Archive for June, 2010
Most people know the importance of regular review with their doctor to ensure that they provide the best health, maintain it. They also understand the importance of preventive medical care, sickness and disease before they can stop progress. But many people fail to neglect their oral health, and even check the bi annual dental care, that the American Dental Association recommends as the minimum amount of dental care, an individual shouldpreserved. How much can be a mistake is something you do not know many of us, and there is no need for this plan with access to good health of the teeth
Poor dental health impacts not only on the appearance of a person’s smile. A lack of dental care was taken to severe illnesses in context. An infection that begins in the teeth or gums can spread throughout the body, and a continuing dental infection, which suffer from many people who can seriously affect the bodyImmune system and its ability to ward off diseases. Furthermore, studies have connected poor oral hygiene to an increased risk for cardiovascular disease, diabetes, and the probability of the birth of underweight babies. A good dental health plan actually negate many of these issues before they start at all.
The reason that many people avoid the dentist’s chair to be feared, even if some people are simply too frightened to go to the dentist, but fear of how much a dental health plan might cost. Although many employers offer medical coverage for their employees after a certain period of employment, it is rare to find an employer that dental health plan coverage in the same way now. So many people neglect of the financial concerns, easy dental care, it searches only when a condition is that causes severe pain.
The problem is that many people believe that good dental health> Plan covers the actual useful services will simply be too expensive for them to consider only. But this is not the case. It is quite possible, a good dental health plan for a few dollars a week, less than you would spend the morning buying coffee every week. The neglect of which the health of the teeth is a bad decision.
Keeping health insurance after a layoff without government assistance would eat up 72 cents of every dollar of unemployment benefits for average Kansas workers and their families.
And the expiration of such assistance in the federal stimulus act threatens to push millions of laid-off workers nationwide into the ranks of the uninsured.
Those are the conclusions of a new report by Families USA, a Washington-based nonprofit, nonpartisan group that advocates for health consumers.
The report, which will be released today in Washington, expresses concern over the expiration of a health-insurance benefit — funded by federal stimulus dollars — for workers laid off between March and December of this year.
Ordinarily, workers who leave a job can continue to receive coverage from their former employer’s insurance plan under a law known as “COBRA” — the Consolidated Omnibus Budget Reconciliation Act.
But COBRA coverage is expensive because the displaced worker has to pay the full premium, including what had been the employer’s share of the cost.
Under the federal economic stimulus bill, the government agreed to pick up 65 percent of the cost of COBRA coverage for as much as nine months for workers displaced by the ongoing economic recession.
But eligibility expired Monday for the first workers to get the COBRA assistance, those who joined the program in March.
And, as the law is currently framed, workers laid off after Dec. 31 will not receive any government help with their COBRA costs.
An estimated 7 million laid-off workers nationwide took advantage of the COBRA-assistance offer.
The exact number of Kansans affected is not available. Federal and state labor, insurance and tax officials could not provide a state-by-state breakdown.
Cost to laid-off Kansans
Families USA analyzed how losing the government assistance will affect individual families.
According to its report, the average cost of insuring a family through COBRA is $369 a month with the government subsidy.
Without it, that cost rises to an average of $1,054 a month — a $685 difference.
The average unemployment benefit in Kansas is $1,465, meaning that without the COBRA subsidy, health insurance alone would consume 71.9 percent of an unemployed family’s income, Families USA calculated.
Ending the subsidy will mean “putting continued health coverage out of reach for most families,” Families USA concluded.
Congress is considering a bill to extend the COBRA subsidy, said Molly Haase, an aide to Sen. Pat Roberts, R-Kan.
Sen. Sherrod Brown, D-Ohio, has introduced Senate Bill 2730 to extend COBRA subsidy eligibility through June 20, 2010.
The bill also would reduce the unemployed worker’s co-payment from 35 percent to 25 percent and extend benefit eligibility from nine months to 15 months, Haase said.
The bill is before the Senate Finance Committee, she said.
Losing the government benefit would make it extremely difficult — in many cases impossible — for laid-off Kansans to continue to provide health coverage for their families, said Bob Brewer, Midwest director for the Society of Professional Engineering Employees in Aerospace.
In Kansas, layoffs of SPEEA’s workers didn’t start until October, so its members will continue to receive benefits for several more months, Brewer said.
However, he added that he expects more layoffs in early 2010 at Boeing and Spirit AeroSystems, and he hopes the COBRA subsidy will be reinstated in time for those workers to continue coverage.
Clinics already burdened
An increase in uninsured Kansans would put more pressure on already heavily burdened low-cost clinics in Wichita.
Dave Sanford, executive director of GraceMed in Wichita, said his clinic is already seeing a rise in patients that is outstripping its ability to get enough providers to serve them.
Even with COBRA subsidies available, many displaced workers are “basically rolling the dice, hoping they don’t have a catastrophic problem until they get called back or they get another job,” he said.
For now, GraceMed is dealing with the crunch by setting appointment times for people with more urgent health problems and extending the wait to get an appointment for routine care, Sanford said.
The clinic also is trying to find doctors willing to moonlight at the clinic in the evenings and on weekends, he said.
People who find their COBRA expiring can comparison shop to try to find a lower-cost policy, said Bob Hanson of the state Insurance Department.
The department maintains a list of insurers licensed to sell medical coverage in Kansas at www.ksinsurance.org/consumers/majmed.htm.
The department also is warning consumers to be wary of companies marketing health plans that seem unrealistically cheap, Hanson said.
“Many companies writing very limited health policies, or noninsurance discount plans, are finding a market for those desperate for low-cost insurance,” Hanson said.
We hardly come across a person who may be fully satisfied with the health care delivery system run by either the government or the private sector. This is true not only for developing but for all the developed countries as well. Every law abiding, contributing individual has some legitimate expectations from the state. Disenchantment with present dispensation of health care compels people to seek better options across the borders. Even the present flow rate of patients from developed to developing countries has assumed the proportions of Medical tourism. Medical tourism is not a one-way traffic. Poor from India are known to visit Rashid Hospital at Lahore for kidney transplants. Medical tourism will definitely bring in world class equipment and services in our corporate hospitals. These corporate tertiary care hospitals can act as excellent referral hospitals. Lack of enough clinical material, as the patients are often referred to in medical parleyences is prompting the doctors from developed world into medical adventurism. Very recently two NGO’s headed by renowned plastic surgeons of Indian origin were in India, claiming to their credit hundreds of cleft lip and palate surgeries conducted in one week. During my brief interaction when I asked them one basic question that how do you justify single step surgery by a single specialist for a clinical entity that require 3-5 set up surgeries by 10 specialists over a period of 20 years, there was no answer. On record local doctors conduct all these surgeries. These NGO’s bring in a battery of trainee resident doctors for hands on training. Dumping of questionable services and drugs continues unabated in the absence of stringent regulations. Clear-cut up to date guidelines by health authorities have yet to be issued to safe guard the health interests of this nation. Most of the drugs banned in developed countries are still being dumped in the Indian market. Commerce alone dictates the policies of multinational companies in health sector of developing countries. State and national medical councils, the watch dogs of our national health interests are controlled by elected representatives from among the doctors. Competitive populism for being elected to these high offices takes away the very sting off these regulators. In this ‘market forces’ driven health sector, apart from other factors, size of the population, economic prosperity and literacy levels dictate the out look of key players. Subjective as well as objective assessments of the health care operations leave people confused with huge piles of data and endless interpretations. At the tail end of govt. health care delivery system is the rural dispensary or the slum revamping center, and the end user an illiterate or semi literate villager or a slum dweller. Dispensary is the humane face, the welfare state can present to its people. In yesteryears the service providers were from among the same social class they used to serve. Doctor can be a friend, philosopher and guide to the locals. Unfortunately the economic and social disparity between the service providing doctors and the service user population has grown enormously. Ad-hocism in health care delivery should be done away with immediate effect. Doctors and paramedical staff appointed on yearly contract basis are not showing any interest in the national programmes. Established private health care providers also have not shown any meaningful commitment for national programmes. Middle class itself has fragmented. Now it is fashionable to assign economic values to any issue like gender, but for social responsibility and justice. In this era of fast paced growth, the unorganized, silently suffering millions can not be wished away. Once reading on biodiversity I stumbled upon a very interesting quote, “only the species with economic importance will survive”. In our active pursuit for magnetizing economy, we assigned economic values to any thing except for morals. Commercialization of education has produced a new breed of professionals who have scant regard for professional ethics. Privatization is the buzzword with governments, because it takes away government responsibility. Private sector players are eyeing many ‘viable’ health institutions. There are no takers for commercially non-viable rural institutions. Rural health institutions dispense social medicine. Very recently one of the key players from private sector health care quoted the cost of developing one bed in corporate hospital at Rs. 30-60 lacs. These corporate health services are definitely out of each of the common man. These type of hospitals are definitely required for a nation with the present rate of growth but ‘bharat’ definitely needs different kind of hospitals. There are very strong social under currents against the exploitive private healthcare, inadequate government sector health care resources and the indifferent approach of welfare state. Health for all is a very lofty but expensive proposition. There are ways and means to reduce the pressure from government institutions. Private-public partnership, health insurance, monitoring and regulation of private sector health care can all make the things bit easy. Preventive health care education can go a long way in improving the public health. Community participation in health care has produced few but wonderful examples. Complementary community participation can make up for minor but critical deficiencies in the government run health care system. Setting up of health system corporations with World Bank assistance has already improved the working of govt. sector health care institutions considerably. Community participation through NGO’s can still improve the system, but most of the meaningful NGO’s turn their back on govt. run health care institutions because of their doubts on the integrity of government officers. Government health care institution are increasingly seen not as caring hospitals but like police stations, where medico legal reports are written and postmortems conducted. Most of the government doctors’ time is spent in courts appearing as medico legal experts witnesses. Emergency, post mortem, and then the VIP duties in addition hardly leave the doctors free for any meaningful job at government hospitals. There is an urgent need to have separate curative, preventive, legal, administrate and health intelligence wings. Government hospitals attract the poorest of the poor, mostly people from the unorganized sector. Their contribution to national GDP is by no means small. With the present growth rate, upward social mobility is seen in every strata of society. Many segments of this unorganized sector can be organised so that they also enjoy the patronage of welfare state in the form of health insurance policies. Apart from direct benefit to these segments of society, the state will benefit from the ‘off loading’ of burden from government run health care system and loading it on insurance driven private sector health care institutions. Poorest of the poor will repose faith in welfare state. Sanjivini, health insurance policy with the Punjab Milkmen Cooperative Societies is already a big success. ECHS (Ex servicemen Contributory Health Scheme) is an other success story. These success stories can be replicated with countless groups like, panwallas, dhabewallas, autorikshaw drivers etc. Simply organize the unorganized sector. There is no dearth of role models from among government doctors also. Their inclusion rather than drift after dissent from the present dispensation of health care will immensely improve the system. Stability of tenure is an excellent incentive government can give to its doctors without costing anything to exchequer. Yet tenure beyond decades should be discouraged as it leads to development of vested interests of the old incumbents and denial of chance to the youngsters. Resource mismatching is a major problem in the govt. run health care system. There are dispensaries where specialists are posted and still many more civil hospitals where non-specialist are posted. These mismatching result in defective and inefficient health care. Nodal Hospitals can be created for round the clock emergency services by cannibalizing defunct and sick institutions where equipment worth crores is lying unused and salary bills are bleeding the exchequer white. Most of the medical officers retire in the same administrate rank. This undue stagnation has forced many a brilliant doctors out of service. By simply seeking options for place of posting, honestly implementing with minimum displacement on merit can also revitalize the govt. doctors’ cadres. Private sector health care delivery system is a totally market driven commercial enterprise. So called ‘market forces’ have least respect for ethical and moral value systems. Multi level marketing chains have evolved in the name of referral systems. End result is exploitation of the unsuspecting common man, who still regards his healer a holy person. This ‘incentive’ system is strengthening the hold of unqualified, unscrupulous and unregistered medical practitioners on illiterate masses. Not many qualified doctors are unscrupulous. A large section of private health care providers feel genuinely threatened by blackmailers of all sorts. Consumer protection act is a very convenient beating stick in the hands of their tormentors.
Under the constant threat of being blackmailed, the private health care providers are becoming more defensive in attitude. More patients are being referred to tertiary care institutions for this reason only, thereby flooding the referral institutions. People have a common feeling that sickness is an invitation for exploitation at the hands of private health care providers. Even the charitable hospitals are charging as heavily as fully private hospitals. Medical profession is fully responsible and capable of self-correction. Medical councils and associations can jointly evolve a fail-safe mechanism to keep their black sheep under check even without government help, but the buck stops with the government. Welfare state is duty bound not only in providing health care delivery system but also proper health care administration and social justice through its health care delivery mechanism.