Hiring a Home Health Care Employee

Providing the primary care for an elder loved one can be difficult. When you cannot deliver all the elder care yourself and support from friends, family, and community organizations is not enough, it may be useful to hire a home health care worker. He or she can offer care from a few hours a week to 24 hours a day, and can provide many other helpful services. Types of in-home health care services include:

General Health Management like administration of medication or other medical treatments
Personal care such as bathing, oral hygiene, dressing, and shaving
Nutrition help like preparing meals, assisting eating, and grocery shopping
Homemaking services including laundry, dishwashing, and light housework
Companionship for example reading to the senior or taking them on walks
Recruiting and Interviewing Applicants
There are many avenues for hiring a home health care employee. Generally, home health care workers can be hired directly or through an agency. Home health care agencies often have a staff that includes social workers and nurses that will manage your care. However hiring an independent home health care worker is generally more cost effective, it will also give you more control over the type of care you receive.

Senior home care workers should be carefully screened for proper training, qualifications, and temperament. Fully discuss the needs of the elder care recipient during an interview with a prospective home health care employee. There should be a written copy the job description and the type of experience you are looking for.

References

Have applicants fill out an employment form that includes the following information:

Full name
Address
Phone number
Date of birth
Social Security number
Educational background
Work history
Before hiring, you should ask to see the senior home care worker’s licenses and certificates, if applicable, and personal identification including their social security card, driver’s license, or photo ID.
References should be checked out thoroughly. Prospective employees should provide the employer with names, dates of employment, and phone numbers of previous employers and how to contact them. It is best to talk directly to previous employers, rather than just to accept letters of recommendations. Also ask the applicant to provide or sign off on conducting a criminal background check

Special Points to Consider

Make sure the person you are considering hiring knows how to carry out the tasks the elder care recipient requires, such as transferring the senior to and from a wheelchair or bed. Training may be available, but make sure the worker completes the training successfully before hiring him or her.

No one should be hired on a seven-day-a-week basis. Even the most dedicated employee will soon burn out. All employees need some time to take care of their personal needs. No worker should be on call 24-hours a day. If the elder care recipient needs frequent supervision or care during the night, a family member or second home health care worker should be able to help out or fill in.

Live-in assistance may seem to be more convenient and economic than hourly or per-day employees but there can be drawbacks. Food and lodging costs must be calculated into the total cost of care, and it could be difficult to dismiss someone without immediate housing alternatives. If you decide to utilize a live-in arrangement, the employee should have his own living quarters, free time, and ample sleep.

Job Expectations and Considerations

Before hiring a senior home health care worker, you should go over the tasks you expect them to perform and other issues, such as promptness, benefits, pay scale, holidays, vacations, absences, and notification time needed for either employer or employee before employment is terminated. If you work and are heavily dependent on the home health care worker, emphasize the importance of being informed as soon as possible if he or she is going to be late or absent so that you can make alternative arrangements. Be clear about notification needed for time off, or what to do in the case the home health care worker experiences a personal emergency that requires them to abruptly leave work. It is important to have a backup list of friends, family, other home care workers, or a home health care agency you can call on.

Be clear about issues concerning salary, payment schedule, and reimbursement or petty cash funds for out of pocket expenses.

You should spend the day with the home health care worker on his first day to make sure you are both in agreement over how to carry out daily tasks. It would also be helpful to supply the home health care worker with a list of information on the elder care recipient such as: special diets, likes, dislikes, mobility problems, health issues, danger signs to monitor, possible behavior problems and accompanying coping strategies, medication schedule, therapeutic exercises, eye glasses, dentures, and any prosthetics.

You should also provide the following information to your home health care worker: your contact information, emergency contacts, security precautions and access to keys, clothing, and locations of washing/cleaning supplies, medical supplies, light bulbs, flashlights, fuse box, and other important household items.

Transportation

Another big consideration in hiring a senior home care worker is how he or she is going to get to work. If they do not have a reliable car or access to public transit, then you might want to consider hiring someone to drive him or her, which might be more economical than using taxis. Inform your insurance company if the home health care worker is going to drive your car when caring for the senior. Your insurance company will perform the necessary driving background checks. If the home health care worker is using his or her car to drive the elder care recipient, then discuss use of her or his car, and conduct a driving background check.

Insurance and Payroll

Check with an insurance company about the proper coverage for a worker in your home.

Make sure all the proper taxes are being drawn from the employee’s check by contacting the Internal Revenue Service, state treasury department, social security, and the labor department. If you do not want to deal with the complexities of the payroll withholdings yourself, than you can hire a payroll company for a fee.

Even if your home health care worker is working as a contractor, you are still obligated to report the earnings to the IRS. Talk to your accountant or financial adviser about making sure you are following IRS rules.

Ensuring Security

You should protect your private papers and valuables in a locked file cabinet, safe deposit box, or safe. If you are unable to pick up your mail on a daily basis, have someone you trust do it, or have it sent to a post box. You should check the phone bill for unusual items or unauthorized calls. You should put a block on your phone for 900 numbers, collect calls, and long-distance calls.

Keep checkbooks and credit cards locked up. Review credit card and bank statements on a monthly basis, and periodically request credit reports from credit reporting agencies. Lock up valuable possessions or keep an inventory of items accessible to people working in the house.

You can help to prevent elder abuse to your loved one by:

Make sure the home health care worker thoroughly understands his or her responsibilities, the elder care recipient’s medical problems and limitations, and how to cope with stressful situations.
Do not overburden the home health care worker.
Encourage openness over potential problems.
The following are possible signs of elder abuse or neglect:
Personality changes
Crying, whimpering, or refusing to talk
Sloppy appearance
Poor personal hygiene
Disorganized or dirty living conditions
Signs of inappropriate sedation, such as confusion, or excessive sleeping
Mysterious bruises, pressure sores, fractures, or burns
Weight loss
If you suspect abuse, act immediately. Do not wait until the situation turns tragic. Investigate the situation by talking to the elder care recipient in a safe situation, or install monitoring equipment. Examples of abusive behavior include yelling, threatening, or over controlling behavior that could involve isolating the senior from others. If the situation is serious, you should replace the home health care worker as quickly as possible. If you fear the elder care recipient is in danger, he or she should be separated from the home health care worker as soon as possible. Place the elder care recipient with a trusted relative or in a respite care facility. Make sure your loved one is safe before confronting the home health care worker, especially if there is concern about retaliation.
Report the situation to Adult Protective Services after ensuring the safety of the elder care recipient. The police should be contacted in the case of serious neglect, such as sexual abuse, physical injury, or misuse of funds.

Supervising a Home Health Care Worker

The most important thing to remember after hiring a home health care worker is to keep the lines of communication open. You should explain the job responsibilities clearly, and your responsibilities to the home health care worker. Do not forget that the home health care worker is there for the elder care recipient and not the rest of the family. For live-in arrangements, the maximum amount of privacy should be set up for the home health care worker’s living quarters. Meetings should be set up on a regular basis to assure that problems are nipped in the bud. If conflicts cannot be resolved after repeated attempts, than it is best to terminate the employee. In such a case, you may have to either place the elder care recipient in a nursing home temporarily or hire a home health care worker through an agency. Reserve funds should be kept on hand in the case of such an emergency.

General Eligibility Requirements for Home Care Benefits

Hiring a home health care worker directly is usually less expensive than hiring through a home health care agency; but if the elder care recipient is eligible and you wish to use assistance from Medicare, you must hire someone through a certified home health care agency. For the senior patient to be eligible, three or more services must be ordered by a physician. Other factors or eligibility are the required need for skilled nursing assistance, or one of the following therapies: physical, speech or occupational. The elder care recipient’s medical needs will determine asset and income requirements.

Hiring Home Health Care Workers through Home Health Care Agencies versus Independently

Different health professionals can assess the elder care recipient’s needs. A nurse or social worker can help with design and coordination of a home care plan. Your care manager, doctor, or discharge planner can help with services being covered by Medicare. They generally help make the arrangements with a home care agency.

You should ask the home health care agency how they supervise their employees, and what kind of training their employees receive. Find out the procedures for when an employee does not show up. Also ask about the fee schedule and what it covers, there may be a sliding fee schedule. Furthermore, find out if they have a policy for minimum or maximum hours. Ask the agency if there are any limitations on the types of tasks performed.

Especially if you have to pay for the care services yourself, find out if there are any hidden costs such as transportation. If all the costs for hiring a care worker through an agency become too much, you may want to consider hiring directly.

Hiring independent home health care workers is not only more economical than using an agency, but it also allows more direct control over the elder care.

Home Health Care vs Assisted Living

Home Health Care in Los Angeles

Home health care is health care that is provided to patients inside their home, and usually by either health care professionals or family and friends. The term “home care” suggests that the care provided is non-medical and more of a custodial nature, whereas “home health care” may suggest licensed staff members. The differences here are similar to the differences between assisted living facilities and nursing homes. Much like assisted living facilities, home health care lets seniors enjoy a good measure of independence. An elderly individual or couple will appreciate having privacy as well as assistance in daily living needs.

What Home Health Care Provides

What kind of services does home health care provide? Home health care may help seniors with daily living needs such as bathing, dressing, house keeping and cooking and dining preparation. Depending on the needs of the resident, there may be special provisions such as transportation services and errands, volunteer programs, exercise and walking, and toileting assistance. More extensive forms of home health care would also provide rehabilitation programs, including visits from physical therapists and nurses. Other qualified home health care professionals may include respiratory nurses, occupational nurses, social workers, mental health workers and physicians.

Who pays for home health care? This type of outside assisted living program can be paid by private resources from the resident or family, by public payers such as Medicare and Medicaid or by employer-sponsored health insurance plans. Medicare will usually not pay for home health care on a long term basis while Medicaid is more likely to help low-income families with little or no assets. Employer-sponsored home health care is likely to be on a short term basis unless the insurance plan is very generous. Most of the time home health care will be paid for by a family’s own resources.

Comparing Home Health Care with Assisted Living

How does home health care compare with in-house stays at nursing homes and assisted living facilities? Most seniors would prefer home health care, of course, as people always do value their privacy. However, there are also circumstances that would necessitate constant supervision of the resident at an assisted living facility, and not only occasional visits. Home health care is basically assisted living, but with even more independence. Therefore a resident that cannot be left alone for long periods of time would be better suited in a nursing or board and care type home.

It might appear that home health care would be cheaper than a stay in a nursing home. However, home health care costs can be just as expensive, depending on the number of hours aides work. Some residents have admitted that full time home health care usually costs twice as much as a stay in a board and care or assisted living home. Most home health care agencies will charge about $20.00 an hour or over. If the resident is relatively independent then the fees associated with the service can be controlled. However, don’t forget that if your needs are minimal to begin with, you could hire a trusted individual to perform the same tasks and save money from paying an agency fee.

Home health care is ideal for seniors who feel well and can easily get around but who need occasional doctor visits and help with housekeeping. It is also a preferable choice if a senior needs full time care but does not want to become a resident in a public nursing home. Full time home health care provides the most privacy and personal attention possible. If you are looking for this type of senior assistance, you should always be mindful of the qualifications of workers, as opening one’s home to a stranger could always be a security risk. The best home health care agencies have screened workers who are well qualified in their field.

How We Can Help You

ElderHomeFinders is a company dedicated to helping seniors locate assistance in the southern California area. We inspect assisted living facilities and retirement communities in the area so that our clients will find the perfect home at a price they can afford. Can ElderHomeFinders also help seniors find home health care? Yes. Our company can put you in touch with the right home health care agency, according to your special needs and budget limitation. We can also advise you on the differences between home health care services and assisted living and board and care facilities and which choice would better work for you. Seniors have worked hard all their life and surely deserve the best health care possible – whether in a senior living facility or in their own home.

It Is Your Right To Receive The Home Health Company Of Your Choice

There seems to be a common misconception in our country regarding the reception of home health services.

First of all, too many people needing home health are under the impression that if they are to receive home health services, they must accept the ongoing or company assigned to them by the discharging hospital or referring physician. This is not only a common myth, but it is also very illegal.

The fact is, if you are needing home health services, all you need is a physician’s order for home health services to satisfy Medicare.

Many physicians are affiliated with rehabilitation companies or home health companies and try to lead you to believe you must take what they give you. Patients are many time too timid to ask for something different.

Nothing could be further from the truth!

When you receive an order for home health services, you can request a specific home health company. In fact, you can even request specific therapists, nurses, or any other facet of home health service or therapy that you like. The discharging hospital or referring physicians are obligated to accommodate your wishes, within reason.

Too many medical groups have created the impression that you have to take what they recommend. This is because many of them have some kind of vested interest in you receiving what they prescribe.

Some physicians have even told patients that if they didn’t accept the home health company or therapist they specified, they would not write the order.

Again, this is illegal and Medicare would be very interested in finding out this information.

Moreover, Medicare is very interested in hospitals or physicians who are only looking after their own interests. Medicare would like to be contacted whenever a physician insists upon you using a certain home health company, rehabilitation group, or medical supply company.

This is called a conflict of interest and again, is very illegal. The reason for this is because many of the physicians referring these services, receive “kickbacks” in the form of financial amenities, or other bonuses. Many times, a physician doesn’t own the company. However, they may own the building the home health company or rehabilitation company works from. When they refer patients for home health services or rehabilitation services, the company receives reimbursement from Medicare. In turn the physician will charge is company outrageous rent fees, and is able to collect by referring patients. This is an indirect form of receiving kickbacks, and again, is illegal.

How To Avoid Being Victimized

You must first be knowledgeable with Medicare laws and regulations. You must also inform your physician that you know the Medicare laws, regulations, and more importantly, your rights as a patient.

Never accept a home health company from your physician if you don’t feel completely comfortable with their services. Even if you receive a referral to receive home health services from a specific company and find that you’re not happy with this company, you have the right to change companies. Furthermore, if you find that the nurses or therapists are not to your liking, you can change nurses or therapists. Many home health companies display behavior that is not consistent with the best interest of the patient. The nurses or nurse liaison, or therapists, may be rude, money driven, or power-hungry, or all of the above. What you need to do is inform the home health company that you wish to change companies and that you are informing your physician of this information.

Next, contact your physician and request a different home health company, nurse, or therapist. Most of the time, your physician will be cooperative. However if you need to be more insistent, you can inform your physician or the referring nurse, that you are well aware of the Medicare laws and regulations. Let them know that you will indeed file a complaint regarding this matter if your wishes are not respected.

Filing A Complaint With Medicare

It is always a good idea to let the physician know that you are knowledgeable of your rights, along with Medicare rules and regulations. If your physician is stubborn, or resists your wishes, it is your right, and obligation, for other patients, to file a Medicare complaint.

To file a Medicare complaint all you need to do is go to the Medicare government web site and inform them of the complaint. You can also contact Medicare through a contact hotline on the telephone to communicate with them. The Medicare hotline is 1-800-447-8477. You can contact Medicare and get more information regarding home health care and your rights at via their website at

How to Become a Home Health Care Nurse

Home Health Care Nursing Information and Overview

Home health care is allowing the patient and their family to maintain dignity and independence. According to the National Association for Home Care, there are more than 7 million individuals in the United States in need of home health care nurse services because of acute illness, long term health problems, permanent disability or terminal illness.

Home Health Care Basics

Nurses practice in a number of venues: Hospital settings, nursing homes, assisted living centers, and home health care. Home health care nursing is a growing phenomenon as more patients and their families desire to receive care in their homes. The history of home health care stems from Public Health Nursing where public health nurses made home visits to promote health education and provide treatment as part of community outreach programs. Today academic programs train nurses in home care and agencies place home health care nurses with ailing individuals and their families depending on the nurse’s experience and qualifications. In many cases there is a shared relationship between the agency and the academic institution.

Many changes have taken place in the area of home health care. These include Medicare and Medicaid, and Long Term Care insurance reimbursement and documentation. It is important for the nurse and nursing agency to be aware of the many factors involved for these rules and regulations resulting from these organizations. Population and demographic changes are taking place as well. Baby boomers approaching retirement and will present new challenges for the home health care industry. Technology and medical care in hospitals has lead to shorter inpatient stay and more at-home rehabilitation. Increases in medical outpatient procedures are also taking place with follow-up home care. This has resulted in the decrease of mortality rate from these technologies and medical care has lead to increases in morbidity and chronic illness that makes the need for home health care nursing a greater priority.

Home Health Care Nurse Job Description

Through an array of skills and experience, home health care nurses specialize in a wide range of treatments; emotional support, education of patients who are recovering from illnesses and injury for young children and adults, to women who have experienced recent childbirth, to the elderly who need palliative care for chronic illness.

A practicing nurse must have the skills to provide care in a unique setting such as someone’s home. The nurse is working with the patient and the family and must understand the communication skills for such dynamics. Rapport is evident in all nursing positions, but working in a patient’s own living space needs a different level of skill and understanding. There is autonomous decision making as the nurse is no longer working as a team with other nurses in a structured environment, but is now as a member of the “family” team. The host family has cultural values that are important and are different for every patient and must be treated with extreme sensitivity. Other skills include critical thinking, coordination, assessment, communication, and documentation.

Home health care nurses also specialize in the care of children with disabilities that requires additional skills such as patience and understanding of the needs of the family. Children are living with disabilities today that would have resulted in mortality just twenty years ago. Genetic disorders, congenital physical impairments, and injury are just a few. Many families are familiar with managing the needs of the child, but still need expert care that only a home health care nurse can provide. It is important that a home health care nurse is aware of the expertise of the family about the child’s condition for proper care of the child. There are many complexities involved, but most important, a positive attitude and positive reinforcement is of utmost importance for the development of the child.

Medication coordination between the home health care nurse, doctor, and pharmacist, ensures proper management of the exact science behind giving the patient the correct dose, time of administration, and combinations. Home health care nurses should be familiar with pharmacology and taught in training about different medications used by patients in the clinical setting.

Many advanced practicing nurses are familiar with medication regiments. They have completed graduate level programs. Home health care agencies believe that a nurse should have at least one year of clinical experience before entering home health care. Advanced practicing nurses can expedite that training by helping new nurses understand the home health care market and teaching.

Employment and Salary

According to the United States Department of Labor, there were 2.4 million nurses in America, the largest healthcare occupation, yet many academic and hospital organizations believe there is a gross shortage in nursing staff. The shortage of nurses was 6% in 2000 and is expected to be 10% in 2010. The average salary for hospital nursing is $53,450 with 3 out of 5 nursing jobs are in the hospital. For home health care, the salary is $49,000. For nursing care facilities, they were the lowest at $48,200.

Training and continuing education

Most home health care nurses gain their education through accredited nursing schools throughout the country with an associate degree in nursing (ADN), a Bachelor of Science degree in nursing (BSN), or a master’s degree in nursing (MSN). According to the United States Department of Labor, in 2004 there were 674 BSN nursing programs, 846 ADN programs. Also, in 2004, there were 417 master’s degree programs, 93 doctoral programs, and 46 joint BSN-doctoral programs. The associate degree program takes 2 to 3 years to complete, while bachelors degrees take 4 years to complete. Nurses can also earn specialized professional certificates online in Geriatric Care or Life Care Planning.

In addition, for those nurses who choose to pursue advancement into administrative positions or research, consulting, and teaching, a bachelor’s degree is often essential. A bachelor’s degree is also important for becoming a clinical nurse specialist, nurse anesthetists, nurse midwives, and nurse practitioners (U.S. Department of Labor, 2004).

All home health care nurses have supervised clinical experience during their training, but as stated earlier advanced practicing nurses hold master’s degrees and unlike bachelor and associate degrees, they have a minimum of two years of post clinical experience. Course work includes anatomy, physiology, chemistry, microbiology, nutrition, psychology, and behavioral sciences and liberal arts. Many of these programs have training in nursing homes, public health departments, home health agencies, and ambulatory clinics. (U.S. Dep. of Labor, 2004).

Whether a nurse is training in a hospital, nursing facility, or home care, continuing education is necessary. Health care is changing rapidly and staying abreast with the latest developments enhances patient care and health procedures. Universities, continuing education programs, and internet sites, all offer continuing education. One such organization that provides continuing education is the American Nurses Association (ANA) or through the American Nurses Credentialing Center (ANCC).

Conclusion

There are many rewards to becoming a home health care nurse. Some rewards include the relationship with a patient and their family, autonomy, independence, and engaging in critical thinking. The 21st Century brings with it many opportunities and challenges. We must meet these challenges head on – there is an aging baby boomer population, a growing morbidity factor due to increased medical technology and patient care, and the growing shortage in nursing care.

Becoming a home health care nurse today is exciting and an opportunity to make a difference one life at a time. With clinical experience and proper education, a home health care nurse will lead the future of medical care.

What to Expect in Home Health Aide Classes

When you certify as a Home Health Aide (HHA) it qualifies you to work in any number of home care settings, and prepares you for a gratifying career as a professional caregiver. Home health care is a rapidly expanding field and even now the demand for home health and personal care trained professionals is at an all-time high. The Bureau of Labor and Statistics has also made quite an amazing job outlook projection suggesting that about 1.3 million new Home Health Aide jobs are needed by 2020.

Formal Training Program

A career in home health care is gratifying in a sense that it allows for flexible hours and gives you the preference to make a difference in the lives of others. All you can do to become a certified Home Health Aide professional is to complete a formal training program. The formal training you receive prepares you to work as a personal care provider in a wide variety of home care settings. The training is doable with minimum prerequisites. You only have to pass a criminal background check and provide a recent negative test result for tuberculosis. And unlike most Certified Nurse Aide training programs, applicants to Home health Aide classes and training programs are usually not required to have a high school diploma or GED. The training curricula itself, however, must meet Federal Guidelines and those of the Accreditation Commission for Health Care (ACHC).

There is a Federal-mandated minimum requirement of 75 hours of instruction, 16 of which must take place in a clinical environment. Training can be completed in just a matter of weeks and you will then be eligible to sit for your State certification exam which includes hands on training with real patients. And all accredited Home Health Aide classes and training programs must cover the fundamentals of both home care and basic health-related sciences, and a dedicated clinical component as specifically spelled out in Title 42 of the U.S. Code for Public Health. Individual State requirements may apply which may increase the number of class hours and the amount of material you have to cover.

Tasks

Once certified, you are allowed to perform basic health-related tasks (e.g. checking of a patient’s pulse rate), but the majority of a HHA’s work shift is usually spent assisting clients with housekeeping and personal care at their place of residence. During a typical work day, a HHA can expect to perform the following tasks:

Maintains safe, secure, and healthy client environment by following standards and procedures, following prescribed dietary requirements and nutrition standards.
Assists client with bathing, dressing, and grooming.
Helps schedule appointments and transportation for client.
Provide client with companionship and monitor well-being.
Assists with transfers and ambulation including use of cane, walker, and wheelchair.
Assists with medication as specified on plan of care.
Provides routine skin care.
Assists self-directing client with use of oxygen equipment.
Supports client by providing housekeeping and laundry services; shopping for food and other household requirements; preparing and serving meals.
Helps family members care for client by teaching appropriate ways to lift, turn, and re-position client; advising on nutrition, cleanliness and housekeeping.
Records client information by making entries in the client journal; notifying nursing supervisor of changing or unusual conditions.
Complete all other duties as assigned within the scope of practice.
Overall, what a Home Health Aide profession entails is all about creating a safe, effective environment for a client in terms of health promotion and maintenance, nursing skills, health care administration, client services, good verbal communication, listening, dependability, emotional control and medical teamwork.

Of course, the job involves performing tasks under the direction and supervision of a registered nurse. And the work requires adherence to practice procedures and standards involving a high degree of accuracy in observing, recording and reporting data.

All About Affordable Health Insurance Plans

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

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

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

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

State-run affordable health insurance programs in California

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

• Major Risk Medical Insurance Program (MRMIP)

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

• Healthy Families Program

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

• Access for Infants and Mothers Program (AIM)

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

Some facts about affordable health insurance in Florida

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

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

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

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

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

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

Some facts about affordable health insurance in Virginia

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

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

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

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

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

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

Some facts about affordable health insurance in Texas

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

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

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

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

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

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

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

A Prescription For the Health Care Crisis

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

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

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

THE PROBLEM OF COST

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

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

WHY HAS HEALTH CARE BECOME SO COSTLY?

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

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

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

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

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

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

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

1. Technological innovation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WHAT VALUE ARE WE GETTING FOR THE DOLLARS WE SPEND?

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

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

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

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

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

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

THE PROBLEM OF ACCESS

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

GUIDELINES FOR SOLUTIONS

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

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

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

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

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

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

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

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

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

Florida Health Insurance Rate Hikes and Quotes

Florida Health Insurance Rate Hike

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

Hard Facts

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

Rate of inflation and heath insurance premium rate increase.

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

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

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

Florida health insurance rate hikes affect whom?

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

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

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

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

Community Needs Health Assessment

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

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

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

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

· Mental health issues

· Poor nutrition and obesity

· Substance abuse

· Violence and safety

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

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

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

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

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

Optimum Health Nutrition is the Pathway to a Healthy Life

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

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

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

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

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