If one had to design a health care system that would seem doomed to failure one might start with one in which the providers of care were fragmented, independent and driven through the reimbursement system to provide ever more services that generate higher income on a fee for service basis. The system would provide care to patients who were isolated from the economic costs of the services by third party payments, through employer funded insurance coverage. Third party payers would make their money through reducing premium payouts, by simply delaying or not paying out what they contracted to provide or extorting deep provider discounts in exchange for directed volume. The approach to care of individual patients would be ad hoc, without significant oversight. Severely ill patients would be passed back and forth by all providers like the black queen of spades in a deck of cards. Bad debts would be written off as "charity care." Insurance premiums would rise faster than the world's oceans in global warming. Sound familiar?
Unfortunately, in an contentious and polarized political democracy little can be done to re-design an antiquated, inefficient, ineffective, and bankrupting cowboy system of health care delivery in a focused, comprehensive way that will likely make a real difference. There are just too many moving parts and special interests involved. There is, however, an incremental change underway as a result of the recent health care reform efforts that have the potential to morph the system into a paradigm that makes more practical sense. Medicare will be providing contracts with Accountable Care Organizations that will have to become clinically integrated systems of efficient hospitals and care providers in order to obtain adequate reimbursement. Expect to see these new systems expanding in the private sector as well.
The government's push toward implementation of global electronic medical records systems will be key to the development of data driven systems competing not only for financial gain, but also for quality in performance and outcomes. Data capability inaugurates performance accountability in managing patient care. With the advent of reliable data there will be more and more focus on evidence based medicine, what works and what does not and we will be moving from a largely intuitive approach to an empirical design in health care delivery. Outliers will be reviewed, evaluated and addressed. The focus will be on system based accountability in providing the most effective method of care and the most reasonable price. This can only occur if hospitals and care providers are focused on and are compensated for the delivery of health not the delivery of care. Look to the rise and advance of fully integrated health care systems compensated in global fixed fees, and view the decay and death of fee for service medicine.
The pace of technology development in the form of electronic medical records, smart electronic medical devices and in communication, storage and cloud computer functioning, augers the potential for what what Ray Kurzweil describes as the "Singularity."
What then is the singularity? It's a future period during which the pace of technological change will be so rapid, its impact so deep, that human life will be irreversibly transformed. Although neither utopian nor dystopian, this epoch will transform concepts that we rely on to give meaning to our lives from our business models to the cycle of human life, including death itself.
Sunday, 10 April 2011
Does the United States Healthcare System Need an Overhaul?
Healthcare is undoubtedly one of the United States' biggest challenges today. Having been declared "broken" by experts over ten years ago, the system has still not shown any improvements. Supposed "fixes" promised by managed care have not surfaced. Instead, health insurance premiums are rising, hassles for patients and physicians continue, and more than 45 million Americans are uninsured.
If the challenges with healthcare that the United States faces are not met swiftly and wisely, the current problems will worsen and new challenges will arise. Even considering that new technology, such as online medical consultations, will increase efficiency, the cost of new tests and treatments are projected to outweigh the savings. As physicians and online doctors get better at treating ailments and illnesses, they will in turn lengthen patients' lives, thereby increasing the number of people requiring medical care.
Additionally, as costs rise, many employers will not be able to handle providing healthcare benefits to their employees. This is just one contributing factor to the growing number of uninsured citizens.
Is Healthcare Reform in Our Near Future?
President Obama has plans in motion to ensure each and every American has access to high quality health care, deeming it "one of the most important challenges of our time." He stated that the number of uninsured Americans is growing, premiums are skyrocketing, and an increasing number of people are being denied coverage every day. In addition, President Obama believes that an improved healthcare system - including one that supports the use of telemedicine and online doctor consultations - is also essential to rebuilding the U.S. economy, in that an improved system will benefit people and businesses - not just insurance and pharmaceutical companies.
According to Darrell M. West, Vice President, Governance Studies at Brookings Institution, "the biggest obstacle to health care reform is fear of the unknown. Anytime you make fundamental changes in the system, there is going to be anxiety from doctors worried about reimbursement levels, patients concerned over access to care, insurers about market competition, and hospitals about cost structures. In this situation of complex proposals and unknowable consequences, it is easy to play to people's fears and scare them into resisting change. What President Obama has to do is persuade people that diving into the unknown future is less risky than the current status quo. If he can overcome the fear hurdle, he will get health care reform."
We Have Evolved...It's Time for Healthcare to Evolve, Too
The way of approaching healthcare in the United States has become outdated. With the rapidly expanding array of technology that is available to the people of the United States, it is no wonder why the way research is done has changed; and the ways in which people communicate has also changed. So what about change in the healthcare system? It is due time for physicians and other healthcare providers to evolve with the times and incorporate telehealth services, such as online medical consultations and online prescriptions, into their practices.
Datamonitor has predicted that the global telehealth market is expected to exceed $8 billion by the year 2012. Telemedicine (often used synonymously with telehealth) is the use of medical information being exchanged from one to another via electronic communication, whether it is the internet or phone. This exchanged medical information in the form of online doctor consultations and printable doctors' excuses online in turn is used to improve the patient's health or direct them in the right path.
Commonly referred to as online medical consultation services, telemedicine is not different from the actual practice of medicine; it is just the application of the standard, accepted practice of medicine, to electronic communication, thus making it more widely accessible and easier to obtain by the general public. With technology at everyone's fingertips, it is no wonder that a rapidly increasing number of people are turning to the internet for online doctor consultations and printable doctors' excuses. To date, approximately 36 million Americans have already been treated by telemedicine through online doctor consultations and/or prescriptions. A survey showed that over 70% of patients indicate that they are willing to try online doctor consultations and online prescription services rather than going into an office when they have a minor illness.
The American Medical Association (AMA) has reported that possibly 70% of all doctors visits are for information or a consultation of sorts that could easily be handled over a phone. All of these visits cost medical providers and patients alike for the unnecessary trips. It has been estimated that as much as $300 billion of health care costs are wasteful and unnecessary, thus resulting in higher insurance costs for groups and individuals alike.
Are These Goals Within United States' Reach?
The three targeted goals when it comes to improving the U.S. healthcare system according to President Obama are the following:
o Reform the healthcare system;
o Promote scientific and technological advancements; and
o Improve preventative care
With the rapid advancement of telemedicine, or online doctor consultation and online prescription services, the aforementioned goals are most definitely within our reach.
For premium telemedicine or "ask a doctor" services, consult with qualified, fully licensed U.S. physicians, or online doctors, on KoolDocs.com. KoolDocs.com telemedicine service offers patients increased access to health care services with added convenience and affordability. KoolDocs.com helps patients avoid the hassle of having to go into the doctor's office for acute simple medical conditions such as bronchitis, colds, coughs, flu, ear infections, sinus infections, laryngitis, sore throats, upper respiratory infections, urinary tract infections, smoking cessation, shingles, athlete's foot, acne, rashes, insomnia, weight loss, herpes, and more. Unlike waiting hours for the typical doctor's office to call back, KoolDocs.com physicians return patients' calls within a one- to three-hour window of time, or whenever is most convenient for the patient. For online doctor consultations, printable doctors' excuses.
If the challenges with healthcare that the United States faces are not met swiftly and wisely, the current problems will worsen and new challenges will arise. Even considering that new technology, such as online medical consultations, will increase efficiency, the cost of new tests and treatments are projected to outweigh the savings. As physicians and online doctors get better at treating ailments and illnesses, they will in turn lengthen patients' lives, thereby increasing the number of people requiring medical care.
Additionally, as costs rise, many employers will not be able to handle providing healthcare benefits to their employees. This is just one contributing factor to the growing number of uninsured citizens.
Is Healthcare Reform in Our Near Future?
President Obama has plans in motion to ensure each and every American has access to high quality health care, deeming it "one of the most important challenges of our time." He stated that the number of uninsured Americans is growing, premiums are skyrocketing, and an increasing number of people are being denied coverage every day. In addition, President Obama believes that an improved healthcare system - including one that supports the use of telemedicine and online doctor consultations - is also essential to rebuilding the U.S. economy, in that an improved system will benefit people and businesses - not just insurance and pharmaceutical companies.
According to Darrell M. West, Vice President, Governance Studies at Brookings Institution, "the biggest obstacle to health care reform is fear of the unknown. Anytime you make fundamental changes in the system, there is going to be anxiety from doctors worried about reimbursement levels, patients concerned over access to care, insurers about market competition, and hospitals about cost structures. In this situation of complex proposals and unknowable consequences, it is easy to play to people's fears and scare them into resisting change. What President Obama has to do is persuade people that diving into the unknown future is less risky than the current status quo. If he can overcome the fear hurdle, he will get health care reform."
We Have Evolved...It's Time for Healthcare to Evolve, Too
The way of approaching healthcare in the United States has become outdated. With the rapidly expanding array of technology that is available to the people of the United States, it is no wonder why the way research is done has changed; and the ways in which people communicate has also changed. So what about change in the healthcare system? It is due time for physicians and other healthcare providers to evolve with the times and incorporate telehealth services, such as online medical consultations and online prescriptions, into their practices.
Datamonitor has predicted that the global telehealth market is expected to exceed $8 billion by the year 2012. Telemedicine (often used synonymously with telehealth) is the use of medical information being exchanged from one to another via electronic communication, whether it is the internet or phone. This exchanged medical information in the form of online doctor consultations and printable doctors' excuses online in turn is used to improve the patient's health or direct them in the right path.
Commonly referred to as online medical consultation services, telemedicine is not different from the actual practice of medicine; it is just the application of the standard, accepted practice of medicine, to electronic communication, thus making it more widely accessible and easier to obtain by the general public. With technology at everyone's fingertips, it is no wonder that a rapidly increasing number of people are turning to the internet for online doctor consultations and printable doctors' excuses. To date, approximately 36 million Americans have already been treated by telemedicine through online doctor consultations and/or prescriptions. A survey showed that over 70% of patients indicate that they are willing to try online doctor consultations and online prescription services rather than going into an office when they have a minor illness.
The American Medical Association (AMA) has reported that possibly 70% of all doctors visits are for information or a consultation of sorts that could easily be handled over a phone. All of these visits cost medical providers and patients alike for the unnecessary trips. It has been estimated that as much as $300 billion of health care costs are wasteful and unnecessary, thus resulting in higher insurance costs for groups and individuals alike.
Are These Goals Within United States' Reach?
The three targeted goals when it comes to improving the U.S. healthcare system according to President Obama are the following:
o Reform the healthcare system;
o Promote scientific and technological advancements; and
o Improve preventative care
With the rapid advancement of telemedicine, or online doctor consultation and online prescription services, the aforementioned goals are most definitely within our reach.
For premium telemedicine or "ask a doctor" services, consult with qualified, fully licensed U.S. physicians, or online doctors, on KoolDocs.com. KoolDocs.com telemedicine service offers patients increased access to health care services with added convenience and affordability. KoolDocs.com helps patients avoid the hassle of having to go into the doctor's office for acute simple medical conditions such as bronchitis, colds, coughs, flu, ear infections, sinus infections, laryngitis, sore throats, upper respiratory infections, urinary tract infections, smoking cessation, shingles, athlete's foot, acne, rashes, insomnia, weight loss, herpes, and more. Unlike waiting hours for the typical doctor's office to call back, KoolDocs.com physicians return patients' calls within a one- to three-hour window of time, or whenever is most convenient for the patient. For online doctor consultations, printable doctors' excuses.
Thursday, 10 March 2011
Medical Alert Systems - A Life Line for Seniors
A personal emergency response system can save your elderly loved one's life in the event of a sudden illness or accident. How do you choose the best senior alert system? In today's feature, we'll review the most popular senior alert systems.
Med Alerts for Seniors
More and more seniors are living alone and wish to maintain their independence. They don't want to leave their home and move in with relatives or go into a senior residence. But if you're like millions of people who worry about an aging loved one, you need to know they're safe and sound. Luckily, today's medical alert devices can help you and your special senior citizen make safe independent living practical.
Medical Alert Systems: How They Work
Senior medical alerts systems are comprised of a push-button call device that activates an intercom device. The push button is worn around the neck as a pendant, around the wrist like a watch or clipped on the belt. Most companies offer all three choices.
When the call button is pressed it activates the monitoring system, which is essentially an intercom device that connects the senior with the monitoring company. The monitoring company's call center then calls the home and attempts to speak with the senior. Based upon the response they get from the senior, the company will follow a predetermined protocol. For example, if the button was pressed accidentally or just to test the device the call center will note the incident - they will not send 911 every time the button is pressed.
What You Need To Know
The call-button has a limited transmission range which is adequate for most homes. But if you wander out of range, the push button will not work. Some monitoring services will be alerted when the transmission device stops working (whether it is because the device is out of range, the battery is dead or other malfunction) - but many cheap monitoring systems do not have this feature. Make sure you pick the right one.
Another important point, with standard senior alerts if the wearer does not or cannot push the panic button, help won't come. If the wearer is unconscious, disoriented and can't push the button, the device won't be of much use. That's why many people choose a device with fall-detection. Many providers advertise "fall detection," but research shows that too often these devices don't detect falls in the real world. That's because these devices are only triggered by a sudden, violent drop - and that's not always the way falls happen in the real world.
Many elderly people fall down by slumping down to the floor. They might feel dizzy so they hold on to the wall and slump to the floor rather than dropping from upright to flat out. When people fall like this, these so-called "fall detectors are useless. So, what is the solution?
We like my Halo for true fall detection. Their device is worn under the clothing and besides being a call-button, it can detect when the wearer stops moving unexpectedly, when their skin temperature is outside the norm and even heart rate changes. It's an affordable service that offers more protection than the standard panic button system. But - since it has to be worn under the clothing and against the skin you may find that your elderly relative may resist wearing it at first. The good news is that it is light-weight and they will get used to wearing it. After a while they won't even notice they're wearing it.
Med Alerts for Seniors
More and more seniors are living alone and wish to maintain their independence. They don't want to leave their home and move in with relatives or go into a senior residence. But if you're like millions of people who worry about an aging loved one, you need to know they're safe and sound. Luckily, today's medical alert devices can help you and your special senior citizen make safe independent living practical.
Medical Alert Systems: How They Work
Senior medical alerts systems are comprised of a push-button call device that activates an intercom device. The push button is worn around the neck as a pendant, around the wrist like a watch or clipped on the belt. Most companies offer all three choices.
When the call button is pressed it activates the monitoring system, which is essentially an intercom device that connects the senior with the monitoring company. The monitoring company's call center then calls the home and attempts to speak with the senior. Based upon the response they get from the senior, the company will follow a predetermined protocol. For example, if the button was pressed accidentally or just to test the device the call center will note the incident - they will not send 911 every time the button is pressed.
What You Need To Know
The call-button has a limited transmission range which is adequate for most homes. But if you wander out of range, the push button will not work. Some monitoring services will be alerted when the transmission device stops working (whether it is because the device is out of range, the battery is dead or other malfunction) - but many cheap monitoring systems do not have this feature. Make sure you pick the right one.
Another important point, with standard senior alerts if the wearer does not or cannot push the panic button, help won't come. If the wearer is unconscious, disoriented and can't push the button, the device won't be of much use. That's why many people choose a device with fall-detection. Many providers advertise "fall detection," but research shows that too often these devices don't detect falls in the real world. That's because these devices are only triggered by a sudden, violent drop - and that's not always the way falls happen in the real world.
Many elderly people fall down by slumping down to the floor. They might feel dizzy so they hold on to the wall and slump to the floor rather than dropping from upright to flat out. When people fall like this, these so-called "fall detectors are useless. So, what is the solution?
We like my Halo for true fall detection. Their device is worn under the clothing and besides being a call-button, it can detect when the wearer stops moving unexpectedly, when their skin temperature is outside the norm and even heart rate changes. It's an affordable service that offers more protection than the standard panic button system. But - since it has to be worn under the clothing and against the skin you may find that your elderly relative may resist wearing it at first. The good news is that it is light-weight and they will get used to wearing it. After a while they won't even notice they're wearing it.
A Socialized Health Care System Requires Population Control and Impeccable Registries
In a nationalized health care system, you need to know who is who - otherwise the system could never be able determine who is entitled. The structure depends on how the system is created and designed, but with a nationalized health care system you will be tracked by the state where you reside and how you move in a manner that is unseen in America. The nationalized health care system becomes a vehicle for population control.
If you leave the United States and are no longer a resident of the state, even if you are a citizen and might maintain a driving license, you will have to report immediately if you want to avoid the 13% health care tax. I use the number 13% as it is in Sweden to exemplify the actual tax pressure that is laid upon you for the nationalized health care.
Let's say you moved and you do not want to pay the 13% tax for services you do not receive, can receive, or want to taken out from the tax roll. The mammoth entity has no interest to let you go so easy. You will end up having to reveal your private life - partner, dwellings, travel, money, and job to prove your case that you have the right to leave the public health care system and do not need to pay the tax. If you have to seek an appeal, your information could be a part of administrative court documents that are open and public documents. As soon as you return to the United States, you will be automatically enrolled again and the taxes start to pile up.
Public universal health care has no interest in protecting your privacy. They want their tax money and, to fight for your rights, you will have to prove that you meet the requirements to not be taxable. In that process, your private life is up for display.
The national ID-card and national population registry that includes your medical information is a foundation of the nationalized health care system. You can see where this is going - population control and ability to use the law and health care access to map your whole private life in public searchable databases owned and operated by the government.
By operating an impeccable population registry that tracks where you live, who you live with, when you move and your citizen status including residency the Swedes can separate who can receive universal health care from those not entitled. The Swedish authorities will know if you have a Swedish social security number, with the tap of the keyboard, more information about yourself than you can remember. The Swedish government has taken sharing of information between agencies to a new level. The reason is very simple - to collect health care tax and suppress any tax evasion.
It is heavily centralized and only the central administration can change the registered information in the data. So if you want to change your name, even the slightest change, you have to file an application at a national agency that processes your paperwork. This centralized population registry makes it possible to determine who is who under all circumstances and it is necessary for the national health care system. Otherwise, any person could claim to be entitled.
To implement that in the United States requires a completely new doctrine for population registry and control. In an American context that would require that every existing driving license had to be voided and reapplied under stricter identification rules that would match not only data from Internal Revenue Service, state government, municipal government, Social Security Administration, and Department of Homeland Security but almost any agency that provides services to the general public. The reason why a new population registry would be needed in the United States is the fact that lax rules dating back to the 1940s up until the War on Terrorism, and stricter identification criteria following 9/11, has made a significant percentage of personal information about individuals questionable.
If America instead neglects maintaining secure records, determining eligibility for public health care would not be possible and the floodgates for fraud would open and rampant misuse of the system would prevail. This would eventually bring down the system.
It is financially impossible to create a universal health care system without clearly knowing who is entitled and not. The system needs to have limits of its entitlement. A social security number would not be enough as these numbers have been handed out through decades to temporary residents that might not even live in the United States or might today be out of status as illegal immigrants.
The Congress has investigated the cost of many of the "public options", but still we have no clear picture of the actual realm of the group that would be entitled and under which conditions. The risk is political. It is very easy for political reasons to extend the entitlement. Politicians would have a hard time being firm on illegal immigrants' entitlement, as that would put the politicians on a collision course with mainly the Hispanic community as they represent a significant part of the illegal immigrants. So the easy sell is then that everyone that is a legal resident alien or citizen can join according to one fee plan and then the illegal immigrants can join according to a different fee structure. That assumes that they actually pay the fee which is a wild guess as they are likely to be able to get access to service without having to state that they are illegal immigrants.
It would work politically - but again - without an impeccable population registry and control over who is who on a national level, this is unlikely to succeed. The system would be predestined to fail because of lack of funds. If you design a system to provide the health care needs for a population and then increase that population without any additional funds - then naturally it would lead to a lower level of service, declined quality, and waiting lists for complex procedures. In real terms, American health care goes from being a first world system to a third world system.
Thousands, if not a million, American residents live as any other American citizen but they are still not in good standing with their immigration even if they have been here for ten or fifteen years. A universal health care system will raise issues about who is entitled and who is not.
The alternative is for an American universal health care system to surrender to the fact that there is no order in the population registry and just provide health care for everyone who shows up. If that is done, costs will dramatically increase at some level depending on who will pick up the bill - the state government, the federal government, or the public health care system.
Illegal immigrants that have arrived within the last years and make up a significant population would create an enormous pressure on a universal health care, if implemented, in states like Texas and California. If they are given universal health care, it would be a pure loss for the system as they mostly work for cash. They will never be payees into the universal health care system as it is based on salary taxes, and they do not file taxes.
The difference is that Sweden has almost no illegal immigrants compared to the United States. The Swedes do not provide health care services for illegal immigrants and the illegal immigrants can be arrested and deported if they require public service without good legal standing.
This firm and uniform standpoint towards illegal immigration is necessary to avoid a universal health care system from crumbling down and to maintain a sustainable ratio between those who pay into the system and those who benefit from it.
The working middle class that would be the backbone to pay into the system would not only face that their existing health care is halved in its service value - but most likely face higher cost of health care as they will be the ones to pick up the bill.
The universal health care system would have maybe 60 million to 70 million "free riders" if based on wage taxes, and maybe half if based on fees, that will not pay anything into the system. We already know that approximately 60 million Americans pay no taxes as adults add to that the estimated 10-15 million illegal immigrants.
There is no way that a universal health care system can be viably implemented unless America creates a population registry that can identify the entitlements for each individual and that would have to be designed from scratch to a high degree as we can not rely on driver's license data as the quality would be too low - too many errors.
Many illegal immigrants have both social security numbers and driver's licenses as these were issued without rigorous control of status before 9/11. The alternative is that you had to show a US passport or a valid foreign passport with a green card to be able to register.
Another problematic task is the number of points of registration. If the registration is done by hospitals - and not a federal agency - then it is highly likely that registration fraud would be rampant. It would be very easy to trespass the control of eligibility if it is registered and determined by a hospital clerk. This supports that the eligibility has to be determined by a central administration that has a vast access to data and information about our lives, income, and medical history. If one single registration at a health care provider or hospital would guarantee you free health care for life and there is no rigorous and audited process - then it is a given that corruption, bribery, and fraud would be synonymous with the system.
This requires a significant level of political strength to confront and set the limits for who is entitled - and here comes the real problem - selling out health care to get the votes of the free riders. It is apparent that the political power of the "free" health care promise is extremely high.
A promise that can not alienate anyone as a tighter population registry would upset the Hispanic population, as many of the illegal immigrants are Hispanics - and many Hispanics might be citizens by birth but their elderly parents are not. Would the voting power of the younger Hispanics act to put pressure to extend health care to elderly that are not citizens? Yes, naturally, as every group tries to maximize its own self-interest.
The risk is, even with an enhanced population registry, that the group of entitled would expand and put additional burden on the system beyond what it was designed for. That could come though political wheeling and dealing, sheer inability from an administrative standpoint to identify groups, or systematic fraud within the system itself.
We can speculate about the outcome but the challenges are clear. This also represents a new threat to the privacy and respect for the private sphere of the citizenry as an increased population registration and control empowers the government with more accurate information about our lives and the way we live our lives. Historically, has any government when given the opportunity to get power taken that opportunity and given that power back to the people after the initial objective was reached? Governments like to stick to power.
To ensure the universal health care system is designed to function as intended it, would require procedures that would limit fraud, amass a significant amount of personal information, have access to all your medical data, and also determine who you are beyond any doubt. Just to be able to determine if you are entitled or not and, track the expenditures you generate.
The aggregation of these data could also open the floodgates for any data mining within these data under the pure excuse that it would help the universal health care system to better "serve you" and lower the costs.
To lower the costs also means to identify which procedures should not be done on which type of patients as it is not viable based on the government's interest to optimize your productivity under your life cycle. The collection of data has a tendency to look inviting and good when we start to collect it but aggregated data and personal information creates a deep intrusion in our privacy.
If you leave the United States and are no longer a resident of the state, even if you are a citizen and might maintain a driving license, you will have to report immediately if you want to avoid the 13% health care tax. I use the number 13% as it is in Sweden to exemplify the actual tax pressure that is laid upon you for the nationalized health care.
Let's say you moved and you do not want to pay the 13% tax for services you do not receive, can receive, or want to taken out from the tax roll. The mammoth entity has no interest to let you go so easy. You will end up having to reveal your private life - partner, dwellings, travel, money, and job to prove your case that you have the right to leave the public health care system and do not need to pay the tax. If you have to seek an appeal, your information could be a part of administrative court documents that are open and public documents. As soon as you return to the United States, you will be automatically enrolled again and the taxes start to pile up.
Public universal health care has no interest in protecting your privacy. They want their tax money and, to fight for your rights, you will have to prove that you meet the requirements to not be taxable. In that process, your private life is up for display.
The national ID-card and national population registry that includes your medical information is a foundation of the nationalized health care system. You can see where this is going - population control and ability to use the law and health care access to map your whole private life in public searchable databases owned and operated by the government.
By operating an impeccable population registry that tracks where you live, who you live with, when you move and your citizen status including residency the Swedes can separate who can receive universal health care from those not entitled. The Swedish authorities will know if you have a Swedish social security number, with the tap of the keyboard, more information about yourself than you can remember. The Swedish government has taken sharing of information between agencies to a new level. The reason is very simple - to collect health care tax and suppress any tax evasion.
It is heavily centralized and only the central administration can change the registered information in the data. So if you want to change your name, even the slightest change, you have to file an application at a national agency that processes your paperwork. This centralized population registry makes it possible to determine who is who under all circumstances and it is necessary for the national health care system. Otherwise, any person could claim to be entitled.
To implement that in the United States requires a completely new doctrine for population registry and control. In an American context that would require that every existing driving license had to be voided and reapplied under stricter identification rules that would match not only data from Internal Revenue Service, state government, municipal government, Social Security Administration, and Department of Homeland Security but almost any agency that provides services to the general public. The reason why a new population registry would be needed in the United States is the fact that lax rules dating back to the 1940s up until the War on Terrorism, and stricter identification criteria following 9/11, has made a significant percentage of personal information about individuals questionable.
If America instead neglects maintaining secure records, determining eligibility for public health care would not be possible and the floodgates for fraud would open and rampant misuse of the system would prevail. This would eventually bring down the system.
It is financially impossible to create a universal health care system without clearly knowing who is entitled and not. The system needs to have limits of its entitlement. A social security number would not be enough as these numbers have been handed out through decades to temporary residents that might not even live in the United States or might today be out of status as illegal immigrants.
The Congress has investigated the cost of many of the "public options", but still we have no clear picture of the actual realm of the group that would be entitled and under which conditions. The risk is political. It is very easy for political reasons to extend the entitlement. Politicians would have a hard time being firm on illegal immigrants' entitlement, as that would put the politicians on a collision course with mainly the Hispanic community as they represent a significant part of the illegal immigrants. So the easy sell is then that everyone that is a legal resident alien or citizen can join according to one fee plan and then the illegal immigrants can join according to a different fee structure. That assumes that they actually pay the fee which is a wild guess as they are likely to be able to get access to service without having to state that they are illegal immigrants.
It would work politically - but again - without an impeccable population registry and control over who is who on a national level, this is unlikely to succeed. The system would be predestined to fail because of lack of funds. If you design a system to provide the health care needs for a population and then increase that population without any additional funds - then naturally it would lead to a lower level of service, declined quality, and waiting lists for complex procedures. In real terms, American health care goes from being a first world system to a third world system.
Thousands, if not a million, American residents live as any other American citizen but they are still not in good standing with their immigration even if they have been here for ten or fifteen years. A universal health care system will raise issues about who is entitled and who is not.
The alternative is for an American universal health care system to surrender to the fact that there is no order in the population registry and just provide health care for everyone who shows up. If that is done, costs will dramatically increase at some level depending on who will pick up the bill - the state government, the federal government, or the public health care system.
Illegal immigrants that have arrived within the last years and make up a significant population would create an enormous pressure on a universal health care, if implemented, in states like Texas and California. If they are given universal health care, it would be a pure loss for the system as they mostly work for cash. They will never be payees into the universal health care system as it is based on salary taxes, and they do not file taxes.
The difference is that Sweden has almost no illegal immigrants compared to the United States. The Swedes do not provide health care services for illegal immigrants and the illegal immigrants can be arrested and deported if they require public service without good legal standing.
This firm and uniform standpoint towards illegal immigration is necessary to avoid a universal health care system from crumbling down and to maintain a sustainable ratio between those who pay into the system and those who benefit from it.
The working middle class that would be the backbone to pay into the system would not only face that their existing health care is halved in its service value - but most likely face higher cost of health care as they will be the ones to pick up the bill.
The universal health care system would have maybe 60 million to 70 million "free riders" if based on wage taxes, and maybe half if based on fees, that will not pay anything into the system. We already know that approximately 60 million Americans pay no taxes as adults add to that the estimated 10-15 million illegal immigrants.
There is no way that a universal health care system can be viably implemented unless America creates a population registry that can identify the entitlements for each individual and that would have to be designed from scratch to a high degree as we can not rely on driver's license data as the quality would be too low - too many errors.
Many illegal immigrants have both social security numbers and driver's licenses as these were issued without rigorous control of status before 9/11. The alternative is that you had to show a US passport or a valid foreign passport with a green card to be able to register.
Another problematic task is the number of points of registration. If the registration is done by hospitals - and not a federal agency - then it is highly likely that registration fraud would be rampant. It would be very easy to trespass the control of eligibility if it is registered and determined by a hospital clerk. This supports that the eligibility has to be determined by a central administration that has a vast access to data and information about our lives, income, and medical history. If one single registration at a health care provider or hospital would guarantee you free health care for life and there is no rigorous and audited process - then it is a given that corruption, bribery, and fraud would be synonymous with the system.
This requires a significant level of political strength to confront and set the limits for who is entitled - and here comes the real problem - selling out health care to get the votes of the free riders. It is apparent that the political power of the "free" health care promise is extremely high.
A promise that can not alienate anyone as a tighter population registry would upset the Hispanic population, as many of the illegal immigrants are Hispanics - and many Hispanics might be citizens by birth but their elderly parents are not. Would the voting power of the younger Hispanics act to put pressure to extend health care to elderly that are not citizens? Yes, naturally, as every group tries to maximize its own self-interest.
The risk is, even with an enhanced population registry, that the group of entitled would expand and put additional burden on the system beyond what it was designed for. That could come though political wheeling and dealing, sheer inability from an administrative standpoint to identify groups, or systematic fraud within the system itself.
We can speculate about the outcome but the challenges are clear. This also represents a new threat to the privacy and respect for the private sphere of the citizenry as an increased population registration and control empowers the government with more accurate information about our lives and the way we live our lives. Historically, has any government when given the opportunity to get power taken that opportunity and given that power back to the people after the initial objective was reached? Governments like to stick to power.
To ensure the universal health care system is designed to function as intended it, would require procedures that would limit fraud, amass a significant amount of personal information, have access to all your medical data, and also determine who you are beyond any doubt. Just to be able to determine if you are entitled or not and, track the expenditures you generate.
The aggregation of these data could also open the floodgates for any data mining within these data under the pure excuse that it would help the universal health care system to better "serve you" and lower the costs.
To lower the costs also means to identify which procedures should not be done on which type of patients as it is not viable based on the government's interest to optimize your productivity under your life cycle. The collection of data has a tendency to look inviting and good when we start to collect it but aggregated data and personal information creates a deep intrusion in our privacy.
Thursday, 17 February 2011
Electronic Medical Record Systems And The Environment
EMR, commonly known as electronic medical record, has opened a new chapter of service quality in the field of healthcare. It has brought opportunities for the medical staff to make their work life as effortless as possible by streamlining clinical procedures. In recent past when EMR was introduced it took huge amount of resources in the form of human capital, postal services and stationery item to process just one file. EMR software has proved to be a environment friendly healthcare system by removing the need for bulky paper work, piles of record keeping and hand written applications and prescriptions, substituting it with the sustainable and atmosphere pro electronic medical record system.
During 1990s, particularly in 1996 when the HIPAA Act came into effect, there was very low electronic medical record usage by physicians. Some of the adoption issues reported then with EMR systems were fears of poor security of sensitive information and the complexity involved in the personal information held. The resulting solution was industry led, as CCHIT was formed to only support the electronic health system but also certify it so that clinics and hospitals can widely adapt to the environment friendly health care option.
EMR Software - An Eco Friendly Alternative?
Much has been said about eco friendly or environmental friendly business alternatives and many business organizations are spending fortunes making their products friendly to the environment. This is the same for electronic medical record system companies. Many larger firms, such as CureMD, NextGen, CERNER, and Epic Care are developing electronic medical records system with paper-free services like electronic medical billing, business process outsourcing, and online registration of patients, online data compilation and electronic entry by physicians. Together with these solutions a popular recent innovation of EMR system is the use of web-accessible patient records.
With the advent of this important module, the healthcare facility becomes accessible nearly anywhere. The product of EMR system aims to deliver well-organized data and information directly to patients so they remain fully informed of their conditions throughout their recovery.
Meanwhile, the primary objective EMR system adoption is to make the work surroundings at clinics and hospitals paper free and efficient while including the minimum probability of errors. This environmental friendly health care system is not only sustainable but will also result in far fewer laboratory appointments for reports, thus easing patient's physical and mental condition.
The Green Merits Of An Electronic Medical Record System
Because a leading-edge electronic medical record system has high processing capability, with applications processed with a single click, it has provided huge efficiency bonuses to practices. With its innumerable benefits it intends to trim down errors and filing time.
These days, resources are limited and we all are trying to find the most environmental friendly way of doing business. EMR systems contribute towards environment protection by converting paper records into software databases. The energy saved in just one electronic medical record is truly surprising, and is a great step for an industry that definitely has no shortage of waste.
During 1990s, particularly in 1996 when the HIPAA Act came into effect, there was very low electronic medical record usage by physicians. Some of the adoption issues reported then with EMR systems were fears of poor security of sensitive information and the complexity involved in the personal information held. The resulting solution was industry led, as CCHIT was formed to only support the electronic health system but also certify it so that clinics and hospitals can widely adapt to the environment friendly health care option.
EMR Software - An Eco Friendly Alternative?
Much has been said about eco friendly or environmental friendly business alternatives and many business organizations are spending fortunes making their products friendly to the environment. This is the same for electronic medical record system companies. Many larger firms, such as CureMD, NextGen, CERNER, and Epic Care are developing electronic medical records system with paper-free services like electronic medical billing, business process outsourcing, and online registration of patients, online data compilation and electronic entry by physicians. Together with these solutions a popular recent innovation of EMR system is the use of web-accessible patient records.
With the advent of this important module, the healthcare facility becomes accessible nearly anywhere. The product of EMR system aims to deliver well-organized data and information directly to patients so they remain fully informed of their conditions throughout their recovery.
Meanwhile, the primary objective EMR system adoption is to make the work surroundings at clinics and hospitals paper free and efficient while including the minimum probability of errors. This environmental friendly health care system is not only sustainable but will also result in far fewer laboratory appointments for reports, thus easing patient's physical and mental condition.
The Green Merits Of An Electronic Medical Record System
Because a leading-edge electronic medical record system has high processing capability, with applications processed with a single click, it has provided huge efficiency bonuses to practices. With its innumerable benefits it intends to trim down errors and filing time.
These days, resources are limited and we all are trying to find the most environmental friendly way of doing business. EMR systems contribute towards environment protection by converting paper records into software databases. The energy saved in just one electronic medical record is truly surprising, and is a great step for an industry that definitely has no shortage of waste.
Thursday, 10 February 2011
The Japanese Health Care System
Japan, a nation with a long life expectancy, a rapidly aging population and a reputation as being expensive, surprising has one of the lowest per capita health care costs among the developed nations. Here is a basic look at the system, how it controls costs and some of its positive and negative points.
Residents of Japan are obliged to join one of two types of health insurance systems. One type is a social insurance plan which is normally for corporate employees. The other is national health insurance, which is for the self-employed, students and others not covered under a social insurance plan.
When someone goes to a hospital in Japan, insurance will usually cover 70%-80% of the costs upfront with the patient paying the difference. For more expensive treatments, the patient can receive a reimbursement for costs incurred.
By law, the insurance plans cannot deny a legitimate claim or refuse anyone regardless of preexisting conditions. Also, medical care is not rationed by age or for any other reason. Most hospitals are privately owned. However, the rates they can charge for most services and drugs are set by Japanese Health Ministry every couple of years.
People are free to choose whichever hospital they like. In spite of the fact Japanese people receive more medical care and spend more time in hospitals, Japan spends less on health care, and health insurance costs are much lower.
Negative points of the Japanese system
Doctors on average see more patients and thus spend less time with each individual patient than in the US. Hospital conditions are often not as nice as those found in the US. For example, unless paying for a private room, most patients stay in shared rooms with the patients separated by curtains. Most hospitals do not take reservations. Patients simply go to the hospital and wait their turn.
Drugs are often over prescribed. One reason for this is that since doctors spend less time with each patient, the sometimes simply prescribe drugs for initial visits instead of more thoroughly diagnosing the problem. The other reason is that hospitals sometimes can make money off the prescriptions.
Since going to the hospital is relatively cheap, people abuse the system and seek medical treatment when it is not really needed. Many hospitals are losing money since prices are often set too low. Also, there is underinvestment in some areas and the system is laden in paperwork and regulation.
While premiums are still much lower than the US, they are rising and an increasing number of people cannot afford them. However, this is often offset by programs that provide medical care for the children and the elderly. Overall, while the Japanese health care system does a good job at providing nearly universal coverage at an affordable price, it is not without it problems.
Residents of Japan are obliged to join one of two types of health insurance systems. One type is a social insurance plan which is normally for corporate employees. The other is national health insurance, which is for the self-employed, students and others not covered under a social insurance plan.
When someone goes to a hospital in Japan, insurance will usually cover 70%-80% of the costs upfront with the patient paying the difference. For more expensive treatments, the patient can receive a reimbursement for costs incurred.
By law, the insurance plans cannot deny a legitimate claim or refuse anyone regardless of preexisting conditions. Also, medical care is not rationed by age or for any other reason. Most hospitals are privately owned. However, the rates they can charge for most services and drugs are set by Japanese Health Ministry every couple of years.
People are free to choose whichever hospital they like. In spite of the fact Japanese people receive more medical care and spend more time in hospitals, Japan spends less on health care, and health insurance costs are much lower.
Negative points of the Japanese system
Doctors on average see more patients and thus spend less time with each individual patient than in the US. Hospital conditions are often not as nice as those found in the US. For example, unless paying for a private room, most patients stay in shared rooms with the patients separated by curtains. Most hospitals do not take reservations. Patients simply go to the hospital and wait their turn.
Drugs are often over prescribed. One reason for this is that since doctors spend less time with each patient, the sometimes simply prescribe drugs for initial visits instead of more thoroughly diagnosing the problem. The other reason is that hospitals sometimes can make money off the prescriptions.
Since going to the hospital is relatively cheap, people abuse the system and seek medical treatment when it is not really needed. Many hospitals are losing money since prices are often set too low. Also, there is underinvestment in some areas and the system is laden in paperwork and regulation.
While premiums are still much lower than the US, they are rising and an increasing number of people cannot afford them. However, this is often offset by programs that provide medical care for the children and the elderly. Overall, while the Japanese health care system does a good job at providing nearly universal coverage at an affordable price, it is not without it problems.
Problems with Our Health Care System
Given the enormous amount of money that is spent on our health care system and the research that has gone into the various diseases we would be excused if we think that there should be able to trust our health care system to deliver quality health care. Sadly, our Western health care system falls well short of what is desired. Instead of healing and health it largely delivers suffering and further disease. Mendelssohn as far back as 1979 (and he wasn't the first to suggest it) considers that the public has been 'conned' about the benefits delivered by 'scientific medicine'. There is a great deal of myth that surrounds our current system.
A part of the myth is that medical practice has produced an overall increase in health in the past one hundred years. However, historical analysis has found that general improvements in social and environmental conditions provide a more adequate explanation of the changes than the rise of 'scientific medicine'. Factors such as the improvement in diet and nutrition, sanitation and improved general living conditions have made the greatest difference.
Hospitals are deadly. Mistakes/errors, accidents, infections, medical drug disasters, diagnostic equipment including; X-rays, ultrasounds and mammograms make hospitals very dangerous. Hard technology has taken over the central role in modern medicine as it is considered effective and efficient. This has however been questioned. It is considered uneconomic and it also causes an unnecessary amount of pain and suffering. Accidents in hospitals now occur more frequently than in any other industry except mining and high rise construction. In addition to this are the medical doctor caused diseases. They are so common that they have their own name - iatrogenesis. Again the general public is unaware of how common this disease is. All told, iatrogenesis accounts for 784,000 deaths each year in the United States - more American deaths than all the wars of the 20th century combined. 98,000 deaths a year are caused by medical errors alone, and surgical errors account for another 32,000 deaths. These figures include only deaths. Officials admit that medical errors are reported in official data only 5 percent of the time, so the problem is much greater - exactly how much greater, no one really knows.
Research carried out in Australia showed that the equivalent of a jumbo jet load of people died unnecessarily died each week in Australia because of medical interventions - this information was contained in an official Health Department report. It was substantially hushed up - because of the potential impact of the information on the general public! We talk about and work to reduce road accidents and we 'ground' airplanes that are shown to have faults - but the general public is generally unaware of the risks that they take when they come under the care of the medical health care system.
Apart from accidents and medical mistakes adverse drug reactions and infections account for many of the incidences of iatrogenesis. Adverse drug reactions are very common. Some of these reactions can be minor but they can also be deadly. There are five main groups into which these adverse reactions can be placed. Those that:
* adversely affect the blood cells,
* cause toxicity in the liver,
* damage the kidneys,
* affect the skin, and
* affect the unborn baby.
The hazardous side effects listed here do not include allergic reactions or medication errors, but rather the effects of the drugs themselves. Out of the 2.2 million cases of serious adverse reactions to drugs each year, authorities have listed four types of drugs as being the worst offenders for adverse reactions. These are antibiotics (17%), cardiovascular drugs (17%), chemotherapy drugs (15%), analgesics/anti-inflammatory drugs (15%). 198 drugs were approved by the FDA from1976 through 1985 and over 50 percent had serious post-approval reactions. Many adverse reactions were discovered during clinical trials and were covered up by pharmaceutical manufacturers in order to get FDA approval. The FDA is also far from blame free when it comes to giving approval for drugs that have serious reactions. The whole drug approval process has many problems and cannot be relied upon to protect the public from dangerous drugs.
Antibiotics are no longer working on many extremely dangerous bacteria or they only work in doses that that cause serious side effects. The development of these antibiotic resistant 'superbugs' is in the order of a crisis. In the years following the introduction of antibiotics they were (and still are) used for the treatment of common colds and flu and other complaints. Antibiotics, such as tetracycline were used (and still are) over long periods of time for the treatment of acne. Ampicillin and bactrim were used for the wrong reasons and there has been a reliance on antibiotics to treat recurrent bladder infections, chronic ear infections, chronic sinusitis, chronic bronchitis and non-bacterial sore throats. The UK office of health Economics in 1997 (cited in Chaitow) reported the following statistics:
· 5,000 people are being killed every year (in UK hospitals alone) by infections that they caught in hospital.
· A further 15,000 deaths are being contributed to by the infections that they caught in hospital.
· One in 16 patients who goes to hospital for anything will develop a 'hospital acquired infection'.
· Many of the infections acquired involve the difficult to treat 'superbugs'.
· USA figures published more than a decade ago show that 1 in 10 patients develops an infection that they caught in hospital - this involves around 2.5 million people every year.
· Every year 20,000 of these people die from their infections and the deaths of a further 60,000 are contributed to by the hospital acquired infection - a large number of these involve antibiotic resistant 'superbugs'.
The current approach of our health care system is ineffective and can potentially cause more harm and damage than the original condition. Although undoubtedly many lives have been saved by timely medical intervention much medical intervention is unnecessary and alternatives, which don't cause the same devastation, are available. Everyone needs to consider the way they interact with the medical system. Try to avoid the health care system if you can and certainly question your medical practitioner very carefully about any intervention they wish to make. Many will not like this questioning and just want to be seen as the 'all knowing, all wise doctor' - but this they are not! Do not be conned and do not buy into myths about the medical profession and health care.
Having said this it is important that if you are currently taking medication that you don't suddenly stop. Seek information, discover alternatives and discuss changing you approach to health care with a health professional. If your current medical practitioner is uninformed about alternatives (as many are) or unwilling to discuss these with you (as many are) then you may need to seek a different health professional who is prepared to help you improve your health rather than just use medical drug prescriptions or surgery!
A part of the myth is that medical practice has produced an overall increase in health in the past one hundred years. However, historical analysis has found that general improvements in social and environmental conditions provide a more adequate explanation of the changes than the rise of 'scientific medicine'. Factors such as the improvement in diet and nutrition, sanitation and improved general living conditions have made the greatest difference.
Hospitals are deadly. Mistakes/errors, accidents, infections, medical drug disasters, diagnostic equipment including; X-rays, ultrasounds and mammograms make hospitals very dangerous. Hard technology has taken over the central role in modern medicine as it is considered effective and efficient. This has however been questioned. It is considered uneconomic and it also causes an unnecessary amount of pain and suffering. Accidents in hospitals now occur more frequently than in any other industry except mining and high rise construction. In addition to this are the medical doctor caused diseases. They are so common that they have their own name - iatrogenesis. Again the general public is unaware of how common this disease is. All told, iatrogenesis accounts for 784,000 deaths each year in the United States - more American deaths than all the wars of the 20th century combined. 98,000 deaths a year are caused by medical errors alone, and surgical errors account for another 32,000 deaths. These figures include only deaths. Officials admit that medical errors are reported in official data only 5 percent of the time, so the problem is much greater - exactly how much greater, no one really knows.
Research carried out in Australia showed that the equivalent of a jumbo jet load of people died unnecessarily died each week in Australia because of medical interventions - this information was contained in an official Health Department report. It was substantially hushed up - because of the potential impact of the information on the general public! We talk about and work to reduce road accidents and we 'ground' airplanes that are shown to have faults - but the general public is generally unaware of the risks that they take when they come under the care of the medical health care system.
Apart from accidents and medical mistakes adverse drug reactions and infections account for many of the incidences of iatrogenesis. Adverse drug reactions are very common. Some of these reactions can be minor but they can also be deadly. There are five main groups into which these adverse reactions can be placed. Those that:
* adversely affect the blood cells,
* cause toxicity in the liver,
* damage the kidneys,
* affect the skin, and
* affect the unborn baby.
The hazardous side effects listed here do not include allergic reactions or medication errors, but rather the effects of the drugs themselves. Out of the 2.2 million cases of serious adverse reactions to drugs each year, authorities have listed four types of drugs as being the worst offenders for adverse reactions. These are antibiotics (17%), cardiovascular drugs (17%), chemotherapy drugs (15%), analgesics/anti-inflammatory drugs (15%). 198 drugs were approved by the FDA from1976 through 1985 and over 50 percent had serious post-approval reactions. Many adverse reactions were discovered during clinical trials and were covered up by pharmaceutical manufacturers in order to get FDA approval. The FDA is also far from blame free when it comes to giving approval for drugs that have serious reactions. The whole drug approval process has many problems and cannot be relied upon to protect the public from dangerous drugs.
Antibiotics are no longer working on many extremely dangerous bacteria or they only work in doses that that cause serious side effects. The development of these antibiotic resistant 'superbugs' is in the order of a crisis. In the years following the introduction of antibiotics they were (and still are) used for the treatment of common colds and flu and other complaints. Antibiotics, such as tetracycline were used (and still are) over long periods of time for the treatment of acne. Ampicillin and bactrim were used for the wrong reasons and there has been a reliance on antibiotics to treat recurrent bladder infections, chronic ear infections, chronic sinusitis, chronic bronchitis and non-bacterial sore throats. The UK office of health Economics in 1997 (cited in Chaitow) reported the following statistics:
· 5,000 people are being killed every year (in UK hospitals alone) by infections that they caught in hospital.
· A further 15,000 deaths are being contributed to by the infections that they caught in hospital.
· One in 16 patients who goes to hospital for anything will develop a 'hospital acquired infection'.
· Many of the infections acquired involve the difficult to treat 'superbugs'.
· USA figures published more than a decade ago show that 1 in 10 patients develops an infection that they caught in hospital - this involves around 2.5 million people every year.
· Every year 20,000 of these people die from their infections and the deaths of a further 60,000 are contributed to by the hospital acquired infection - a large number of these involve antibiotic resistant 'superbugs'.
The current approach of our health care system is ineffective and can potentially cause more harm and damage than the original condition. Although undoubtedly many lives have been saved by timely medical intervention much medical intervention is unnecessary and alternatives, which don't cause the same devastation, are available. Everyone needs to consider the way they interact with the medical system. Try to avoid the health care system if you can and certainly question your medical practitioner very carefully about any intervention they wish to make. Many will not like this questioning and just want to be seen as the 'all knowing, all wise doctor' - but this they are not! Do not be conned and do not buy into myths about the medical profession and health care.
Having said this it is important that if you are currently taking medication that you don't suddenly stop. Seek information, discover alternatives and discuss changing you approach to health care with a health professional. If your current medical practitioner is uninformed about alternatives (as many are) or unwilling to discuss these with you (as many are) then you may need to seek a different health professional who is prepared to help you improve your health rather than just use medical drug prescriptions or surgery!
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