Health Care and Doctors

The long standing relationship between patients and doctors has long been revered as the sacred cow of the medical industry. Health care has been a critical component of how people relate to physicians and other medical providers. For hundreds of years, no one would dare to rock that boat. However, more and more these days, reports indicate that many patients are losing faith and trust in their doctors. An article in the NY Times this week shows that about 25% of patients feel their doctors expose them to unnecessary risks and medical treatment.

Another study indicated that trust between patients and doctors determines how strongly people take recommended medications. This mistrust is now showing up in books, on the internet, and with personal testimonies of patients. Additionally, patients are big on privacy which improves satisfaction with medical providers according to a report released this month by Atlantic Information Services. Patients with shared hospital rooms had lower satisfaction than patients in private rooms, and patients like to be in settings where no one else is listening to the details of their medical condition.

The NY Times stated that the reasons for the frustration are complex. Physicians only have a few minutes to spend with each patient due to more demands on time and less reimbursements per patient from insurance companies. People are also upset about the increasing number of medical errors and lack of personal interest by doctors when patients are being treated. The rise of direct-to-consumer advertising by drug companies and internet sites have taught patients how to research their own health issues leading to more skepticism and questioning. Doctors were once the primary source of medical information and how to be treated, but that has changed now with the advent of the internet and other media. Patients become very annoyed and impatient with medical providers when doctors appear not to be attentive with what the patients are saying or requesting.

The article goes on to report that there appears to be a disconnect between the way patients and doctors view medicine. Patients are interested in being tended to, listened to, and being well while doctors are trained to diagnose disease and treat it. However, even though it may be challenging and time consuming, patients can find a new provider to help improve the relationship between them and the doctor for more open communication. You should also go to the doctor's office with a list of questions so you don't forget any important medical issues; and if the physician tries to exit the exam room too fast, you can stop the doctor by saying, "I still have some more questions." Patients who are open with their doctors about their feelings and fears will often get a similar return of open dialogue.

According to the Journal of Post Graduate Medicine, patients are arriving to their clinics armed with information they have found on the web, with a preconceived idea about their diagnosis and treatment options, more demanding regarding convenience and ease of access. They want to actively participate in therapeutic decisions and want all the decisions to be informed and intelligent. Meet the new empowered patient; empowered by the information technology and its benefits. Health information seekers on net have exponentially increased from 54 million in 1998 to 110 million (U.S. figures) in 2002 and are ever increasing; and 80% of adult Internet users, or about 93 million Americans, have searched for at least one of the sixteen major health topics online. This makes the act of looking for health or medical information one of the most popular activities online, after email (93%) and researching a product or service before buying it (83%).

The Journal reports that the classical e-patient belongs to the younger age group. Women are more likely to have searched for a health topic than males. The classical e-patient is better educated and is more likely to belong to the higher income group. They search for specific medical condition (63%), medical treatment or procedure (47%), diet and nutrition (44%), exercise and fitness (36%). This is the group of patients who are very critical of their health problems. They have been brought up in this information age and make optimum use of the internet and other sources. Before the information era, knowledge of medicine belonged only to the physician. The patient's role in his or her physician's office was simply to listen and comply.

However, the Internet has opened up the doors of information like never before according to the Journal report. There are innumerable sites ready to dish out detail information about the patient's condition. Not just basic information, the e-patient also has easy access to latest developments, various different treatment modalities available for the condition and can then make an intelligent choice. He approaches the physician with preconceived notions based on the Internet information. Due to the extensive resources available on the net, e-patient is a highly informed patient. They use information technology to take informed decisions for themselves as well as their elderly relatives. An informed patient is obviously an intelligent patient and wants to play a much more active part in the management of his condition. This generation also makes up the impatient patient. They are used to cellulars, ATMs, broadband access, net banking. They are used to the pace of life and “at the click of the mouse” convenience in life. They are used to the convenient, personalized services provided by the other sectors like travel, finance etc. They want quick, convenient and personalized approach to their health problems, too.

The JPGM Journal continues to indicate that for most of the 20th century, due to the lack of information, patients suffered the era of “Doctor knows best”. However, come the information age and patients are empowered with information. The immediate fallout is the replacement of trust by skepticism and weariness. “Blind trust” is being replaced by “Informed trust”. In fact the first health contact which traditionally was the family physician; is slowly being replaced by the internet in many cases. Patients search the net and consult their physician armed with information. A Harris Online poll found that patients who use the Internet to look for health information are more likely to ask more specific and informed questions of their doctors and to comply with prescribed treatment plans.

Yet, there has been a tremendous resistance from the health care professional to the changing dynamics of the doctor-patient relationship in this information age. The main concerns being the variable and unreliable nature of medical information on the net, the lost human touch and also the perception of the informed patient as the problem patient. The Internet age offers opportunities to improve the patient-physician relationship by sharing the burden of responsibility for knowledge. Patients still trust the information given by their physician than what is available on the net. The physician should now assume the role of Consultant helping his patient to sort the information available on the internet and arrive at informed and intelligent decisions. Doctors have found that it may take less time to explain complex medical information to Internet users than to non-users. Physicians should accept consumer contribution as valuable.

The doctor-patient relationship can be a great one when patients are informed and feel that their health care provider is genuinely interested in them as a patient and a person. When physicians start treating patients as numbers on a chart they will lose the confidence of those who are relying on them for health care. When patients feel like they are cattle being herded in and out of offices, they are likely to stampede.

Until next time. Let me know what you think.

Health Care and Shared Costs for Employees

Next year, over a third of employers plan to increase cost sharing in their medical plans according to a report issued by PricewaterhouseCoopers. That means that workers will have to pay more for health care than they have been, and companies will be taking less of the risk and expense. Yahoo News reported Health care costs are expected to rise more than 10% into 2009, according to a survey of insurers done by Aon Consulting Worldwide; and that increase is the smallest Aon has seen in six years. Experts say it shows that efforts to tame costs, such as employee wellness or disease management programs, may be paying off. Actuaries expect costs to rise an average of 10.6% during 12-month rating periods starting this year between April and September.

But the percentage likely won't be what the average employee faces for a premium hike next year according to the Yahoo News article. It doesn't reflect insurance plan designs or changes an employer might make to benefits plans. Many employers have started researching their benefit options for 2009, and some consultants say it's too early for predictions on next year's health care plan costs. Costs are still rising to keep up with growing patient demand for services, the needs of an aging population and prescription drug and technology costs, according to Aon Consulting. Overuse and misuse of services and an "out-of-control medical liability system" also contribute to increases. Additionally, health insurers have offered disease management programs and encouraged the use of cheaper generic drugs to help contain costs. Doctors, hospitals and employers all have worked to curb costs. But costs are continuing to increase.

The Seattle Times this month reported findings from a study done by AARP. Workers may have to contribute more to keep their health-insurance coverage. Among the findings:
1.) Cost sharing: Nearly half of the companies said they now pay 100 percent of the insurance premiums. An additional 26% pick up at least three-quarters of the costs, and 12% cover at least 51% of the premiums.
2.) Coping plan: If current cost trends continue, 29% of the employers said, it's extremely or very likely they will raise workers' share of premiums in the next three years. Twenty-five percent said they will increase deductibles.
3.) Terminating coverage: If health-care costs were to rise 10% above current levels, 14% of firms said they would drop health coverage. If costs rose 15% higher, 27% would do so. If costs rose 25%, four in 10 employers said they would stop providing coverage.

AARP found that employers' rising health-care costs are threatening thousands of workers with an even steeper toll -- the loss of any employer health coverage. Two-thirds of the employers surveyed said that if trends continue, they plan to pass along higher costs by upping employees' share of premiums, deductibles or co-payments -- or all three -- in the next three years. Many American workers are oblivious to the true cost of health care "because they're not paying the bill." However, one solution may be for employers to subsidize workers so that they can purchase coverage for themselves. One of these ways is through HRAs. Health Reimbursement Accounts can help workers pay for some health care treatments that can reduce the cost of health insurance. Any change must be comprehensive to work. It would require Americans to wean themselves from expensive medical technologies and take more responsibility for their health.

Businesses still battling health-care costs, though, according to the Central New York Business Journal. As reported by InsuranceNewsNet, it's no secret that increasing health-insurance premiums are one of the biggest cost drivers for small businesses. They feel that they are at a disadvantage compared to larger counterparts when it comes to access to coverage. A NASE (National Association of Self Employed) study indicated that of the more than 46% of responding businesses offering health insurance, only 18% offer coverage for full-time employees. The self-employed indicates more that 65% cite cost as the single most significant barrier to offering health insurance to employees.

The Business Journal also indicated that one of the factors expected to help drive medical cost increases in 2009 is the health-care industry is in an era of booming construction to replace facilities and adjust to consumer demands, such as a preference for private hospital rooms and a move to outpatient venues, as reported by Mercer Consulting. Use of generic drugs instead of brand names could save billions of dollars, if patients would learn to ask their doctors about those drugs. Employers should focus on helping workers with reducing waistlines and cutting the smoking rates. Furthermore, employers need to rely on prevention and disease-management programs to hold down cost increases in 2009, rather than shifting higher levels of cost-sharing onto workers.

The consulting services company Hewitt has reported that as the economy continues to weaken, and because salary increases are expected to remain similar to last year, employers are becoming increasingly sensitive to the effect higher health care costs have on employee take-home pay and payroll deductions. As a result, more companies move away from traditional employer strategies—such as employee cost-shifting—toward more aggressive and innovative steps that not only help mitigate health care costs, but also keep more money in employees' pockets. Employers must continue to take aggressive steps in 2009 to mitigate the impact of high premium increases on their health care budgets.

Steps to accomplish this goal are:
--Consolidating Vendors and Moving to Self-Insured Plans: this creates more purchasing power and leverage through the negotiation process and typically results in more realistic assumptions around such factors as overhead and risk margins, while also reducing overall cost by having a smaller number of health plans to manage. Also, they are consolidating plan participants under self-insured arrangements where they assume the full financial risk for medical claim costs and pay the health plan an administrative fee for services such as claims processing and provider network management.
--Increasing Focus on Improving Employee Health: employer interest in building employee knowledge and ownership for managing their health continues to grow. Most employers believe that keeping employees healthy has a direct impact on controlling health care costs, maintaining high levels of productivity and mitigating absences. Health- and wellness-related programs that address the spectrum of health risk from the healthy to the chronically ill—including health risk assessments, disease management programs, nurse help lines, and smoking cessation and weight management programs—are the most widely offered; however, emerging strategies such as value-based health plan designs and biometric screenings are rapidly gaining interest among employers.
--Aggressively Negotiating With Health Plans: employers are also holding their health plans accountable for delivering on specific program measures, including participation levels, clinical outcomes, reductions in claim costs, and member satisfaction levels. Companies are coming to the negotiation table well-informed and ready to articulate their requirements.
--Shifting Costs to Dependents: as employers struggle with making their health care budget dollars stretch further in an environment of continued high costs, some are beginning to cost-shift a portion of their dependent subsidy dollars to employees. This is taking many forms, whether through increased payroll contributions for dependent health care coverage or by applying surcharges to encourage dependent spouses to take coverage under their own employer's plans.

As prices for health care continue to rise, including insurance premiums and medical treatments, employers are seeking multiple ways to afford insuring workers. Creative options must be considered in order for employees to survive the health care marketplace.

Until next time. Let me know what you think.

Health Care and Salmonella

This is the year of the upset stomach and diarrhea. Salmonella has been the buzzword in the food and drug industry over the past few months, and the tomato industry has suffered unspeakable damage due to the FDA warning about this health care issue. Last week, this government agency lifted the warning regarding eating tomatoes that were thought to be responsible for the recent Salmonella outbreak. Attention has now shifted to the jalapeño pepper as the likely culprit. Since concerns remain regarding the risk of becoming ill from food contaminated with Salmonella, it is still relevant to know about Salmonella and diseases that it can cause in humans. And according to eDocAmerica,the FDA is continuing to investigate the current Salmonella outbreak in order to confirm the source of contaminated food. This is an extremely labor intensive process, since fresh produce can become contaminated at any point along the supply chain, from the field or greenhouse where it is grown to distribution points to food preparation in restaurants and homes.

The CDC reports that it is collaborating with public health officials in many states, the Indian Health Service, and the U.S. Food and Drug Administration (FDA) to investigate an ongoing multi-state outbreak of human Salmonella serotype Saintpaul infections. An initial epidemiologic investigation in New Mexico and Texas comparing foods eaten by persons who were ill in May to foods eaten by well persons identified consumption of raw tomatoes as strongly linked to illness. A similar but much larger, nationwide study comparing persons who were ill in June to well persons found that ill persons were more likely to have recently consumed raw tomatoes, fresh jalapeño peppers, and fresh cilantro. These items were commonly, though not always, consumed together, so that study could not determine which item(s) caused the illnesses. Recently, many clusters of illnesses have been identified in several states among persons who ate at restaurants. Most clusters involve fewer than 5 ill persons. Three larger clusters have been intensively investigated. In one, illnesses were linked to consumption of an item containing fresh tomatoes and fresh jalapeño peppers. In the other two, illnesses were linked to an item containing fresh jalapeño peppers and no other of the suspect items. Other clusters are under active investigation. The accumulated data from all investigations indicate that jalapeño peppers are likely to be a major cause of this outbreak. Fresh serrano peppers and fresh tomatoes remain under investigation. Investigators from many agencies are collaborating to track the source of the implicated peppers and other produce items. Since April, 1256 persons have been infected with Salmonella Saintpaul.

As reported by eDocAmerica, Salmonella is a type of bacteria that can live in the intestines of animals and humans. There are a number of strains of Salmonella bacteria and one is even responsible for causing Typhoid Fever. The particular strain of Salmonella that is responsible for the current epidemic is known as Salmonella Saintpaul. An infection with Salmonella bacteria is called salmonellosis. Symptoms include diarrhea, fever, and abdominal cramps. The illness usually lasts 4 to 7 days and most people recover without treatment. In some instances, the diarrhea becomes very severe, resulting in dehydration. The infection can also spread from the intestine into the blood stream to other parts of the body. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness.

The folks at eDocAmerica go on to say that Salmonella live in the intestinal tracts of humans and other animals, including birds, pet reptiles, dogs and cats, pigs and cattle. Infected humans, contaminated water, raw dairy products and chicken eggs can also serve as reservoirs for spread of the illness. The illness can develop when the Salmonella bacteria is ingested. This could occur in a variety of ways. Eating contaminated food, particularly poultry, meat and eggs is one of the most common ways. Food may also become contaminated by the hands of an infected food handler who did not wash their hands with soap after using the bathroom. With the current epidemic, contaminated tomatoes and peppers have both been suspected although recently, tomatoes were cleared. Infection can also occur after handling pet reptiles that harbor the bacteria or even after cleaning up after your dog. In those with a normal immune system, Salmonella infections usually resolve after 4 to 7 days and no treatment other than oral hydration is necessary. When severe diarrhea and dehydration complicates the illness, hospitalization and administration of intravenous fluids may be required. There are antibiotics that are effective against Salmonella however; indiscriminate use can result in the development of antibiotic resistance. Use of antibiotics is typically reserved for when the infection travels outside of the intestines to other parts of the body.

Be sure that high risk foods such as poultry, ground beef and eggs are cooked thoroughly as warned by eDocAmerica. Don't eat or drink foods containing raw eggs (Caesar salad dressing, homemade ice cream, etc.) or raw (unpasteurized) milk. Kitchen work surfaces and utensils should be washed with soap and water if they came in contact with potentially contaminated food. Since infants, the elderly, and those with immune compromise are particularly at risk from salmonellosis, be especially careful with their food preparation. Hands should be washed with soap after handling reptiles, birds, or baby chicks, and after contact with pet feces. At this time, the FDA is advising people in high risk populations such as elderly persons, infants and people with impaired immune systems to avoid eating raw jalapeño and raw serrano peppers. And, consumers may continue to eat canned jalapeños and serranos processed in a commercial food-processing facility, or foods that contain them; for example, the canned processed jalapeños and processed salsas sold in grocery stores.

The CDC recommends that consumers everywhere are advised to follow the general food safety guidelines below:
--Refrigerate within 2 hours or discard cut, peeled, or cooked produce items
--Avoid purchasing bruised or damaged produce items, and discard any that appear spoiled.
--Thoroughly wash all produce items under running water.
--Keep produce items that will be consumed raw separate from raw meats, raw seafood, and raw produce items.
--Wash cutting boards, dishes, utensils, and counter tops with hot water and soap when switching between types of food products.
--Cooking vegetables kills bacteria, including Salmonella.

Advice from the CDC also concludes that the contaminated peppers may still be in grocery stores, homes, and restaurants. Until more is known about the likely location of contamination, the FDA is advising all persons to avoid consuming raw jalapeño peppers and dishes containing those raw peppers. Consumers should be aware that raw jalapeño peppers are often used in the preparation of fresh salsa, pico de gallo, guacamole, and other dishes. Cooked or pickled peppers from jars and cans are not part of this warning.

The FDA recommends the following safe-handling practices for fresh produce for food-service providers, retailers, and restaurateurs:
--Wash hands thoroughly with soap and warm running water before and after handling fresh produce.
--Make sure that food employees are reporting illness and are not working while sick.
--Purchase food from known safe sources and maintain its safety from time of receiving through service.
--When fresh produce is received, follow supplier recommendations, if provided, regarding handling, storage temperatures, "use by" dates, and other recommendations for the produce.
--Avoid receiving or using damaged and partially decayed produce.
--Store raw produce such that it does not contaminate other foods with soil, etc. Store any fresh produce, whole or cut, where other products – especially raw meat and poultry – cannot cross-contaminate it.
--Segregate fresh produce from other refrigerated foods in refrigeration units by using a separate set of storage racks or separate cooler, if possible. Cover and store washed cut produce above unwashed, uncut fresh produce. Store all produce off the floor.
--Wash, rinse, and sanitize all sinks, utensils, cutting boards, slicers, and food preparation surfaces before use with fresh produce.
--Always wash fresh produce under running, potable water before use. Soaking produce or storing it in standing water is not recommended for most types of fresh produce. Commercial, “fresh-cut” tomatoes and other produce have already been washed before processing and should be considered ready-to-eat with no further need for washing unless the label says otherwise.
--Refrigerate foods prepared with fresh-produce ingredients.
--Do not re-serve freshly prepared dishes containing raw produce, including dishes made with raw tomatoes, cilantro, and hot peppers, such as salsa and guacamole.

Mexican food restaurants and other eateries have been taking a hit this summer as a result of the Salmonella outbreak. The tomato industry will survive, but it has been a rough patch for growers and food distributors. The FDA continues to search for the basis of the contamination, but it has been a long slow tortuous path, and the end is not in sight yet. However, the current culprit appears to be fresh jalapeno peppers as advised by the various government agencies and private health care groups. So, be careful what and where you eat. Pay attention to how your food is prepared. Make sure that you consume food that has been properly cooked.

Until next time. Let me know what you think.

Health Care and Good Employee Teeth

Going to the dentist takes time. If you're a working man or woman, you typically will need to miss time away from the office or your jobsite when you go to your appointment. Even if you only go for a cleaning once every six months, that still counts as time missed for productivity that otherwise would be beneficial towards your economic betterment. However, not going to the dentist for even minor preventive procedures will definitely result in more serious oral health issues later that require even a greater amount of time missed from work.

According to a report this month issued by Employee Benefit News, dental illness is the most common of all chronic health concerns and accounts for significant loss of workforce productivity and significant health care costs. Studies show workers who get their dental care completed and maintain good oral health do far better on the job than those who do not. Oral health reduces the chance for emergency visits and the pain and discomfort that can harm a worker's focus and confidence. Workers, confident about their family's health, are more focused, productive and secure. Absenteeism for dentist visits, pain, discomfort and poor self-confidence harm production, employee confidence and quality of life across the corporate community. Reports from the last 10 years provide some detail regarding the impact of oral health on the workplace.

Workers experience 164 million hours of lost work time each year due to dental visits. The country's annual cost for general dental care is estimated at $60 billion dollars, which does not account for cranial facial care and care for oral problems, such as oral cancer or chronic pain syndromes. These medical costs are estimated to average $100,000 per individual for the lifetime care required to address these oral illnesses and developmental problems.

Dental insurance coverage can influence people's decisions to use dental care. During 1996, 42.9% of all dental expenditures were paid by private dental insurance. During 1997, less than 50% of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. National data shows that, even with dental insurance, out-of-pocket expenses for dental care are about 50% of the total cost as reported by the study.

Here are some amazing stats offered by the Dental Aid website:
--95% of all Americans are afflicted by oral disease. Oral Cancer is more common than leukemia, melanoma of the skin, Hodgkin's disease and cancers of the brain, liver, bone, stomach, thyroid gland, ovaries or cervix.
--Lost work due to dental problems equates to 164,000 American workers off the job for the entire year.
--140 million Americans do not have dental insurance.
--Upon retiring, 85% of Americans have no dental insurance.

Employee Benefit News goes on to say that studies increasingly demonstrate the health and cost implications of oral illness to well-known chronic illnesses. Poor oral health impacts diabetes, heart disease, stroke, prenatal health, pneumonia and brittle bone disease in women. Common medications for blood pressure and mood disorders can harm oral health. Dental care costs exceeded the costs for cancer and diabetes.

Workers desire dental care as an important part of benefit programs. In fact, workers select health programs that include dental care at a greater rate than when medical benefits are offered alone. As reported by the U.S. Department of Labor's Bureau of Labor Statistics, about 80% of workers participate in benefit programs if dental care is part of the program. And, approximately 92% of unionized employees and 75% of nonunion workers select dental coverage if offered. This behavior is fairly consistent nationally. However, only 46% of the nation's workers have access to dental care through an employee benefit program. Although employers can offer dental care benefits, this does not mean that the employee receives appropriate care. Common mouth infections, tooth decay, bleeding gums, bone loss around teeth and oral malodor are consequences of risky behaviors and poor self-care. The information about these statistics has been made available in the Employee Benefit News Survey.

The Health and Human Services Department states that oral diseases can affect individuals, their family, the community, and society as a whole. Oral health problems can affect a person's ability to maintain a job or get promotions. They can also contribute to lowered academic achievement and goals. These effects have increased likelihood when a deformity due to the oral health condition is involved. Families may be affected if an individual cannot perform household functions or play his or her usual role in the family due to an oral health condition. Since some population groups bear a heavier burden of oral disease than others, the effects on these communities may be more pronounced than on the population as a whole.

The website for Employee Benefit News continues its overview of dental health and employee behavior. Healthy behaviors that support oral health go far beyond a healthy smile. People usually do not receive oral health information specific to their situation, nor do they know the benefits of timely dental visits for preventive care. Each person's risk for poor oral health is specific to his or her lifestyle and general health and can be measured through questionnaires about behaviors and situations that are significant to oral health and general health. Individuals will certainly respond to information that is specific to them, removes misconceptions about oral problems and helps them to become wise consumers of health care. Personalized oral health education can be easily facilitated through secure, interactive online risk assessment tools provided by a corporate wellness program at very low cost. This approach can significantly benefit the entire corporate community, provide precise data for program evaluation, direct timely dental preventive health care and reduce overall health care costs.

Lost time, lack of productivity, employee health, and reduced revenues are all critical reasons to make sure that employers should encourage workers to maintain good oral health. Providing access to a quality dental plan at affordable rates will help reduce the problems associated with employees who have problems related to poor oral health.

Until next time. Let me know what you think.

Health Care and Mental Health

Mental health issues are a big concern for many Americans including those suffering from various illnesses, health care providers and treatment centers, government agencies, and insurance carriers. The American Psychiatric Association released a report in May, 2008, that the economic impact of lost revenues amounted to over $193 billion each year in the U.S., noting that the evidence shows that the indirect costs of mental illness are enormous. The financial loss is attributed to lost earnings from unemployment among people with mental illnesses, and lower earnings among employees as a result of 30 days or more of missing performance on the job--some of those issues include bipolar disorder, psychosis, manic depression, violent behavior, attempted suicide, depression, and panic disorder. And, in older Americans, dementia and Altzheimer's are also a significant societal problem.

A report from the US Surgeon General was recently released that speaks to mental illness and its effects on the nation. The burden of mental illness on health and productivity in the United States and throughout the world has long been profoundly underestimated. Data developed by the massive Global Burden of Disease study, conducted by the World Health Organization, the World Bank, and Harvard University, reveal that mental illness, including suicide, ranks second in the burden of disease in established market economies, such as the United States. Nearly two-thirds of all people with diagnosable mental disorders do not seek treatment. When people understand that mental disorders are not the result of moral failings or limited will power, but are legitimate illnesses that are responsive to specific treatments, much of the negative stereotyping may dissipate.

Scientific American reported in January, 2008, that in any given year 26% of American adults suffer from mental disorders, based on guidelines in the official handbook for diagnosing mental illness, the DSM-IV. Only about a fifth of the cases are serious enough to cause a major disruption of everyday life, however, which has prompted some experts to call for more stringent diagnostic criteria. Others counter that tracking mild symptoms is important for preventing their escalation into more severe illness. Nearly half of all people who have one illness also suffer from at least one more. According to the National Institute of Mental Health, even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness. In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Many people suffer from more than one mental disorder at a given time. Nearly half (45%) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.

The current editor of FierceHealthCare has recently noted that as the debate in Congress over mental health parity in health insurance illustrates, there's no consensus in our society--or even in the healthcare industry--as to how to deal with the mentally ill. But it might be a good start to expose and focus on those issues, and the role they play in creating tragedies and violence in the healthcare workplace.The lack of understanding and attention may be, in part, because mental health is on a separate track from just about all other healthcare services. Patients who present a mental health problem in primary care are referred to a psychiatrist and/or therapist, neither of which have much contact with the PCP. Patients who turn up in the emergency department with a mental health crisis are shunted to a psych ward without much of a medical workup, and they seldom get any counseling or other forms of psych support until they're placed in a bed in the psych unit. No wonder the industry is ill-equipped to deal with mentally-ill patients.

Comments continue on FierceHealth Care to state that as long as mental healthcare is not only in short supply, but is also completely walled off from routine medical care, no one in the system is likely to know how to handle these cases. This needs to change, and fast. Take the issue of nurses getting assaulted by irrational patients. Of course, it's horrible that anyone should be assaulted on the job. However, given that nurses in an ED can expect to encounter irrational and potentially violent patients regularly, why not train them in the restraint techniques used by psych specialists and give them more formal training in psychiatric management? Neither of these would prevent violent incidents from happening, but nurses would have much better tools to cope with them. And of course, it would be extremely helpful to offer counseling or other support to patients while they wait for psych services. On the primary care level, why not contract with a mental health specialist even one day a week? Patients could see the psychiatrist--or even a less-costly counselor--who would report back directly to the primary care physician and help him or her understand that patient's needs. Such coordination could prevent many a sick patient's mental illness from escalating out of control.

There may be some positive news on the near horizon. The Wall Street Journal reported today that after long negotiations, the House and Senate have come to an agreement on mental health parity. After wrangling over the issue for more than a decade, a deal has emerged that seems to satisfy a pretty wide range of interest groups. Under the bill, employers who offer mental health coverage will have to provide benefits that are comparable to those for other maladies. Under current law, it’s fairly common for plans to, say, charge higher co-pays for mental health coverage than for other kinds of health care. The bill exempts employers with fewer than 50 employees. And it allows employers to choose which, if any, mental health conditions will be covered.

According to the National Institute of Health, mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important at every stage of life, from childhood and adolescence through adulthood. Everyone feels worried, anxious, sad or stressed sometimes. But with a mental illness, these feelings do not go away and are severe enough to interfere with your daily life. It can make it hard to meet and keep friends, hold a job or enjoy your life. Mental illnesses are common – they affect about one in five families in the U.S. It is not your fault if you have one. These disorders – depression, phobias, bipolar disorder, schizophrenia and many others - are real diseases that you cannot will or wish away. Fortunately, they are often treatable. Medicines and therapy can improve the life of most people with mental illnesses.

If you feel that you are having difficulty coping with any behavioral or mental health issue, seek professional assistance as soon as possible. Or, if you know someone that you suspect is having problems in this area, try to help them seek medical attention. It's one thing to have a "blue Monday" or feel out of sorts due to physical problems, health problems, bad news, or other temporary situations. It is altogether different to suffer from severe emotional or psychological problems that are more traumatic or long term. Even though the mental illness category covers a huge number of disorders and medical needs, the primary concern is to seek help right away. Better to get assistance in the early stage of a mental illness than to wait and suffer from a more serious diagnosis and the long term effects of ignoring the problem.

Until next time. Let me know what you think.

Health Care and the States

Currently, the nation's health care marketplace is buzzing with political ads about universal coverage and new proposals from the leading Presidential candidates. This year, health care is the hot topic on the minds of a significant number of Americans. Both the Democratic and the Republican parties each have their own versions of what they think the landscape should be in the new paradigm of health care and insurance. Alot of each plan is pretty scary; and both candidates are purveying on the internet, in speeches, and in other media their plan to make Americans healthy, wealthy, and wise when it comes to health care.

Not to be outdone, several states have gotten into the health care game with their own versions of what health care should be for the citizens of those respective states. Rather than waiting for a national program rolled out at the federal leveral, various state governments are taking the bull by the horns and developing their own health care program, most of which is designed to help the uninsured population in those states. Overall, the latest statistics from the federal government and other sources indicate that over 47 million Americans nationwide are not insured. That translates to about 16% of the total U.S. population that is not covered by health insurance.

The New York Times this month reported what is going on in the health care world. Congress, meanwhile, is considering legislation that, among other steps, would make it significantly easier for small businesses to organize insurance-buying pools. Despite bipartisan backing in both the House and Senate, it is uncertain whether the bills can be passed in this, an election year. But proponents say the legislation would almost certainly be reintroduced next term. Because smaller businesses cannot spread the costs and risks of an individual’s high medical bills over a large work force the way a big company can, they often must settle for less-generous coverage that leaves workers with substantial out-of-pocket medical expenses. Many small employers simply choose not to provide health benefits, which can cost more than $12,000 a year for a family of four.

Universal health care is not a new concept. The Boston Globe online this month spoke to some brief history at the national level starting in 1993. The last time a national healthcare plan was attempted, under President Clinton in 1993, the presidential panel charged with devising a proposal was widely criticized for not consulting enough with Congress, and protracted disagreements erupted, delaying its progress for months and ultimately resulting in its eventual demise. Currently, many see as the political climate as the best chance for widespread changes in the healthcare system in 15 years. Senator Ted Kennedy has a renewed effort that appears to be designed to identify areas of common ground between Democrats and Republicans, business and labor, providers and insurers, and others before the new president takes office.

According to the article in the New York Times today, the states are taking a variety of approaches. To help ease the burden of insurance premiums that have roughly doubled since 2000, some, like Arizona, are extending tax credits to small employers that provide medical coverage. Others, including New Mexico and Montana, are exploring ways to let small businesses band together to amass the purchasing power of big employers. Massachusetts plans to let small businesses benefit from its state-supervised insurance program. And some states, like Colorado, have passed tougher laws governing what insurers can charge small companies and business owners. And who can forget the health care war going on in California? The state of California has had an ongoing battle between "The Governator" and its legislature over state mandated insurance for the uninsured. It will take a while to sort all that out.

But, despite broad interest in the issue, though, making significant changes at the state level can be difficult both politically and practically. Connecticut has had an ongoing problem with this issue with differences between the state legislature and their governor. Connecticut had already taken significant steps meant to help small employers provide affordable health coverage. It was among the first, for example, to pass laws intended to limit the large annual jumps in premiums that tend to plague small businesses. But even Connecticut has yet to find a way to reduce the potential risk to a small company or insurer if even a single employee develops a serious illness and runs up tens or hundreds of thousands of dollars in medical bills. And, Massachusetts, in its widely watched effort to overhaul health insurance, has focused so far on making affordable coverage available to individuals. But later this year the state plans to expand the program to small employers, letting them participate in the state-supervised marketplace set up to give individuals group purchasing power.

The cost of insurance tend to be a bigger burden for a smaller business as reported by the NY Times. And employers that do continue to provide health benefits are tending to ask workers to pay more of the overall premiums. So even when small business owners offer coverage, their employees may not be able to afford to sign up. Many small business owners say it is hard to understand how their insurers are pricing the premiums. State laws now typically make it impossible for businesses to cross state lines to create their own purchasing pools, and small companies have had little success to date in being able to band together in sufficient numbers within state borders. But the federal legislation would let businesses form such purchasing pools more easily, even across state lines. The legislation would also prevent insurers in any state from basing their premiums on the health status of employees — a prohibition now on the books in only a minority of states. The legislation would also offer tax credits to businesses that provide coverage insurance to their employees. The states, meanwhile, will continue experimenting with their own efforts.

Recently, according to the Boston Globe article, a network of Massachusetts advisers assembled for discussion, including healthcare lawyers, economists, nonprofit leaders, doctors, and health insurers who may be asked to work on specific aspects of a national plan. At a recent meeting in Boston, the group discussed how different elements of the Massachusetts approach might work on a national level. Whether the Democrats and the Republicans and myriad interest groups can overcome their differences over the next year remains to be seen, but several of those participating in the discussions expressed optimism about that possibility.

America is moving down the path of universal health care. Although the case in favor of it is strong, wiser heads should prevail to ensure the country does not go to a one-payor system on a federal level. The costs and potential difficulties of administering it will far outweigh the benefits of a government run health care system. Common sense should rise above convenience.

Until next time. Let me know what you think.

Health Care and Consumer Confusion

There is some consumer confusion in the market place today about certain medical treatments, cost control, and health plans and how they work. Much of it relates to sourcing accurate information related to pricing and transparency. Health care information blog Health Populi has recently stated that consumers are interested in a variety of financial instruments to help them purchase health care. However, even when given a choice to shop for and eventual purchase insurance, millions of people don't. And, consumers are confused about health plan choices and need help in financial decision making.

Health Populi goes on to state that beyond insurance products, for example, some consumers like the idea of discount cards and annuities. There are options for Long Term Care, High Deductible Health Plans and HSAs, PPOs and HMOs, and even traditional insurance. Some vendors are even pushing some exotic plans that offer FSAs and HRAs through employer-based insurance. Companies are into wellness programs and more to help save money and get workers involved in the process.

According to the Blog's author, there isn't a great deal of variance in consumers' minds between the uses of these mechanisms based on whether the funds would go to long-term care, catastrophic expenses, or medical cost increases. The biggest differentiator is for catastrophic expenses, where consumers seem to understand the application of a savings vehicle. Many consumers like the idea of paying for support and advice for guidance. However, while about 70% of consumers want such support when shopping for new coverage, only 41% of those who had access to it found it "satisfactory." You know you have a problem with your health system when you're more concerned about the cost of your care than fighting your disease.

According to the Commonwealth Fund, on one hand, John and Joan Q. Public know exactly what they want: high-quality care at discount prices. They want it fast, they want it convenient, they want it cheap and--of course--they want the best health care system in the world. On the other hand, they don't know how the system works, what it costs or what their role is. They are still happy to use word-of-mouth to select doctors and hospitals. They tend to ignore data on quality, and 89% of people surveyed by the Fund said they were either very or somewhat satisfied with their physician. Just over 50% ranked the care they receive from their physician as excellent. Yet, two-thirds of Americans do not see the same physician for more than five years, and 23% don't even have a regular doctor. Consumers like their doctors, but don't establish long-term relationships with them.

However, the reasons that people doctor-hop have little to do with whether they're satisfied with the care they receive--it is usually for external reasons. According to a Harris poll, 50% of respondents say they changed doctors in the past five years because the medical provider was not covered by their health plan, they moved, or the doctor moved or retired. As reported in the San Francisco Business Times, consumers and employers are pushing for more standardized, easy-to-use tools that approximate what Consumer Reports does for car shopping and similar examples of comparison purchasing; and greater transparency is an important goal. Americans are hoping ways will be found to make quality and cost data more easily accessible and relevant to consumers.

The array of options, often contradictory data, and questions about the credibility and ease of use of some sites appear to have combined to make them less influential than many proponents expected. Such tools are irrelevant to patients unless the information they provide is germane to patients' particular treatment context, coverage situation, and personal preferences or values, according to the SF news article. The ongoing proliferation of quality "report cards" and rankings by hospital groups, medical providers, and health plans appears to be confusing consumers as much as enlightening them, some experts say, which may help explain why they're having limited impact on consumer behavior.

Health care price transparency is a good idea - it allows people to make informed decisions about where and when to seek non-emergency health care. In some cases, health care price transparency has not been proven to reduce health care costs. Some people may postpone or forgo preventative care which would prevent more expensive health conditions. Also, the information does not help people who require costly emergency care, such as treatment for a heart attack. This may be due to a certain lack of incentive on the part of consumers to do homework to find the information they need, or the information is just not available or displayed in a consumer friendly format. In order for consumers and purchasers to get better care at a lower cost, they need and want useful information according to the Robert Wood Johnson Foundation. There have been a number of significant advances in the effort to improve health care quality. Information on the quality and cost of health care will empower consumers to make informed decisions about their health care. Therefore, it is imperative that the information patients, consumers and their families receive is accurate, clear and relevant to them.

The Foundation also suggests that many different private- and public-sector groups have designed models for assessing performance and reporting data. However, the proliferation of multiple, uncoordinated and sometimes conflicting initiatives has significant unintended consequences for different stakeholders—unnecessarily burdening physicians, nurses, clinics and hospitals; creating confusion among consumers; and detracting from efforts by employers to design programs that meet the needs of their employees.

Americans like the power of personal choice. Unfortunately, most consumers have lulled themselves into a dream-like state with the easy availability of insurance co-pays. If you don't take charge of your own health care needs, then you will suffer the consequences of ignoring the best options for controlling costs and getting the quality of care you desire. Take the initiative to investigate various medical providers, costs for health care treatment, and available options to get the best care for the best price. It's your health, and it's up to you to keep it. Don't pass the buck, or you'll be paying big bucks for health care that is not the best for you, your family, or your employees.

Until next time. Let me know what you think.

Health Care and Cost Control

These days, everything costs more than it did this time last year. Gasoline has escalated to over $4 a gallon, and the price of oil is above $140 a barrel. Food prices have jumped as well as the costs of delivery to market. Americans are faced with inflationary prices unlike we have experienced for many years. Health care is no different. The good news is that health care premium increases rose at their lowest rate in eight years. The bad news is that the average increase is still more than 6%, and that’s still more than twice the rate of inflation. There are challenges to keep control of costs, especially for employers--benefit cost structure is increasing, and it remains difficult to shift some, much less all, of the increasing costs to employees.

Information available from Workforce Management provide some solutions. Here are a couple of easy ones:
1. Full coverage for preventive care benefits: This one is pretty simple. Drive intermediate to long-term utilization of your health care plan down by providing a healthy stipend ($500 per year? $1,000?) for preventive care covered at 100 percent. Thinking short-term in this area will drive up your long term major-medical costs.
2. Pit the providers against each other: Another simple one. If you have a contract expiring in any area, don’t be a rookie. Shop around. Areas you may not spend much time evaluating, like dental, vision and disability, are especially ripe for providers who are making pushes for market share. That means that there’s usually a provider willing to beat your current rate to get the contract signed.

Next are more complex solutions:
3. Carve out your prescription benefit: "Prescription carve-out" refers to the option for your company to use a pharmacy benefit management company, or PBM, to manage the pharmaceutical component of your medical plans, rather than allowing the traditional PPO or HMO to package it with their services on the medical side. The biggest benefits of the prescription carve-out are volume discounts and formulary design from a big provider like Caremark or Medco. Additionally, if you are a small company on a self-insured PPO/HMO, you may not control the ultimate design of your plan, and as a result may be covering things that aren't ordinarily covered nationally. Control doesn't mean taking benefits away, but it's always good to have options. Formulary design through the carve-out is also the best way to drive up your plan’s generic usage, which is where the real savings are.
4. Phone in the doctor visits: Services like TelaDoc allow your employees (over 12 years of age) to get personalized, non-emergency medical care over the phone without having to go to the doctor’s office. After completing a medical history, services like this allow employees to speak with doctors on an 800 number, receiving diagnosis and prescriptions over the phone for the most common conditions like strep throat, sinus infections or flu. The cost savings look like this: Each call costs roughly $35, versus $85 per doctor’s visit, or a $200 per "doc in the box" visit, or a $400 per emergency room visit. You can do the math.

And finally, here are solutions that could rankle employees:
5. Trust but verify on spousal/dependent coverage: This one’s personal. By doing an audit and forcing documentation that spouses and dependents who are on your plan are actually related to the employee in question, you can drop your total number of covered individuals by as much as 10 percent. Of course, in doing this, you’re presenting employees with a tough message on trust, and the ones who are not being forthright will be the ones with the worst reaction. Related flavors of this intervention include higher premiums for spousal coverage when the spouse is eligible for health care coverage elsewhere.
6. The carrot and the stick, aka penalties for unhealthy employees: With consumerism and wellness programs slow to deliver savings, companies are beginning to replace the carrot with a stick. The only question is the pace of change. The old strategy in this area (the carrot) is to offer financial incentives to employees who have healthy lifestyle habits or who participate in wellness and fitness programs. That’s nice, but it hasn’t always generated the change needed. If you want to be hardcore, you can join an increasing number of companies that take the opposite approach and penalize workers (the stick) for unhealthy choices, such as smoking, by charging them higher premiums. Proceed with caution.
7. Forced mail-order Rx: If you have mail order in place and want to drive up your generic use rate by another 5 percent to 10 percent, gather your courage and force any covered individual with a recurring prescription to use the mail-order system once they’ve made two visits to the pharmacy. You’ll benefit by maximizing your overall percentage of generics under the plan. Warning: While many people think such a move would be welcomed by employees (who wouldn’t want the convenience of mail order, right?), the reality is this option involves employees who ignore your communications being stranded at Walgreens, unable to get their meds. Chaos and escalated calls to your CEO will ensue.

If you are contemplating self insurance as a business owner or small company, be cautioned about some of the risks associated with this cost control measure. HealthFinanceNews.com gives good advice. Here are three pitfalls that can create unexpected costs:
1. Unfavorable employee mix--
It’s impossible to completely eliminate the risk of unexpected, high-dollar health claims. But here’s a guideline to lower your risk. Health claim stats suggest the “ideal” employee population for a self-insured plan is predominately young, non-smoking and male. If this doesn’t match your employee population, your costs may be higher. Be aware that stop-loss insurance carriers often “laser” those employees considered higher risk. Lasering means that your company would have to pay out much more in claims for these employees before the stop-loss coverage kicks in.
2. Loss of network discounts--
Some firms learned after the fact that going the self-insurance route caused them to lose providers’ network discounts they previously received under fully insured plans. When evaluating plan vendors’ administration-only options, ask: Will the vendor’s network alliances work in your best interests, cost-wise? Will the vendor only oversee claim payments or negotiate to build the best provider network, quality-wise, for your employees? Bottom line: You should get the same kinds of plan designs, networks and discounts as a fully insured plan.
3. Wasteful reinsurance contracts--
If the language of your reinsurance contract doesn’t match your health plan’s summary plan description, you may be paying for coverage you don’t need and can never use. It’s also key to make sure your firm has enough money in reserve to cover run-out claims and other costs that may occur before reinsurance will cover payments. Best practice: annual audits of your financial reserves.

According to CNNMoney.com, roughly 159 million people get their insurance subsidized by an employer and don't have to pay tax on that subsidy. On average, workers in employer plans pay only 28% - or $2,800 to $3,300 - of the premiums for family coverage and 16% (roughly $600 to $700) for single coverage premiums. By contrast, the 15 million who buy health insurance on their own don't get any subsidies or tax breaks, unless they're self-employed. Right now, whether a company offers its workers insurance - and offers to pay for it - is voluntary.

But maybe health care is different-something we hear often these days. Except when it isn't, as reported by the U.S. Chamber Magazine.com. Take LASIK eye surgery, for example. Doctors providing this service are constantly upgrading their expensive machines, looking for ways to attract customers and providing additional services. Still, the prices have fallen significantly since these procedures first became available. Why? The primary reason is that patients are paying out of their own pockets and demand value for their dollars. Herein lies the fundamental economic principle that explains why health care costs are growing much faster than the rate of inflation: cost insulation. In the vast majority of cases, when a patient goes to the doctor, hospital, or pharmacy, someone else-i.e., the employer, health insurer, or government-is paying the bill. And when someone else is paying the bill, consumers have little reason to care about the costs. When we as consumers are insulated from the cost of our purchasing decisions, we tend to consume more.

In this Chamber report by the Council for Affordable Health Insurance, we will never get health care costs under control until consumers have a reason to seek value-just as they do in every other sector of the economy. And the only way we're going to do that is to remove some of the cost insulation that pervades the health care system. Consumers in most markets can compare and contrast the costs and benefits between products and services and determine for themselves whether one is providing additional value. And since they are paying for the product or service themselves, they have an economic incentive to get value for their dollars. However, in most medical care there are no prices. And for good reason: Consumers don't really care about prices because they aren't paying the bill! As a result, most medical providers have no idea what it costs them to provide a particular service, and patients who want to know can't find out.

How do we move to a system where patients are seeking value for their health care dollars but are still protected from the financial devastation that could come from a major accident or illness? Actually, many employers have already discovered the answer. The U.S. Chamber report goes on to say that some companies are shifting away from traditional health insurance to a high deductible health insurance policy, in conjunction with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA).

The high deductible policy costs less-often significantly less-than a traditional policy, allowing the employer to give part or all of those savings to the employee. With the HSA, for example, employers might provide a policy with a $5,000 deductible for a family, but they put $3,000 or $3,500 into a tax-free personal account that belongs to the employee. Money left over in the HSA at year's end rolls over and grows with tax-free interest. Because that money belongs to the employee, he or she has an economic incentive to ask the question that is seldom asked today: Doctor, how much will that cost? Should a major accident or illness occur, health insurance kicks in to cover those costs and protect the employee's assets. And this approach appears to be working. Employers offering so-called consumer driven policies are seeing annual premium increases in the low single-digit range; those with traditional policies have seen average increases of 8% to 14% over the past several years.

There are definite ways to control costs in health care. The issue is whether you are willing to make the choices that are required to manage them. Some are easy, and some are not. Saving money, though, is always in your best interest.

Until next time. Let me know what you think.

Health Care and the 4th

After 232 years, the fateful experiment called the United States of America is still going strong. Although our nation has been battered about by the storms of war both foreign and domestic, Americans are going to celebrate our national birthday with more vigor than ever before. There will be backyard barbecues, picnics on the lawn, family reunions, travel to historic locales, and fireworks. Oh, the fireworks! Americans love fireworks--the bigger the better. We ooh and aah every year on the Fourth of July when we see the bombs bursting in air as if we had never seen such sights before. Children scream with glee as they see the colors and hear the big boom sounds of each star burst in the night sky. "Wow, did you see that one?'' they ask. And our country is satisfied at the end of the holiday night that we have worshipped at the altar of national pride on the single most important day of the year when our patriotism hits its high water mark.

You may ask, "What does the 4th of July have to do with health care?" Alot! Every year, there are thousands of accidents involving fireworks. The National Council on Fireworks Safety wants to prevent all injuries from consumer fireworks. Sadly, each year, there are over 100 injuries reported to the NEISS reporting hospitals. Based on these actual injuries, the CPSC produces an estimate of injuries on a national basis. The estimate for calendar year 2006, based upon 261 reported injuries, was 9,200 estimated injuries. Injuries per 100,000 pounds of consumer fireworks sold was 3.4 injuries in 2006, as compared to 8.0 injuries in 1997. Thus, the injury rate has dropped by more than half in the past ten years. The rate has decreased both because of a large increase in usage and a general decrease in injuries.

The CDC has reported that fireworks can be associated with blindness, third degree burns, and permanent scarring. Fireworks can also cause life-threatening residential and motor vehicle fires. More than half of the reported injuries were burns. Burns were the most common injury to all body parts except the eyes and head areas, where contusions, lacerations and foreign bodies in the eye occurred more frequently. Firecrackers were associated with the greatest number of estimated injuries, followed closely by injuries associated with sparklers and those associated with rockets. Between 2000-2005, more than one-third of the fireworks-related deaths involved professional devices that were illegally sold to consumers.

The CDC lists how these injuries occur:
1.) Availability: In spite of federal regulations and varying state prohibitions, many types of fireworks are still accessible to the public. Distributors often sell fireworks near state borders, where laws prohibiting sales on either side of the border may differ.
2.) Fireworks type: Among the various types of fireworks, some of which are sold legally in some states, bottle rockets can fly into peoples' faces and cause eye injuries; sparklers can ignite clothing; and firecrackers can injure the hands or face if they explode at close range.
3.) Being too close: Injuries may result from being too close to fireworks when they explode; for example, when someone leans over to look more closely at a firework that has been ignited, or when a misguided bottle rocket hits a nearby person.
4.) Lack of physical coordination: Younger children often lack the physical coordination to handle fireworks safely.
5.) Curiosity: Children are often excited and curious around fireworks, which can increase their chances of being injured (for example, when they re-examine a firecracker dud that initially fails to ignite).
6.) Experimentation: Homemade fireworks (for example, ones made of the powder from several firecrackers) can lead to dangerous and unpredictable explosions.

Here are some safety tips as promoted by the National Council on Fireworks Safety:
Review Our Safety Tips...
USE FIREWORKS OUTDOORS ONLY.
OBEY LOCAL LAWS. IF FIREWORKS ARE NOT LEGAL WHERE YOU LIVE, DO NOT USE THEM!
ALWAYS HAVE WATER HANDY (A HOSE OR BUCKETS OF WATER)
ONLY USE FIREWORKS AS INTENDED. DON’T TRY TO ALTER THEM OR COMBINE THEM.
NEVER RE-LIGHT A “DUD” FIREWORK (WAIT 20 MINUTES AND THEN SOAK IT IN A BUCKET OF WATER)
USE COMMON SENSE WHEN USING FIREWORKS. SPECTATORS SHOULD KEEP A SAFE DISTANCE FROM THE SHOOTER. AND THE SHOOTER SHOULD WEAR SAFETY GLASSES.
ALCOHOL AND FIREWORKS DO NOT MIX. HAVE A “DESIGNATED “SHOOTER
ONLY PERSON OVER AGE 12 SHOULD BE ALLOWED TO HANDLE SPARKLERS OF ANY TYPE.
DO NOT EVER USE HOMEMADE FIREWORKS OR ILLEGAL EXPLOSIVES; THEY CAN KILL YOU! REPORT ILLEGAL EXPLOSIVES TO THE FIRE OR POLICE DEPARTMENT IN YOUR COMMUNITY.
THE NATIONAL COUNCIL ON FIREWORKS SAFETY INVITES YOU TO CELEBRATE OUR NATION’S HERITAGE ON THE FOURTH OF JULY, BUT CELEBRATE SAFELY!

The Nemours Foundation also advertises using caution with fireworks. The best way to protect your family is not to use any fireworks at home — period. Attend public fireworks displays, and leave the lighting to the professionals. Lighting fireworks at home isn't even legal in many areas, so if you still want to use them, be sure to check with your local police department first. If they're legal where you live, keep these safety tips in mind:
--Kids should never play with fireworks. Things like firecrackers, rockets, and sparklers are just too dangerous. If you give kids sparklers, make sure they keep them outside and away from the face, clothing, and hair. Sparklers can reach 1,800° Fahrenheit (982° Celsius) — hot enough to melt gold.
--Buy only legal fireworks (legal fireworks have a label with the manufacturer's name and directions; illegal ones are unlabeled), and store them in a cool, dry place. Illegal fireworks usually go by the names M-80, M100, blockbuster, or quarterpounder. These explosives were banned in 1966, but still account for many fireworks injuries.
--Never try to make your own fireworks.
--Always use fireworks outside and have a bucket of water and a hose nearby in case of accidents.
--Steer clear of others — fireworks have been known to backfire or shoot off in the wrong direction. Never throw or point fireworks at someone, even in jest.
--Don't hold fireworks in your hand or have any part of your body over them while lighting. Wear some sort of eye protection, and avoid carrying fireworks in your pocket — the friction could set them off.
--Point fireworks away from homes, and keep away from brush and leaves and flammable substances. The National Fire Protection Association estimates that local fire departments respond to more 50,000 fires caused by fireworks each year.
--Light one firework at a time (not in glass or metal containers), and never relight a dud.
--Don't allow kids to pick up pieces of fireworks after an event. Some may still be ignited and can explode at any time.
--Soak all fireworks in a bucket of water before throwing them in the trash can.
--Think about your pet. Animals have sensitive ears and can be extremely frightened or stressed on the Fourth of July. Keep pets indoors to reduce the risk that they'll run loose or get injured.
--If a child is injured by fireworks, immediately go to a doctor or hospital. If an eye injury occurs, don't allow your child to touch or rub it, as this may cause even more damage. Also, don't flush the eye out with water or attempt to put any ointment on it. Instead, cut out the bottom of a paper cup, place it around the eye, and immediately seek medical attention — your child's eyesight may depend on it. If it's a burn, remove clothing from the burned area and run cool, not cold, water over the burn (do not use ice). Call your doctor immediately.

Fireworks are meant to be enjoyed, but you'll enjoy them much more knowing your family is safe. Take extra precautions this Fourth of July and your holiday will be a blast! Have a great Holiday.

Until next time. Let me know what you think.

Health Care and Medical Bills

Medical bills can create a huge amount of stress related to debt management and the emotional and physical toll of health issues. The Commonwealth Fund recently published a survey indicating that 45% of underinsured Americans and 51% of uninsured people have problems paying medical bills. Many of these individuals and families were borrowing to pay off medical bills which only delay the inevitable financial strain and pending problems to pay off debt. Often, consumers are not sure what to do and get deeper into debt by ignoring the problem. If the bill gets turned over to a collection agency, the opportunities to work out a solution substantially decrease. The ability to negotiate a payment with the health care provider disappears. As reported in the Dallas Morning News, patients need to continue an open dialogue with the medical office to set up feasible billing arrangements.

According to the National Consumer Law Center, Americans are living longer, in part due to dramatic advances in medical care. One of the costs of longer life expectancies is that someone has to pay for this medical care. While access to quality medical care is essential for seniors and should be a universal right, it can leave them saddled with unmanageable medical debt, and consumer law remedies are critical in helping seniors avoid financial ruin due to overwhelming medical bills. Medical debt issues are critical for many older Americans, especially low- and moderate-income seniors. One out of seven older Americans has reported that paying medical bills was either "very difficult" or used up all their savings. While many do have access to health insurance to pay for the bills, there are still gaps in the systems that burden seniors with substantial health care debt.

If you are burdened with large medical bills, you should know that there is a range of powerful consumer tools at your disposal. There are a number of legal and non-legal strategies, including:
--Informal advocacy and negotiation.
--Finding outside sources of funds to pay the medical debt.
--Debt prioritization strategies.
--Bankruptcy.
--Potential affirmative claims under federal and state fair debt collection practices acts, state consumer protection acts, and other state laws.

Also, according to the NCLC, another effective method to deal with medical debt is to find someone else to pay for it. Be sure that you apply for any assistance programs to which you are entitled. This may include government or private programs, such as:
--Insurance
--Medicaid
--Medicare Savings Programs (Qualified Medicare Beneficiary, Specified Low-Income Medicare --Beneficiary and Qualified Individual Programs)
--Pharmacy Assistance Programs
--Charity Or "Free Care" Eligibility
--Other Charity Programs

The NCLC also reports that sometimes people simply cannot afford to pay medical bills and all their other bills. In that case, it is important to make sure that you do not forego payment of higher priority bills, such as mortgages or car loans, in order to pay medical bills. Medical bills are unsecured debt, and as such usually should not take priority over secured debt or essential expenses such as food and utilities. However, the priority of a medical debt does depend on your individual circumstances and may need to take non-financial factors into account, such as ability to obtain future care from a certain facility to which you owe a debt. You should understand that you should never move medical bills up in priority because of debt collection harassment.

According to CreditCard.com, if you've been hit with an unexpected medical bill, your first thought might be to reach for your wallet and pull out a credit card. Don't, experts say. Savvy consumers should comparison shop for payment options when paying for medical expenses. Consumer counselors suggest negotiating lower bills with medical providers before paying the bill. Here are some helpful tips they offer:
1. Everything's negotiable. You may be able to get a portion of the bill reduced. A hospital bill typically includes items for surgery, anesthesiology, medications, X-rays and other expenses. Contact information for each should be included on the bill. Try talking to the service providers to see if they will reduce their fees in any way.
2. Payment plans. If you can't pay the entire balance at once (and many people can't), work out a payment plan with the doctor or hospital. Some charge no interest; others do. Make sure the plan is realistic and based on your ability to pay. Stick to the plan. If your circumstances change, contact the medical provider and try to negotiate a different arrangement. Get all payment terms in writing by asking the medical provider to send you written confirmation so there is proof.
3. Credit reports. According to Experian and TransUnion -- two of the three major credit reporting agencies -- hospitals, doctors and medical providers rarely report payment information to the bureaus. On the other hand, payments on credit cards, installment loans and lines of credit are all reported to the credit bureaus. So working out a payment plan with the doctor or hospital may be a better option for you if you're concerned about medical debt lowering your credit score.
4. Charity begins at the hospital. The majority of hospitals across the country, especially nonprofit hospitals, have charity care programs that pick up all or part of the cost of care for indigent or special needs families. Some restrict such aid to the uninsured or offer discounted services to the insured with limited incomes. Medical bill negotiators complain, however, that the availability of these programs is often poorly publicized in hospitals. Patients must often ask about them and actively seek them out. Don't be embarrassed to ask! Hospitals have financial counselors and patient advocates who may be able to offer advice.
5. Accurate billing. Review the bill. Hospital bills often arrive several weeks after your visit and may be several pages long. Don't put it aside for later. Go through the charges. Are they accurate? Billing disputes should be resolved before putting the expense on a credit card or loan installment.
6. Collection agency calls. Don't ignore them. If your account has gone to a collection agency, you have already received written notice in the mail. Dodging or avoiding the collector will only make matters worse and further damage your credit report.
7. The fine print. If you have a company-sponsored health insurance plan, pay attention to the details of what's covered -- not just how much the office visit co-pays are, but the lifetime cap, the deductible, and what services are or aren't covered.
8. Denial of service. A medical provider may ask you to pay all or some of your outstanding balance before you can make another appointment. This may be less likely to occur if you have been in touch with them and followed through on repayment plans in the past. If you have a long relationship with the doctor, ask to speak to him or her directly to plead your case. Note: By law, if you have a medical emergency, a hospital must treat you regardless of your ability to pay.
9. Local assistance programs. Your state or local government may have assistance programs that can help offset medical costs. Call your city, county or borough government representative or municipal social service agency or community organizations.
10. Support groups. Connect with local support groups and charities. Members of cancer, diabetes, autism or other illness support groups may prove a valuable resource base for finding doctors as well as navigating the complex health care system.
11. A little help from your friends. Feeling overwhelmed or intimidated by the whole process? Medical bills can be complicated as can figuring the best payment options for your family budget. If you're facing a medical crisis, you may not want or have the time or energy to deal with the fine details, but are comfortable in asking a friend or someone you trust to help. Because of privacy laws, that person will need written permission to discuss the details of your bill with the hospital or doctor.
12. Do your homework. When looking for a new doctor, in addition to asking questions about weekend office hours or board certification, ask about financing options for bill payments. 13. Budget. Budget. Budget. Everyone should have a family budget and have money set aside money in an emergency fund. Most financial planners advise having three to six months' living expenses in case you are unable to work or are hit with an unexpected bill.
14. Insure against job loss. Consider getting short-term disability insurance, which pays you part of your salary should you become ill and cannot work. Loss of income from an illness is a major factor in many medical-related bankruptcy filings.
15. Nonprofit credit counselors. Get help. Find an accredited counseling agency to help you sort through the bills and draft a payment plan that works for your family budget. The two major accrediting agencies for credit counselors are the National Federation of Credit Counseling and the Association of Independent Consumer Credit Counseling Agencies. Each has an online referral service to certified local counselors.

U.S. News and World Report said in 2007 that hospital and doctor bills, copayments, deductibles, and other medical expenses have contributed to the balances of nearly a third of low- and middle-income households that have credit card debt. Medically indebted young people between the ages of 18 and 34 have the highest level of credit card debt of any age group, and many in this age bracket don't have health insurance. Healthy young people are more likely than other age groups to shrug off the need for health insurance, leaving them financially vulnerable if they get sick. In addition, young people just starting out in their careers often don't have a financial cushion to absorb unexpected medical expenses. When people are sick they want to be treated and they want to get well. They sometimes feel obligated of pay off their bills even though they don't have the resources to do so, because they want to maintain a good relationship with their medical providers.

Paying for medical bills can be highly stressful. In addition to dealing with health care issues, the added emotional and mental strain can lead to other physical complications such as high blood pressure and other medical conditions. Before you pull out your card to pay for medical services, consider trying to negotiate the payment terms with your provider. Some will offer long-term plans or a reduced fee, especially if you're uninsured. When it comes to medical bills, talk may literally be cheap, as reported by U.S. News and World Report. Be careful with your health, and your bank account will thank you.

Until next time. Let me know what you think.