Friday, May 9, 2008

Health Care and Employee Substance Abuse

AISHealth has reported this month that 9% of U.S. workers drink alcohol in ways that contribute to absenteeism and higher health care costs, according to a new study from The George Washington University Medical Center. Substance abuse has become a chronic problem in the workplace. As noted last summer by the Hazelden Foundation and reported by Medical News Today online in July, 2007, a national survey of human resources professionals shows that while substance abuse and addiction are recognized as among the most serious problems faced in the workplace, employer policies and practices are not fully addressing the problem. The survey also found that although most companies offer employee assistance programs, many do not openly and proactively deal with employee substance abuse issues, do not refer employees to treatment programs and face barriers that prevent them from helping employees seek and receive addiction treatment.

The Foundation concluded that treating drug and alcohol addiction results in more people finding their path to recovery, it results in more resilient families, more productive work places and healthier and safer communities. Yet, according to the survey, more than 67% of HR professionals today believe that substance abuse and addiction is one of the most serious issues they face in their company. Absenteeism, reduced productivity and a lack of trust are major problems stemming from substance abuse that affect the efficiency and success of companies across the country. Despite the serious nature of the issue and the wide adoption of policies and programs, many HR professionals are not referring employees to treatment programs. About 22% of HR professionals say their companies openly and proactively deal with employee substance abuse and addiction issues. Also, 85% of HR professionals believe that offering education programs to build understanding of addressing addiction in the workplace would be an effective component of a solution to this problem.

The results concluded that employee substance abuse and addiction can have a negative effect on business, and the most significant problems companies experience due to employee substance abuse and addiction were absenteeism (62%); reduced productivity (49%); lack of trustworthiness (39%); negative impact on the company's external reputation (32%); missed deadlines (31%); increased health care costs (29%); and unpredictable, defensive interpersonal relations (29%). Also, addiction issues may make new hires less attractive but do not deter commitment to current employees; and there is a growing issue for women with regard to substance abuse and addiction, according to the survey. One problem, though, is that the HR professionals surveyed believe that getting employees to acknowledge or talk about the issue is their toughest challenge.

The site for the Safety Daily Advisor reports that workplace drug and alcohol abuse, which, despite the government’s decades-long war on drugs, drains business of more than $100 billion a year. These costs come from lost productivity, vastly higher rates of absence than those of nonabusers, and workers’ comp claims many times as high. The human cost, to co-workers, families, and the abusers themselves, is, of course, immeasurably higher. They also recommend that an employer policy should state the following:

--A prohibition of illegal drugs and drug or abuse-related items and actions, spelling out the meaning of such definitions as “controlled substances”, “drug paraphernalia”, and conditions such as “under the influence.” (Note that, under the Americans with Disabilities Act, you may not simply ban all drugs in the workplace.) They also recommend a an employer have a policy on alcohol, which is a legal substance. Your company can, however, prohibit its consumption, or even its presence on premises, which includes use of company vehicles. Your company's policy should also spell out permitted uses, such as at social functions.
--Limitations on legal, prescribed drugs, such as permitting only one day’s supply at a time, in original containers, taken per a doctor’s instructions. You also may reserve the right to consult with your own doctors as to whether prescribed medications could create hazards in a given employee’s specific job circumstances.
--Enforcement Actions. This section of your policy must spell out your rights and procedures in ridding your workplace of illegal drugs and in controlling alcohol usage.

These work place policies should also include detailing an employer's right to reasonably search employee lockers and other personal spaces, and to conduct medically-efficacious testing, both pre-employment and during tenure of employment, when such tests are advisable. This usually includes after an incident, or when an employee shows signs of impairment, but testing can also be random, as long as all employees are treated with equal fairness.

Penalties: This section should detail your right to remove from the premises and discipline proven abusers, right up to termination. It should also provide penalties for those refusing to be tested or to cooperate in investigations stemming from drug or alcohol abuse. Employee rights to counseling or use of an EAP should also be spelled out here. And, as in many policies, the concept of employment-at-will should be restated. Be aware, however, that if your organization is unionized, the policy you write will be considered fair game for negotiation in the collective bargaining process. The Safety Daily Advisor has additional resources for this employee issue.

Substance abuse in the work environment needs to be addressed swiftly and with the best decorum. Employees who have the tendency to drink or take illegal drugs on the job are also likely to not be the most dependable. They also are going to make working conditions difficult for their co-workers. If your customers notice a problem, then you have lost business which affects the bottom line of staying in business. Many companies have a zero tolerance policy--one strike and you're out. Some businesses are a little more lenient, but they have a real need to maintain policies in place to deal with employee substance abuse. A worker, manager, or executive who is drunk or high on the job is a huge problem, and the results can be catastrophic if not properly addressed. Whatever your HR employee manual states about this particular situation, it needs to be strictly enforced.

Until next time. Let me know what you think.

Thursday, May 8, 2008

Health Care and Skin Cancer

It’s National Melanoma/Skin Cancer Detection and Prevention Month! According to the Skin Cancer Foundation, since 1996, May has been a time for educators and health professionals to spotlight skin cancer prevention, detection and treatment. Skin cancer is the most common form of cancer in the U.S., with over one million new cases diagnosed every year. Left untreated, skin cancers can be very dangerous, but with early detection — and intervention — most are curable. More than 250,000 cases are diagnosed each year, resulting in approximately 2,500 deaths each year, and 1 in 5 Americans and one in 3 Caucasians will develop skin cancer in the course of a lifetime. More than 90% of all skin cancers are caused by sun exposure, and your risk for skin cancer doubles if you have had five or more sunburns as reported by information on the SCF website.

The National Institute of Health reports that the two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common. Anyone can get skin cancer, but it is more common in people who:
--Spend a lot of time in the sun or have been sunburned
--Have light-colored skin, hair and eyes
--Have a family member with skin cancer
--Are over age 50

The NIH recommends that you should have your doctor check any suspicious skin markings and any changes in the way your skin looks. Treatment is more likely to work well when cancer is found early. If not treated, some types of skin cancer cells can spread to other tissues and organs. According to, a basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangiectases. The texture of such a spot is often shiny and translucent, sometimes referred to as "pearly." It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain melanin pigment, making them look dark rather than shiny. Superficial basal cell carcinomas often appear on the chest or back and look more like patches of raw, dry skin. They grow slowly over the course of months or years. Basal cell carcinomas grow slowly, taking months or even years to become sizable. Although spread to other parts of the body (metastasis) is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.

The information on goes on to talk in great detail about various types of skin cancers. They have extensive material about the disease, what causes it, how to avoid it with preventive measures, and how to get it treated. Good prevention techniques can include avoiding sun exposure in susceptible individuals. It is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups. Common sense preventive techniques include:
--limiting recreational sun exposure.
--avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon).
--wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun.
--regularly using a waterproof or water resistant sunscreen with UVA protection and SPF 30 or higher.
--undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor.
--avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light).

Squamous cell carcinoma is cancer that begins in the squamous cells, which are thin, flat cells that look like fish scales under the microscope. The word "squamous" came from the Latin squama, meaning "the scale of a fish or serpent" because of the appearance of the cells.
Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Thus, squamous cell carcinomas can actually arise in any of these tissues. Squamous cell carcinoma of the skin occurs roughly one-quarter as often as basal cell carcinoma. Light-colored skin and a history of sun exposure are even more important in predisposing to this kind of cancer than to basal cell carcinoma. Men are affected more often than women. Patterns of dress and hairstyle may play a role. Women, whose hair generally covers their ears, develop squamous cell carcinomas far less often in this location than do men as reported on

Unlike basal cell carcinomas, squamous cell carcinomas can metastasize, or spread to other parts of the body. These tumors usually begin as firm, skin-colored or red nodules. Squamous cell cancers that start out within solar keratoses or on sun-damaged skin are easier to cure and metastasize less often than those that develop in traumatic or radiation scars. One location particularly prone to metastatic spread is the lower lip. A proper diagnosis in this location is, therefore, especially important. Based on information on, it is highly recommended you seek immediate treatment.

So here is Skin Cancer At A Glance:
1.) There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
2.) Skin cancer is the most common form of cancer in humans.
3.) Ultraviolet light, which is in sunlight, is the main cause of skin cancer.
4.) The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal. Unexplained changes in the appearance of the skin lasting longer than two weeks should be evaluated by a doctor.
5.) Nonmelanoma skin cancer is generally curable. The cure rate for nonmelanoma skin cancer could be 100% if these lesions were brought to a doctor's attention before they had a chance to spread.
6.) Treatment of nonmelanoma skin cancer depends on the type and location of the skin cancer, the risk of scarring, as well as the age and health of the patient. Methods used include curettage and desiccation, surgical excision, cryosurgery, radiation, and Mohs micrographic surgery.
7.) Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

The Mayo Clinic says that all three types of skin cancer are on the rise — but most skin cancers can be prevented by limiting or avoiding exposure to ultraviolet (UV) radiation and by paying attention to suspicious changes in your skin. And with early detection, you can receive successful treatment for most skin cancers, even the most aggressive forms. Don't play around with this skin condition as it only gets worse without treatment. Be careful in the sun and with outdoor activities. Cancer goes after anyone with no discrimination. Better to be safe than sorry.

Until next time. Let me know what you think.

Wednesday, May 7, 2008

Health Care and HIV/AIDS

According to, about 40,000 people are diagnosed with HIV/AIDS annually in the United States. HIV stands for human immunodeficiency virus. This is the virus that causes AIDS. HIV is different from most other viruses because it attacks the immune system. The immune system gives our bodies the ability to fight infections. HIV finds and destroys a type of white blood cell (T cells or CD4 cells) that the immune system must have to fight disease as per the definition by the CDC. Also, they show that AIDS is the final stage of HIV infection. It can take years for a person infected with HIV, even without treatment, to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infections. When someone has one or more of these infections and a low number of T cells, he or she has AIDS.

Information available by the Center for Disease Control (CDC) indicates that HIV was first identified in the United States in 1981 after a number of gay men started getting sick with a rare type of cancer. It took several years for scientists to develop a test for the virus, to understand how HIV was transmitted between humans, and to determine what people could do to protect themselves. During the early 1980s, as many as 150,000 people became infected with HIV each year. By the early 1990s, this rate had dropped to about 40,000 each year, where it remains today. AIDS cases began to fall dramatically in 1996, when new drugs became available. Today, more people than ever before are living with HIV/AIDS. CDC estimates that about 1 million people in the United States are living with HIV or AIDS. About one quarter of these people do not know that they are infected: not knowing puts them and others at risk.

HIV is a fragile virus. It cannot live for very long outside the body. As a result, the virus is not transmitted through day-to-day activities such as shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, drinking fountain, doorknob, dishes, drinking glasses, food, or pets. You also cannot get HIV from mosquitoes. HIV is primarily found in the blood, semen, or vaginal fluid of an infected person. HIV is transmitted in 3 main ways:
1.) Having sex (anal, vaginal, or oral) with someone infected with HIV
2.) Sharing needles and syringes with someone infected with HIV
3.) Being exposed (fetus or infant) to HIV before or during birth or through breast feeding.

The CDC also warns that the only way to know whether you are infected is to be tested for HIV. You cannot rely on symptoms alone because many people who are infected with HIV do not have symptoms for many years. Someone can look and feel healthy but can still be infected. In fact, one quarter of the HIV-infected persons in the United States do not know that they are infected. Once HIV enters the body, the body starts to produce antibodies—substances the immune system creates after infection. Most HIV tests look for these antibodies rather than the virus itself. There are many different kinds of HIV tests, including rapid tests and home test kits. All HIV tests approved by the US government are very good at finding HIV. HIV also can be transmitted through blood infected with HIV. However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk for HIV infection through the transfusion of blood or blood products is extremely low. The U.S. blood supply is considered among the safest in the world.

According to the Mayo Clinic, in the 25 years since the first reports of the disease, AIDS has become a global epidemic. Worldwide, an estimated 38.6 million people are living with HIV, nearly half of them women and girls between the ages of 15 and 24. And though the spread of the virus has slowed in some countries, it has escalated or remained steady in others. In 2005, more than 4 million people were newly infected with HIV; 25 million have died of AIDS since the epidemic began. Despite improved treatments and better access to care for people in the hardest-hit parts of the world, most experts agree that the pandemic is still in the early stages. With a vaccine probably decades away, the best hope for stemming the spread of HIV now lies in prevention, treatment and education.

There are also many complications that can result from getting the AIDS virus. The Mayo Clinic also says HIV infection weakens your immune system, making you highly susceptible to a large number of bacterial, viral, fungal and parasitic infections. You may also be vulnerable to certain types of cancers. But treatment with anti-retroviral drugs has markedly decreased the number of opportunistic infections and cancers affecting people with HIV. It's now more likely these infections will occur in people who have not had treatment. Some of the additional health problems can be as follows:
--Bacterial infections, such as bacterial pneumonia and tuberculosis.
--Viral infections, such as viral Hepatitis and HPV.
--Fungal infections, such as Cryptococcal meningitis.
--Parasitic infections, such as Cryptosporidiosis causing chronic diarrhea.
--Cancers, such as Non-Hodgkins lymphoma.

Granted, HIV/AIDS is a highly infectious disease. The best way to not contract it is to be careful with any contact that you may have with someone who has the disease, and to maintain safe lifestyle practices. Abstinence is the primary way to keep from contracting HIV/AIDS, but in today's society, that is typically not the common practice. As a result, the spread of this disease and its complications has become a huge international health problem. If you are sexually active, always remember to practice safe sex. The amount of time it takes for symptoms of AIDS to appear varies from person to person. Some people may feel and look healthy for years while they are infected with HIV. It is still possible to infect others with HIV, even if the person with the virus has absolutely no symptoms. You cannot tell simply by looking at someone whether he or she is infected. According to information published online by the Nemours Foundation, when a person's immune system is overwhelmed by AIDS, the symptoms can include:
--extreme weakness or fatigue
--rapid weight loss
--frequent fevers that last for several weeks with no explanation
--heavy sweating at night
--swollen lymph glands
--minor infections that cause skin rashes and mouth, genital, and anal sores
--white spots in the mouth or throat
--chronic diarrhea
--a cough that won't go away
--trouble remembering things

Staying healthy is a good way to avoid getting HIV/AIDS. A very simple way to stay healthy is hand washing as noted by the Mayo Clinic. Hand washing doesn't take much time or effort, but it offers great rewards in terms of preventing illness. Adopting this simple habit can play a major role in protecting your health. Although it's impossible to keep your bare hands germ-free, there are times when it's critical to wash your hands to limit the transfer of bacteria, viruses and other microbes. Despite the proven health benefits of hand washing, many people don't practice this habit as often as they should — even after using the toilet. Throughout the day you accumulate germs on your hands from a variety of sources, such as direct contact with people, contaminated surfaces, foods, even animals and animal waste. If you don't wash your hands frequently enough, you can infect yourself with these germs by touching your eyes, nose or mouth. And you can spread these germs to others by touching them or by touching surfaces that they also touch, such as doorknobs. Infectious diseases that are commonly spread through hand-to-hand contact include the common cold, flu and several gastrointestinal disorders, such as infectious diarrhea. While most people will get over a cold, the flu can be much more serious. Some people with the flu, particularly older adults and people with chronic medical problems, can develop pneumonia. The combination of the flu and pneumonia, in fact, is the eighth-leading cause of death among Americans.

Always wash your hands:

  • After using the toilet
  • After changing a diaper — wash the diaper-wearer's hands, too
  • After touching animals or animal waste
  • Before and after preparing food, especially before and immediately after handling raw meat, poultry or fish
  • Before eating
  • After blowing your nose
  • After coughing or sneezing into your hands
  • Before and after treating wounds or cuts
  • Before and after touching a sick or injured person
  • After handling garbage
  • Before inserting or removing contact lenses
  • When using public restrooms, such as those in airports, train stations, bus stations and restaurants
HIV/AIDS is deadly. Don't be careless with lifestyle choices related to this health issue. There is still no way to cure AIDS, and at the moment the only way to remain safe is not to become infected, which makes prevention so important. Combinations of antiviral drugs and drugs that boost the immune system have allowed many people with HIV to resist infections, stay healthy, and prolong their lives, but these medications are not a cure. One of the reasons that HIV is so dangerous is that a person can have the virus for a long time without knowing it. That person can then spread the virus to others through high-risk behaviors. HIV transmission can be prevented by:
--abstaining from sex (not having oral, vaginal, or anal sex).
--always using latex condoms for all types of sexual intercourse.
--avoiding contact with the bodily fluids through which HIV is transmitted.
--never sharing needles.

Be safe, not sorry. Use your common sense, not your libido, to make wise choices that will affect your health and your life.

Until next time. Let me know what you think.

Tuesday, May 6, 2008

Health Care and Children

The American Academy of Pediatrics advocates that all children should have access to comprehensive, age-appropriate, quality health care. They advocate that all newborns, infants, children, adolescents, young adult patients through age 21 years, and pregnant women must have access to comprehensive health care benefits that will ensure their optimal health and well-being. The AAP wants medical services to be included in the health benefit plans offered by all private and public insurers. These services should be delivered by appropriately trained and board eligible/certified pediatric providers, including primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists. All providers of prenatal care should be able to identify a full range of medical and psychosocial risks and to refer patients for appropriate care throughout pregnancy. These services should be delivered in a variety of appropriate settings, and coordinated through the child's medical home, and they also should be delivered in an efficient manner that does not compromise the quality of care.

As a matter of fact, the AAP laundry list of services they want available to all children is very extensive and includes the following:

1.) Medical care including: a) health supervision with preventive care and immunizations according to the American Academy of Pediatrics' "Recommendations for Preventive Pediatric Health Care," and b) diagnosis and treatment of acute and chronic illness, developmental disabilities, learning disorders, and behavioral problems.
2.) Surgical care.
3.) Mental health, substance abuse, and services for other psychosocial problems including therapy, crisis management, day treatment, and residential care. This should also include evaluations and treatment of learning disabilities and related disorders such as attention deficit hyperactivity disorder.
4.) Emergency medical and trauma care services for children.
5.) Inpatient hospital and critical care services.
6.) Pediatric critical care, pediatric medical subspecialty, and pediatric surgical specialty consultations occurring either in the inpatient or outpatient setting.
7.) Family planning services.
8.) Pregnancy services including: a) genetic counseling and related services as needed; b) prenatal care; c) prenatal consultation with a pediatrician or board eligible/certified provider of pediatric care; d) care for all complications; e) counseling and services for all pregnancy management options; and f) care for the pregnancy of a dependent of a policyholder.
9.) Care of all newborn infants including: a) attendance at and management of high-risk deliveries or those mandated by hospital regulations; b) health supervision; c) treatment of congenital anomalies and other medical and surgical conditions; d) newborn intensive care services; and e) when indicated by the infant's physician, a follow-up visit in the child's home or in the physician's office within 48 hours of discharge.
10.) Laboratory and pathology services including screening for metabolic and other congenital disorders.
11.) Diagnostic and therapeutic radiology services.
12.) Anesthesia services including anesthesia when appropriate for all "covered" procedures.
Early intervention services and therapies for developmental, rehabilitative, and habilitative purposes including, but not limited to: a) physical therapy; b) speech therapy and language services; c) occupational therapy; and d) audiology.
13.) Home health care services including, but not limited to, private duty nursing, attendant care, and respite care.
14.) Intermediate or skilled nursing facility care in lieu of hospital care.
15.) Hospice care.
16.) Case management and care coordination integrated with child's primary care provider and family as required by those with special health care needs.
17.) Medical and social services required to evaluate and treat suspected child physical and sexual abuse in both inpatient and outpatient settings.
18.) Transfer/transport to a hospital or health facility.
19.) Preventive and restorative dental care and oral surgery.
20.) Nutritional and lactation counseling services.
21.) Prescription drugs, medical and surgical supplies, and special nutritional supplements, including, but not limited to, those prescribed under national clinical trials for acquired immunodeficiency syndrome/human immunodeficiency virus and other conditions.
22.) Rental or purchase and service of durable medical equipment including, but not limited to, equipment necessary to administer aerosolized medication and to monitor their effects, corrective eyeglasses or lenses, hearing aids, breast pumps, prostheses/braces, electrical and other types of ventilators, cardiorespirator monitors, oxygen concentrators, and customized wheelchairs.

Wow! That's a huge amount of medical care and treatment options for kids. Unfortunately, there is no perfect insurance coverage or medical plan on the market that includes all these items. If there was one that was all inclusive, it would cost an absolute fortune. Parents do their best to provide health care for children from the pre-natal stage through college, and the cost to do that is astronomical in the current market. Unfortunately, there are more than 9 million children lack health insurance, and millions more have inadequate coverage in the wealthiest nations in the world. Providing health coverage for all children should be a national priority. Investing in children's health yields many benefits, including improved development, improved school performance, and long-term savings in health care costs according to the Campaign for Children's Health Care.

Children need access to health care, and they should also be seen by a primary physician for regular checkups and ongoing medical needs. Nothing takes the place of a consultation with a physician, a health history, a physical exam, and a two-way conversation with time for questions and answers. The Nemours Foundation has many tips for pediatric health. Learning about health isn't just about medical diseases and conditions. It's also learning about the amazing ways the body works — and how to keep it working in the best way possible. It's about normal physical development and stages — and how they can differ from person to person. It's about the emotions and worries almost everyone faces — and how to keep things balanced. It's about stress that can interfere with daily life — and what to do to get some help. It's about thinking ahead so you can do the things you need to stay healthy — and how to prevent the things that can cause serious problems later on. It's about how families function in the good times — and in the bad. It's about the joys and challenges of parenting — and what families can do to help their kids and teens travel along the path that's best for them.

The Associated Press reports that over 200 million children worldwide do not have access to basic health care. As a result, about 10 million children, most from the developing world, die each year from treatable illnesses. An alarming number of countries are failing to provide the most basic health services that would save lives, with 30% of children in developing countries not getting basic health intervention such as prenatal care, skilled assistance during birth, immunizations and treatment for diarrhea and pneumonia. Wide disparities in health care for the poorest and best-off children are seen even in the highest-ranked countries. Use of existing, low-cost tools and knowledge could save more than 6 million of the 9.7 million children who die every year from easily preventable or curable causes, said the report issued by Save the Children. Some treatments include antibiotics that cost less than $0.30 to treat pneumonia, the top killer of children under 5, and oral rehydration therapy—a simple solution of salt, sugar and potassium—for diarrhea, the second top killer.

The United States has one of the best health care systems in the world. Yet, there is still room for improvement, especially for treating children and providing coverage for special and catastrophic health care needs. In addition to improving the status of uninsured children in out country, there needs to be a focused effort to help developing countries set up sustainable primary care networks in socially and economically disadvantaged areas. Much of this work is supported by private donations from foundations, corporations, charitable organizations, and individuals. The disadvantage is that many developing countries have no infrastructure to support health care, and many more governments are not interested in focusing resources to manage the health care and medical needs of their respective populations--especially children. In addition, there are some countries that have cultural mandates that disallow anyone in certain ethnic or caste demographics to even have access to health care.

Although the U.S. has a huge problem with about 16% of the population being uninsured, it could be worse. What our faith-based organizations, private corporations and employers, insurance companies, the medical community, and the government need to do is to more effectively manage the costs of medical treatment and to step up coordination of efforts on local, regional, and a national level to reign in the upward spiral of health care expenses. There are ways to manage costs more efficiently and decrease unnecessary expenses. Universal health care is not the answer; the net result would be government control of our health care system and a huge tax burden on the American taxpayer. Less money in the pocket means less health care for families and children.

Until next time. Let me know what you think.

Monday, May 5, 2008

Health Care and the Campaign

Americans have been watching the current Presidential political race with more enthusiasm this time than in recent years. An historic battle of epic proportions has been going on in the Democratic party between two candidates that have serious potential to be the 44th President of the United States. Democrats will be choosing between the first woman and the first African-American candidate ever to win the nomination for this national office. This horse race may actually come down to the wire and need a photo finish to verify who will go up against the Republican candidate, John McCain. Although not officially nominated until the national convention, Senator McCain will likely be the clear winner as he is the only candidate to qualify with enough delegates. This foregone conclusion in the Republican party has allowed him to move ahead with a strategy that will help galvanize Republicans to win in November--or at least that's the common hope among the party faithful.

According to Market Watch, health care has figured prominently in the Democratic presidential candidates' domestic policy proposals, with Sen. Hillary Clinton and Sen. Barack Obama promoting similar visions for expanding health coverage and reducing wasteful spending in the current system. Both candidates call for greater insurance industry regulation to ensure that people with pre-existing conditions can get health coverage. The biggest difference between the two is that Clinton wants to compel individuals to buy coverage while Obama only wants mandated coverage for children. On the other side of the campaign aisle, John McCain, the presumed Republican nominee, released details of his health-care plan at the end of April, 2008. It would grant refundable tax credits to people who buy their own health coverage outside of the employer-sponsored system. His plan, according to Reuters, would use tax credits to help shift from employer-based insurance coverage to an open market system where people can choose from competing policies.

Likely, the candidates likely will shift their health-care focus as the campaign progresses as reported by the Kaiser Foundation on Market Watch. As we move to the general election where the candidates are no longer speaking to the base but in particular to independent voters. If all the candidates begin to understand the public is viewing health care as a pocketbook issue, health care will be increasingly framed as an economic issue. Also, there will be opportunity for elected officials, not just candidates, to view health care differently according to the Foundation.

Lawmakers may start to include health care more in their broader economic policies similar to climbing the high hill of health reform. The Kaiser Foundation also suggests that reaching an agreement on how best to overhaul the health-care system remains elusive. There exists a profound ideological divide in Washington in particular about how to reform health care, and it will not be easy to come up with the money to pay for reforming health care. Changes in the economy and the public's growing insecurity about health-care costs are laying the groundwork for nationwide reform.

As reported by Reuters, the sharply contrasting health care visions of Republican John McCain and his Democratic presidential rivals offer the promise of a grand campaign debate -- if the candidates find room on a crowded agenda. While health care reform ranks as the second-biggest domestic issue after the economy in most national opinion polls, it will compete with the Iraq war, taxes, high gas prices and other topics for a prime-time spot in the campaign for November's presidential election. Nearly two decades of health care debate has made little headway toward finding a consensus approach, and the issue has not been a key factor in a presidential election since the collapse of the Hillary Clinton-led reform effort in 1994.

Additionally, as reported in the Reuters article, at least some of the political fury that doomed Clinton's health care initiative in 1994, when she was first lady, was fueled by the reluctance of people to abandon their employer health coverage. The Commonwealth Fund, a private nonpartisan foundation that supports health policy research, found in a 2007 survey that four of every five Americans, including about 75% of Republicans, believed employers should either provide health insurance for workers or contribute to the cost.

Currently, Senators Clinton and Obama seek universal health coverage for the 47 million Americans without insurance. Clinton would mandate coverage, while Obama would require it only for children.The Democratic plans would keep the existing job-based insurance system but expand government involvement in a hybrid public-private system. McCain calls the Democratic plan a "big government" solution that limits choice. Democrats say his plan reduces the incentive for companies to offer coverage and puts workers at risk of not getting it -- particularly those with pre-existing conditions that insurance companies will not cover according to the Reuters news release this month.

Market Watch also indicates that health care is certainly front and center on the minds of most Americans. Because most working-age Americans receive health insurance through their jobs, their worries about the economy are often interwoven with their anxiety about getting and keeping coverage. For many, losing a job or having their hours cut means losing access to affordable health insurance. About 158 million people had employer-sponsored health insurance last year, but job-based coverage has been eroding as costs climb, according to the Kaiser Family Foundation. In 2007, 60% of employers offered health benefits to at least some of their workers, down from 69% of firms that offered it in 2000. Health-care costs have been rising much faster than wages and general inflation. Since 2001, insurance premiums for family coverage have ballooned 78%, while wages have risen 19% and inflation has gone up 17%, according to Kaiser's annual employer health benefits survey.

As we get closer to the respective party conventions this summer, the focus on health care will heat up. Americans are tired of costs going up on everything from the price of gasoline to the cost of a visit to the doctor's office. Now with pricing at an all time historical high point to fill up your tank, getting to the family doctor is more critical than ever before. Although universal health care is not a viable option for the nation's economy, the current slate of Presidential candidates will need to work with Congress for an affordable solution. Whomever occupies the Oval Office this time next year will have lots of work to do.

Until next time. Let me know what you think.

Friday, May 2, 2008

Health Care and Nursing Homes

According to a study released this month by Genworth Financial and reported in the Dallas Business Journal, the cost of nursing home care has increased for most cities in Texas over the last five years. The study also indicated that nursing home costs rose an average of 24% over the five-year period, higher than the national average of 17 percent. When it comes to the cost of one year in a private nursing home, however, Texas is doing better than the nation as a whole.

According to the New York Sun this week, as New York hospitals wrestle with cutbacks and budget constraints, nursing homes are finding a new role in treating patients who are well enough to be sent home but need additional care. In a departure from their traditional role, nursing homes statewide in recent years have seen an influx of patients seeking short-term, rehabilitative care, as cash-strapped hospitals treat and discharge patients as quickly as possible. With increasing turnover rates at nursing homes, a number of facilities citywide are responding to the demand, taking on costly renovation projects that shrink the number of long-term beds but add space devoted to short-term care.

This movement toward short-term care is a response in part to financial pressures on hospitals to decrease length of stay and move patients out, and in part to decreased demand for long-term care beds, as other options have become more available for the elderly and disabled as also reported by The NY Sun. Industry leaders said the move to "diversify" their services — by offering home care, day care, assisted living, and rehabilitation — reflects an attempt by some facilities to stay afloat. For many nursing homes, rehabilitation services are seen as lucrative. Administrators said they lose money on long-term residents because Medicaid reimbursement rates are low, but some said Medicare — which pays for patients getting rehabilitation therapy — pays better. While reimbursement rates vary by facility, one nursing home administrator said he earns $400 each day for rehabilitation patients, compared to $250 each day for nursing home residents. As a result, there also has been increased competition among facilities seeking to attract and admit "good patients," or those with the most potential to be treated and discharged.

The cost of care in a private nursing home has risen dramatically according to Genworth. The national average is $76,460, which Genworth notes is more than one and a half times the average annual household income of $48,201. One year in a San Francisco nursing home now costs an average $100,101, the survey said. Semi-private rooms cost considerably less. As a comparison average costs for private one-bedroom units in assisted living centers, according to the Genworth survey for such a unit is $36,090. The study surveyed more than 10,000 nursing homes, assisted living facilities and home care providers in all 50 states.

Who pays for these costs? Individuals pay for a large portion of their nursing home costs. Medicaid, the payment source for people without sufficient income and assets to pay for themselves, accounts for about 45% of all long-term care spending. Medicare, medical insurance for people age 65 and older and those on Social Security disability, accounts for only 11% of nursing home costs since Medicare does not pay for nursing home care for the “long-term,” as some people mistakenly believe. Individuals who receive long-term care in a nursing home not covered by Medicare must pay the entire cost themselves whether it is from their Social Security check, pension, or savings. If individuals don’t have sufficient income or savings to pay for long-term nursing home costs, they “spend down” their income, savings, and other assets to help pay for their care until they are eligible for Medicaid, a Public Aid payment source.

According to Pacific Life, long term nursing home expenses can have a devastating impact on your retirement savings. Many people over 65 erroneously believe that Medicare will pay most or even all of their nursing home bills, or that their HMO will pick up the cost. That’s simply not true. And, the result is that many people are surprised to discover they will have to pay the greater portion of these costs out of their own pockets. Many consumers do not understand that Medicare and Medicaid provide only limited financial assistance with long-term care needs. While Medicare will cover up to 100 days of skilled nursing home care per benefit period, after 20 days beneficiaries must pay a coinsurance fee. Medicaid provides financial assistance for approximately 70% of nursing home residents, but some are required to deplete their assets before the program will pick up the bill for their care.

The cost of nursing homes, long-term care, retirement communities, and other independent living facilities is extremely variable. It’s important that you research all of these costs and factor them into your retirement planning, and this comes as Baby Boomers are approaching retirement amid worries that they haven't saved enough to cover day-to-day expenses as well as long-term medical care costs. The Genworth report has shown that the costs for nursing homes, assisted living facilities and some in-home care services have increased for a fifth consecutive year, and could rise further if a shortage of long-term care workers isn't resolved. The study also found study found that low wages and benefits as well as a lack of training and career-advancement potential have made it difficult to attract workers to the elder care industry and retain them.

As reported online with Time, an elderly person typically spends 2- 1/2 years in a nursing home, or more than $190,000 on average at today's costs. As an option, adult day health care, sometimes at a community-based center, can monitor medication, provide therapy and ensure that people with cognitive problems are watched and don't wander off. These centers are proving popular with families who have elderly parents living in their homes and need daytime support so they can continue jobs, take care of children or just get a break from caregiving. Adult day health care has an average daily cost of $59; that would work out to about $15,000 a year for participation five days a week.

America’s elderly with special needs and their loved ones have always paid a high price for long-term medical care. The emotional and financial toll of an extended stay in a care facility or nursing home can be extremely costly. Per the folks at The Money Alert, an added possibility is to purchase a Long Term Care plan. Even with the increase in health care costs for the elderly, many consumers don’t realize the benefits of long-term care insurance. Some long-term policies cover not only skilled nursing facilities but also in-home care and companion care. They propose that with healthcare costs rising, long-term care insurance can potentially offer relief from many years of steep bills and debt. Appropriate coverage depends on your financial situation and your retirement plan, so consult with your financial professional for help in selecting the right policy for you.

The greatest advice is to start planning now for the possibility that a nursing home or assisted living could be in your future. Make wise choices for your financial future. Do the right thing when it comes to making plans for the "Golden Years." Don't forget that time passes more quickly than we realize, and you will need to prepare for end-of-life options.

Until next time. Let me know what you think.

Thursday, May 1, 2008

Health Care and HSAs

Health News Digest reported this month that HSA sales have been on the rise. According to a study released by AHIP, more than 6.1 million Americans are covered by Health Savings Account (HSA)-eligible insurance plans, a 35% increase since last year, a new census by America’s Health Insurance Plans found. HSAs were authorized starting in January 2004. Since then, AHIP has conducted a periodic census of its members participating in the HSA plan market. Employers and individuals across the country and across the age spectrum are choosing HSA plans, which are now an important part of the portfolio of coverage options offered by health plans.

Key findings from the census include: There was an increase of approximately 1.6 million Americans enrolled in an HSA plan since January 2007. Previous censuses found that 4.5 million were enrolled in January 2007, 3.2 million were enrolled in January 2006, and 1.0 million were enrolled in March 2005. Additionally, 30% of individuals covered by an HSA plan were in the small-group market, 45% of individuals covered by an HSA plan were in the large-group market, and the remaining 25% were in the individual market. Also, HSA products accounted for 31% of new coverage issued in the small-group market. Individual market consumers selected HSA products for 27% of their new purchases of health insurance according to the AHIP report.

Health savings accounts are a relatively new product pushed by the Bush administration as a way to slow rising health care costs. Workers who purchase health insurance plans with a high deductible can deposit up to $2,900 into the account tax-free, or up to $5,800 for families. And, consumers can use the money in their account to pay their medical expenses, or they can save it for future needs, including retirement as reported by an article released by the Associated Press on Yahoo News. Overall, enrollment in such plans represents about 3.4% of the private insurance market, said America's Health Insurance Plans, which compiled the latest enrollment projections. The Association said more than a quarter of new enrollees were previously uninsured.

Information from Wikipedia: Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a High Deductible Health Plan (HDHP). The funds contributed to the account are not subject to federal income tax at the time of deposit. Funds may be used to pay for qualified medical expenses at any time without federal tax liability. Withdrawals for non-medical expenses are treated very similarly to those in an IRA account in that they may provide tax advantages if taken after retirement age, and they incur penalties if taken earlier. These accounts are a component of consumer driven health care.

Credit Union Times has reported about HSAs as tax-free, portable savings accounts that can be used to pay for medical expenses including prescription and over-the-counter drugs incurred by individuals, spouses or dependents. These accounts are accompanied by high-deductible comprehensive insurance policies that cover preventive care and larger medical bills. Unused HSA money rolls over from year to year and can then be used to pay for medical care up to the plan’s deductible.

Proponents of HSAs believe that they are an important reform that will help reduce the growth of health care costs and increase the efficiency of the health care system. According to proponents, HSAs encourage saving for future health care expenses, allow the patient to receive needed care without a gate keeper to determine what benefits are allowed and make consumers more responsible for their own health care choices through the required High-Deductible Health Plan. As per the Associated Press release, supporters of health savings accounts say the accounts make health coverage affordable because the insurance policies that accompany them generally require lower monthly premiums.

Also, have you taken a close look at your retail receipts lately? Many companies, such as CVS and Target, are now marking expenses that they think may be HSA-qualified. That is because anyone with a health savings account can reimburse themselves for those expenses tax-free according to HSA for America. Keep in mind that CVS doesn’t decide what you can pay for from your HSA, you do. So check closely, as they may miss something. When you have an HSA, all medical expenses (including aspirin, doctor visits, dental, eyeglasses, alternative care) become tax deductible.

Opponents of HSAs say they worsen, rather than improve, the U.S. health system's problems because people who are healthy will leave insurance plans while people who have health problems will avoid HSAs. There is also debate about consumer satisfaction with these plans. The Associated Press release indicates that critics question whether the poor and those with high medical expenses can afford all the up-front costs. They're concerned the plans are attracting two extremes: those who buy the policy because it's cheaper, but are unable to invest in the savings accounts, and those who use the accounts to generate tax breaks.

The GAO (Government Accountability Office) said national surveys indicate that more than 40% of people who purchased high-deductible plans don't open a health savings account, even though they were eligible to do so. Participants said they lacked information about the accounts, they could not afford them, or they did not believe they needed them. Also, Celent found there has been inadequate pre-and post-sale education, insufficient decision-making tools, and limited employer funding of accounts. Consumers are overwhelmed by the choices and are unable to conduct an adequate cost/benefit analysis.

There will continue to be both acceptance and opposition to HSAs. The key to growth in the market will be for employers to make sure that their workers have access to all the information about how the plans work and the availability to participate. Credit Union Times has indicated that a big key to a successful remodel is pleasing the consumer and generating positive word of mouth as indicated by Celent. During this period, those financial institutions that add value will have a chance to gain higher ground. That means to attract business and be on top, platforms must constantly be enhanced from the back office to customer facing ones. The rise of double accounts is already occurring and will continue, driven in part by baby boomers entering retirement. Consequently, financial institutions need to develop a long-term strategy that encompasses not only growth in new HSAs but also retention of customers.

HSAs are a good thing. More and more employers have been offering them to employees. Also, individual consumers should consider purchasing them. HSAs can be a great way to make the best use of your health care dollars.

Until next time. Let me know what you think.