhc.state.fl.us/schs/pdf/hsa_tri-fold_brochure.pdf
6 HSA/HDHP CENSUS 2008 by Hannah Yoo, Center for Policy and Research, America’s Health Insurance Plans
7″HEALTH SAVINGS ACCOUNTS Early Enrollee Experiences with Accounts and Eligible Health Plans” John E. Dicken Director, Health Care.
8 Thomas Wilder and Hannah Yoo, “A Survey of Preventive Benefits in Health Savings Account (HSA)Plans, July 2007,” America’s Health Insurance Plans, November 2007
9 Gladwell, Malcolm, “The Moral Hazard Myth”, The New Yorker (29-08-2005)
10 2008 Benchmark Survey HAS Bank
11. Employer Health Benefits 2007 Annual Survey, Kaiser Family Foundation
12. Health Savings Accounts and High Deductible Health Plans: Are They An Option for Low-Income Families?Catherine Hoffman and Jennifer Tolbert for Kaiser Family Foundation, October 2006
13. Medicare Prescription Drug, Improvement, and Modernization Act of 2003

I am an ardent reader who also loves to write as well. I am an MBA with specialization in finance.