Tag

insurance

Vaccination Nation

By | ChangeEngine, Health, The Global Is Local | No Comments

My arm is killing me. I got my flu shot yesterday, fine, great. I am adding to the collective resistance to the flu for 2013 and 2014, go me! However at the moment, my arm hurts and I’m a little bit annoyed with my past self for allowing me to be stuck with a needle.

By contrast, one of my colleagues mentioned that her son doesn’t believe in vaccination and is going to India without getting any of the so-called “required” shots. Although I find it a little bit challenging to get behind that perspective, his perception is a useful one to consider.

The perception of interventions differs widely among different groups. For example, many younger people believe that insurance is unnecessary. Women and men have differing attitudes about what constitutes sufficient health care services. Different economic, social, and ethnic groups also demonstrate a diverse range of values and preferences — not just about health services, of course, but about trends, fashion, technology, social practices, religious beliefs, and so on.

These differences have substantial public health impact. Especially in a place like Baltimore, home of Henrietta Lacks, there is still a strong memory of the crimes of the Tuskegee syphilis study that only adds to a long history of discrimination, segregation, and well-earned mistrust of institutions. Currently, this plays out in disparities in rates of HPV vaccination among young women, influenza vaccination, and of course overall disease burden.

In my opinion, the duty to educate and promote healthy interventions falls on the institutions that have generated so much mistrust in the past — government, large hospitals, pharmaceutical companies, and the like. The successful experiences of the private sector — particularly in marketing and advertising — in spreading innovation among groups that are new to the United States might be one source of inspiration. Spreading immunization adoption among a population could follow the same model as spreading smartphone adoption — both benefit the maker of the technology (money in their pocket), the recipient (resistance to disease, greater productivity), and the group as a whole (herd immunity, better educational and economic prospects).

Regardless of the rationale behind a mother’s resistance to a vaccination program, the motivation remains consistent — protecting her child from harm. This is true here and around the world. The World Health Organization has found that vaccine adoption has less to do with medical understanding of the vaccine itself than with social norms and trust of the vaccine provider. This lesson must be taken to heart when attempting to address the 2.5 million vaccine-preventable deaths in Asia and Africa every year, and also when attempting to improve influenza and HPV vaccination numbers in Baltimore. A recent uptick in polio cases in Somalia is cause for concern, but so is the fact that the first few cases of influenza have been reported in Maryland. We can all do something about the second of these, at least, by taking steps to protect ourselves as well as encouraging our friends and families to do the same.

Obamacare? Isn’t That Socialized Medicine?

By | Health, The Global Is Local | No Comments

A recent trip up the East Coast to visit family and friends presented a brief but intense glimpse into the debate that still rages around the Patient Protection and Affordable Care Act, now often referred to as Obamacare, even by the President himself.

Some aunts were very enthusiastic, some suspicious, some entirely opposed, and everyone confused. Many people I talked to — friends, family, and brief acquaintances — had some facts that they were holding onto firmly, which often informed their overall opinion. Some facts were more factual than others, but given the scope of the legislation and the broader health care debate, this is hardly surprising. A representative of the Kaiser Family Foundation health news branch was on NPR this morning, and she pointed out that many of those that the law is likely to benefit most don’t even know that they will soon be eligible for coverage.

If you have concerns about your own eligibility and how to move forward, I recommend Leanne’s post, A Guide to Shopping for Health Exchange Insurance Plans, that ChangeEngine published earlier this week. She links to several other resources that could also help further your understanding. But a more cerebral question has now been kicking around in my head for the past 48 hours: if clever, well educated people with lots of resources have a hard time grasping the basic elements of this law, and the implications that will soon be forthcoming, how on earth will someone who has a limited social support network, perhaps limited internet access, and other limitations fare?

I believe that the roll-out of the ACA will have a net societal benefit, but on the individual level, many questions remain. Questions of access, for instance, as I just mentioned, or of equity for those caught in between economic categories: too ‘wealthy’ to qualify for Medicaid, too ‘poor’ to access high quality insurance products. There are answers out there to these questions, and I plan to devote myself to finding as many of them as I can between now and the beginning of October, when the open enrollment begins on state exchanges and Healthcare.gov, the federal portal.

If you have burning questions that you would like to have answered, please put them into the comments section at the bottom of this post. If there are a sufficient number of questions to warrant it, the next edition of this column will be devoted to answering them. If not, I will endeavor to answer the most pressing concerns that I have heard from friends and family over the past week, since I am confident they will apply to just about all of us.

In the meantime, please stay healthy!

Where Obamacare Fails

By | Health | No Comments

I shy away from criticizing Obamacare too much because I think it provides some major improvements to our health care system. Personally, the law has positively impacted me — more free preventative care, more services covered and longer coverage. But lately I’ve become a bit fed up with my own health insurance and doctors’ visits, and it’s hard not to ignore all the negativity surrounding the law. Obamacare isn’t the problem here. It’s definitely not the solution either. Rather, Obamacare is kind of like a band-aid that distracts you from the real problem — a health care system that perpetuates inequality.

Ironically, this past year I met a lot of bright-eyed Johns Hopkins students who came to be a part of the “best” health care system in the world. And our medical education is arguably the best in the world (thanks to the 1910 Flexner Report that set Johns Hopkins Medical School as the gold standard for medical education and compared all other schools to it.) There’s no doubt our doctors can do amazing things. A news report stated that a Chicago suburban hospital has a 97% survival rate for gunshot wounds that enter the ER. Considering that a bullet can enter your upper torso and exit in your lower torso, damaging every organ in between, that is a spectacular rate. It’s the long-term care after the fact where we drop the ball.

Here’s an all-too-typical story: a patient is admitted to the hospital, can’t get out of bed for weeks on end and when it’s time to leave,  they no longer have the strength to walk. Patients lie in their hospital bed for weeks eating crappy hospital food and their only option for exercise is to be the creepy person walking up and down the hallway in their hospital gown dragging the IV stand. Healthcare in the United States is amazing at the quick-fix, but when it comes to helping a patient overcome root causes of illness, we don’t really try. There’s rarely any sufficient patient education or measures taken to prevent re-admittance to the hospital.

What’s even worse is what can come after the hospital — a nursing home. No one wants to be in one. Not even the workers like being there. If you can’t afford at-home help, off you go to spend most of your time eating more crappy food and watching more TV in bed.

Patients at all hospitals should be receiving holistic care. Take the New York program that allows doctors to prescribe vegetables, for instance. Instead, many patients are being subjected to a long-standing though theoretically taboo practice called “patient dumping” where patients at one health facility are forced to another, usually because of their insurance status. Though hospitals are required to treat whoever enters their doors under the Emergency Medical Treatment and Active Labor Act of 1986, patient dumping still occurs, even as horrible as busing people to another state.

Soon about 30 million more people will have health insurance, but it’s scary to think that “patient dumping” might still occur even if the majority of Americans are insured. Will you be referred to a crappier facility if you have the cheapest health insurance? That’s the thing with our health care system — if you have more money, you receive better and faster care. There will be minimum benefits thanks to Obamacare, but people with more money will still be able to afford better health insurance even with the “Cadillac” tax for the more exhaustive insurance plans. In Germany, health insurance will cover spa days and yoga if your doctor prescribes it. Why can’t everyone have benefits that would get a “Cadillac” tax? If only we could take a step back and realize the care we’ve been delivering is actually not the best in the world, then maybe we could start on the path to the equal holistic care we all need and deserve.

IMAGE CREDIT. [robcares.com].

A La Sante!

By | Health | No Comments

It’s no secret that j’aime la France. It’s in my blood. And you know who else loves the French? The French. Besides their wine, cheese and “c’est la vie” attitude, one of their biggest bragging points is their health care system. In 2000 when the World Health Organization ranked health systems, France came out on top. The curious thing is that if you take a closer look, our red, white and blue cousins have health care very similar to ours yet spend about half of what we do.

So how do they do it? The French have coverage in two ways. The first is through the government’s Sécurité Sociale. Each working person pays an income tax to finance universal coverage. If you’re not working, pas de problème, there are taxes on tobacco, alcohol and pharmaceuticals that also help pay for universal coverage.  De plus, co-pays were most recently added to the pot. The Sécurité Sociale pays for 70 percent of fees and the customer pays the remaining 30 percent if you’re referred by or seeing a primary care physician. This may sound high to an American, but fees are set each year by the government and they are also made known to the patient so prices stay low even though doctors are paid by fee-for-service. In every doctor’s office and hospital the cost of every service provided is presented in clear view.

Even though 100 percent of the population is covered through Sécurité Sociale, more than 92 percent of the population also buys supplemental insurance. This can help pay for that extra 30 percent and give you coverage for some bonus services. This insurance can be private, but providers are not allowed to compete by lowering health premiums. Instead they can offer different benefits and ways to cover the 30 percent.  Supplemental insurance is also provided by employers with about half of the cost split by an employer and employee.

Like ours, France’s health care system is not simple, but everyone has coverage. Even illegal immigrants — after they’ve been in country for three months — receive health insurance. And people can go to any doctor they please, unlike in the U.S. where you must stay within your insurers network. And coverage is cheap too. People pay small co-pays at doctor’s visits but to make it even fairer people with chronic illnesses, low-income people and pregnant mothers get free services.

The most magnifique component of France’s health care system is the little plastic health insurance card. The “carte vitale” or “life card” contain all the information needed for a doctor to not only adequately asses the patient but asses how the patient will pay. All medical records have been digital since the 1990s and tell the doctor every note, exam and service the patient has had. The processing of services is also done digitally by the “carte vitale.” The doctor inputs the services and this alerts the government and the supplemental insurance of payment which must be given to the doctor within three days. It’s fast and cuts down enormously on medical errors, unknowns and administrative costs.

En bref, when it comes to health care, the French get more bang for their buck. They have more freedom of choice, better quality, lower costs and more efficiency. Many French people still complain about the rising costs and doctors complain about their low salaries (a general practitioner in France will make about a third of what one in the U.S. makes). Both countries rely heavily on employer-based insurance, pay doctors by fee-for-service and both countries demand choice. But WHO ranked France’s system number one for many reasons — low infant mortality rates, higher life expectancies, low medical errors and low deaths in preventable illnesses. The French decided that health care for all is more important than free markets and excessive salaries, and it paid off. I think we can learn a thing or two from that.

IMAGE CREDIT. [my.aup.edu].