Medical Updates

Getting Men to the Doctor

2009-05-18T13:55:00.000-07:00

Doctors say there is overwhelming evidence that men are not getting their health checked often enough.

The average woman in the United States now has a life expectancy of 80 years, while the average man can expect to live five years less.

Doctors say men could live longer if they would take their health more seriously.

Dr. Tom Campbell of the University of Rochester School of Medicine explains, "Men are much more likely to smoke, drink too much, use drugs, to not take care of themselves the way that women do. So, all of that adds in to an increased risk of dying prematurely."

However, married men live longer than singles because they have wives who push them to see the doctor. But, doctors say, unless it is an emergency situation, there are better ways to get a man to see a doctor than by nagging.

Campbell suggests, "In some situations, it may even work to help facilitate things. If the man doesn't have a physician, get him a physician…maybe [you could say], 'If I made an appointment, would you be willing to go to that appointment?'"

That approach works for Wilfred and Lenna Jordan.

Wilfred said he felt “all right,” but is seeing a doctor because his wife, Lenna, made an appointment for him.

Now, he's going to live a longer life.

Doctors urge women to check on the health of single men in their families.

Source: http://www.13wham.com/news/local/story/Getting-Men-to-the-Doctor/jAq8ya96PEKUA8X3e2Nlug.cspx

Organ Donation Practices Vary Among Pediatric Hospitals

2009-05-13T09:17:00.000-07:00

Criteria for organ donation after cardiac death are better defined in pediatric hospitals than they once were, but policies still vary substantially between hospitals.

Only 7% of surveyed pediatric hospitals were without policies to allow patients who do not meet neurological criteria for death to donate organs, Armand H. Matheny Antommaria, M.D., Ph.D., of the University of Utah School of Medicine, Salt Lake City, and colleagues reported in the May 13 issue of the Journal of the American Medical Association.

Among pediatric centers that do have formal policies, the most potentially troubling omissions and variations centered on transplant personnel's role in care before death, declaration of death, and use of premortem interventions to improve organ recovery, they said.

Donation after cardiac death has gained renewed interest since the 1990s because of a persistent mismatch between supply and demand.

Policies to govern ethics and standards for this type of donation have been developed to deal with controversy over whether donors were really dead, if premortem interventions hastened their deaths, and whether efforts to limit warm ischemia compromise palliative care, Dr. Antommaria's group noted.

Since 2007, the Joint Commission has required all hospitals to address donation after cardiac death and the United Network for Organ Sharing has proposed a model for recovery protocols.

To see how well those recommendations are being followed, the researchers surveyed 105 of the 124 member centers of the National Association of Children's Hospitals and Related Institutions.

Among these facilities, 72% had policies for donation after cardiac death and another 19% reported that their policy was under development.

Only one center had a policy that permitted organ donation from "brain dead" donors who had unanticipated cardiac death if the donor was already in the operating room.

The rest allowed donation after cardiac death only after planned withdrawal of life-sustaining treatment in patients such as those with irreversible catastrophic brain injury or end-stage neuromuscular diseases.

One of the areas in which "variation may not be justified" was in the use of premortem interventions, such as use of anticoagulants and vasodilators, to improve organ recovery, Dr. Antommaria said.

Just 36% of the policies prohibited such interventions before death if they might cause harm or pain.

And although guidelines say that informed consent should be required for these interventions in all policies, only 75% included this criterion, Dr. Antommaria noted.

It's not as clear, however, what impact on organ outcomes and family bereavement would come from the variation in where withdrawal of life-support was to take place, he said.

Of policies that specified a location, 54% required withdrawal in the operating room whereas 4% required it to occur in the intensive care unit.

Issues around declaration of death were also a "major point of contention," the researchers noted.

Among the centers surveyed, 18% did not specify criteria for declaring death. Even among those that did, criteria were sometimes subjective -- such as no pulse on palpation -- although professional consensus statements called for objective criteria.

Because transplantation ethics require that organ procurement cannot be before, or cause the donor's, death, consensus statements also recommend waiting at least two but no more than five minutes to declare death to preclude spontaneous recovery.

But about 5% of the centers required alternative waiting periods before organ recovery with one center requiring less time and three requiring longer times.

Importantly, 12% of the policies did not preclude transplant personnel from declaring death and 49% did not prohibit their involvement in premortem management.

Lack of a clear and ethical standard on this measure may harm the organ transplantation system, the researchers said. "Fear that physicians will prematurely declare death to obtain organs and mistrust of the medical profession are important reasons why individuals may decline to donate organs."

Although there may be heightened sensitivity to the ethics of organ donation in children, the researchers found no significant differences between policies in hospitals that treated only children and those that care for both children and adults.

They cautioned that the policies do not necessarily reflect physician behavior at the hospitals.

Source: http://www.medpagetoday.com/Surgery/Transplantation/14156

Sustainability in health care

2009-05-13T09:16:00.000-07:00

by Prof. Pierre Mallia

Sustainability in health care has become an issue. Indeed it can be envisaged that our health care system needs an overhaul, especially when it comes to first patient contact – primary care. This area has been neglected for a considerable time. The present system served us well for a long time, but over the last few years, strains from different parts could be felt. If you do not have a good and sustainable primary care system, it is inevitable that many more patients are referred to hospital. This leads to longer waiting lists and more expenditure.

A hospital physician is not a primary care physician, and indeed is held to a different standard of care. Inevitably, once a patient is an out-patient, more tests are done. When one considers the number of extra tests, the time in man-hours, from physicians, to nursing assistance at out-patients, to paramedical services, and the number of “extra” patients, which run into the hundreds every week, and which could have been dealt with in the primary care setting, one begins to understand the nature of our problem.

Recently, the casualty services of Mater Dei issued another call for GPs to work as primary care physicians within this service. It is obvious therefore that many people turn up at casualty, presumably many of them with a letter of referral by another doctor, who do not need any kind of emergency service. Of course the primary care doctor who referred them would not have had the means to assess the patient fully. Sometimes a GP wants an X-ray rather quickly; the only place to send the patient to is casualty.

For a long time family medicine, the main player in primary care, was considered by many the Cinderella of the profession. This is certainly not the case any longer. Doctors are highly trained and the Malta College of Family Doctors has seen to it that formal post-graduate training is to be put into place. Moreover vocational training has been set up within the Department of Health for all doctors to work in health care. This was a direct result of EU requirements. But the government is responsible for all doctors given the warrant to work in the community and therefore vocational training should be a must for all. This is really about the right of a patient to be seen by someone whom the government has released into the community and on whom one can put one’s trust. Patients do not go around asking whether their doctors have had vocational training. It should therefore be in place for all.

Family medicine is now a speciality in its own right. The specialist register, which contains specialities like internal medicine, surgery, psychiatry, etc, has also family practice on its list. This is not only recognised by the European Union but is a requirement. Doctors with several years experience were, by right, put on the list. But new doctors have to have their vocational training in order to have the right to be listed. But what is the use of this list if it does not translate into upholding it in (family) practice. If family practice is truly a speciality, then presumably there is more to it then the first MD qualification, which is in fact the case. This begs the question why can some not specialise and yet still be allowed to do practice. Is an MD enough? Do patients have a right to be seen by someone who is a specialist, once the EU has stated that GPs must specialise?

There are many areas which are the sole realm of primary care medicine and family medicine and which a hospital-trained doctor cannot tackle appropriately. In the first instance there is more specialisation in preventive medicine and in the management of chronic diseases over long periods of time than is the case in hospital. Then there are areas which the family doctor deals with in the community, such as screening, vaccination advice, child surveillance, care of elderly in the community, well-woman, and well-man clinics, drug and other substance abuse, and domestic violence. There are also the psycho-social issues besides the biological which family doctors are trained to consider in the assessment of any malady. People often present one problem only to reveal a hidden manifestation. One has to be trained to tackle problems in the community rather than refer cases; this requires that FPs are equipped to do so. Not to mention then the more subtle issues of how the disease of one individual affects the family and indeed how the family affect the illness in turn. The FP builds over time a genogram of the family knowing intricate details of family dynamics which allow for better management of a condition. All this is more conducive if we have patients registered with their family doctor. But patient registration is not enough. For it to be a success one must re-think and revamp the system.

If we want to sustain our primary care system, so that in turn it can sustain and remove the extra burden from the secondary care setting, then it is our obligation to see that only those doctors on the specialist list are allowed to practise in the community. Only in this way would the health department have the confidence to allow GPs to do the work which at present has to be rubber stamped by a specialist. This ranges from prescriptions to other procedures which can be done within this community setting.

For example, patients who need statins (an anti-cholesterol drug), or an SSRI (the new class of anti-depressants), must go through a consultant to get approval if they are to receive it as a free medicine. Now GPs prescribe these drugs all the time; so why not allow them to give approval of the drug. Is it our culture which lacks this trust in GPs; and if so, why? GPs act as gatekeepers in many countries; most notably the UK. When taking vocational training into account, UK doctors will be no more qualified than Maltese ones. Once they are on the specialist register, they have acquired the necessary trust.

Indeed it should be the case that consultants within the primary care system come from primary care themselves, and not from the hospital setting as is presently the case. It is true that hospital doctors do a stringent exam of the Royal College of Physicians. But, as has been pointed out, this is oriented to hospital medicine, and not primary care. Perhaps the fear is that GPs will over-prescribe. If they are allowed to be gatekeepers, this will probably not be the case. The fact is not that GPs over-prescribe, but that the system is more stringent in handing out certain drugs. We are oblivious to the fact that these drugs do indeed decrease the incidence of hospitalisation, costing the government less money.

In the UK, primary care is far from perfect, but they have come to the stage of having GPs with a special interest (GpsWI). A GP can have an interest in any area, say gastroenterology. Even if he or she cannot be on the specialist list of gastroenterology, certain procedures and tests can then be done in primary care. Hospital doctors can then dedicate themselves more to the cases which require their expertise.

Family doctors have done their part. Their colleges and associations have been on the forefront to introduce continuing medical education, continuing professional development (tens of thousands were invested, some paid for personally, to train the trainers), the introduction of undergraduate training in family medicine in the MD curriculum and a post-graduate Masters. If it were not for family doctors, vocational training would not be in place. Diplomas, both local and foreign, and Masters degrees, have been offered through the Malta College of FPs. By right family doctors (FPs), do not call themselves GPs any longer. It is now the government’s turn.

If one wants to decrease the burden and expense of the hospital setting, then one must invest in the primary care setting. It is also a true (although unfortunate) reality, that just like in any other profession, remuneration has to be considered. One cannot expect primary care doctors to go through more intense training to become specialists, and then continue to pay them a scale seven salary. If becoming a family doctor will require up to 10 years training, then one must adjust one’s salary accordingly. If one wants primary care doctors to take on more responsibility there must be trust on one side and more formal qualifications on the other. This is what college memberships, vocational training, and specialist registers are about. And as other countries that boast good family medicine services have periodic re-validation, so must this be introduced and phased in locally. We are no more special or better than our colleagues. Indeed local doctors do organise their own continuing education programmes through their associations, but this must be formalised and made more systematic to keep one’s licence. This will give the authorities the confidence required to entrust more onto primary care; which, as observed repeatedly by the World Health Organisation, is the key to better health care systems.

Source: http://www.independent.com.mt/news.asp?newsitemid=87859

Providing Free Drug Samples To Patients Risks Harm To Public Health, Experts Argue The tradition of American physicians handing out free drug samples

2009-05-13T09:15:00.001-07:00

The tradition of American physicians handing out free drug samples to their patients "has many serious disadvantages and is as anachronistic as bloodletting and high colonic irrigations," say two academics in an essay in PLoS Medicine.

Susan Chimonas, a researcher at the Center on Medicine as a Profession at Columbia University, New York City, USA, and Jerome Kassirer, former editor of the New England Journal of Medicine and a distinguished professor at Tufts University School of Medicine, Boston, USA, argue that giving "free" samples is "not effective in improving drug access for the indigent, does not promote rational drug use, and raises the cost of care."

Although the pharmaceutical industry has claimed that providing free samples helps financially struggling patients, Chimonas and Kassirer cite research showing that low-income uninsured patients are in fact less likely to receive free samples than patients with continuous insurance. Many samples, they say, "are appropriated by physicians for personal or family use," and in one study nearly half of pharmaceutical sales representatives surveyed reported using samples themselves or giving them to their friends and relatives. These studies, say Chimonas and Kassirer, indicate that samples often reach the wrong people and are frequently misused.

Samples are also ineffective, they say, at lowering patient costs. "Indeed, evidence shows that patients who received free samples had higher out-of-pocket costs than their counterparts who were not given free samples." Samples raise the cost of health care, as companies recoup marketing costs through higher prices and increased sales volume.

In addition, giving free samples risks poor quality of health care. For example, when low-income patients are given a ''starter pack'' of samples and a prescription to fill for the remaining period of treatment, they might not be able to afford the cost of the extension, leading to discontinuity of treatment. In doctors' offices, detailed patient education regarding sample use rarely occurs, and when it does, it usually lacks information about drug interactions or instructions on how the drug should be taken. And given the lack of oversight of samples by a skilled pharmacist, there is a risk that expiration dates could be overlooked.

"It is difficult to escape the conclusion," say the authors, "that the prime motivation behind the provision of free samples is marketing." Samples have a major influence on physicians' prescribing habits, they say, and are one of the most effective ways sales representatives get their foot in the door to pitch their companies' products. The authors call for the medical profession to halt the practice of accepting samples from the pharmaceutical industry and distributing them to patients.

This work was supported by the Institute on Medicine as a Profession, the Pew Charitable Trusts, and the Prescription Project. The funders had no role in the decision to submit this manuscript or in its preparation.

Source:
http://www.sciencedaily.com/releases/2009/05/090511210415.htm

Ruling to the detriment of medical profession?

2008-08-19T11:09:00.000-07:00

Ed Thomas - OneNewsNow - 8/19/2008 8:55:00 AM

By a unanimous vote on Monday, the California Supreme Court affirmed the right of a lesbian woman to be inseminated by doctors over their religious and moral objections. That ruling is being harshly criticized by faith-based groups that have fought to preserve physicians' right to practice their faith as part of their professional ethics.

The justices ruled that California's anti-discrimination laws extend to even medical treatment of homosexuals, and wrote that doctors at the North Coast Women's Medical Group, a private fertility clinic, had neither "a free-speech right nor a religious exemption" from the laws.

Attorney Mailee Smith of Americans United for Life (AUL), spokeswoman for the Christian Medical & Dental Associations and several other faith-based groups who presented amicus briefs in the case, said the ruling takes away a federally protected Constitutional right of physicians to freely exercise religion.

"The Supreme Court in California actually made the Constitution of the United states secondary to state-created law in California," says Smith.

AUL expects that by forcing healthcare professionals to choose between conscience and career, the medical field will lose doctors, nurses, and other healthcare professionals who are already in short supply. "It defies common sense that a patient would want a doctor to violate his or her conscience in practicing medicine," Smith laments. "A diminished physician population is not good for medical care."

Bob Tyler of Americans for Faith and Freedom, counsel for the fertility clinic physicians, says it is his firm's intent to appeal, and hopes the U.S. Supreme Court will take the case. In the meantime, he says state judges have set a destructive precedent to religious liberty with the ruling, which will affect state residents in a broad way.

"It affects physicians immediately...but it affects everybody in California, no matter your profession," says Tyler.

Meanwhile, Smith says the case is far from over in the trial court. After interpreting the discrimination law's application, justices must now decide if clinic doctors were telling the truth about their objection to Guadalupe Benitez being unmarried, as opposed to being a lesbian -- an issue which Smith says will determine if Benitez wins or loses her suit.

http://www.onenewsnow.com/Legal/Default.aspx?id=219034

Medical Vacations: The Retiree Health-Care Solution?

2008-08-12T19:14:00.000-07:00

By Billy and Akaisha Kaderli
from
http://www.fool.com/personal-finance/retirement/2008/08/12/medical-vacations-the-retiree-health-care-solution.aspx

The debate over U.S. health-care reform rages on. But why wait for someone else to dictate your future? You have many options -- if you're willing to take a vacation. If recovering from a medical procedure while lying on a palm-swept beach, relaxing by the hotel pool, or shopping for terrific bargains sounds good, then medical vacations may be exactly the right solution for you.

From hip replacement to heart surgery, more people are discovering the advantages of traveling abroad for their medical needs.

A big growth industry
In just the past few years, medical vacations have gone from a tiny niche market to an impressive growth story with substantial market-share gains. From Mexico to India, Costa Rica to Thailand, hospitals are taking advantage of this global trend. And U.S. companies are taking note as well. Aetna (NYSE: AET) and Blue Cross Blue Shield of South Carolina are among the health-care companies tailoring their corporate health insurance plans to give employees the opportunity to head to India or elsewhere for surgeries such as knee replacements and the more modern, less invasive approach to hip replacement, hip resurfacing.

In the Western Hemisphere, Costa Rica is currently the "in" destination for travelers, especially for dental and cosmetic surgery needs. You can schedule online and receive a custom-made package, appointment and prices in your email response.

For years, people in the American Southwest have capitalized on the high-quality dental work available south of the border for a fraction of U.S. prices. Now more people are traveling to Guadalajara in Mexico for body augmentation and other surgeries, too. Many of the doctors there are U.S.-trained, and the equipment is top of the line. (We know, because we've used it.)

In Asia, one of the world's most acclaimed hospitals is located in Bangkok, Thailand. Bumrungrad looks more like a five-star hotel than a medical facility -- until you get to the third floor. World leaders from around the globe fly here for medical procedures. Bumrungrad's website is user-friendly, as is its professional, English-speaking staff. The hospital has more than 200 surgeons who are board-certified in the United States. We have quipped many times that the cheapest health care plan is an air ticket to Bangkok.

Also close by is the Bangkok Heart Hospital. Both of these facilities are located in the center of the city, with easy access to shopping and attractions. If necessary, they will arrange your hotel stay along with the medical procedure you're having performed, all without waiting times or disqualifications. Your entire extensive physical will be done in one morning, with your blood results and consultation that afternoon. In and out in a single day. How's that for service?

Is it safe?
Many people interested in medical tourism are concerned about the quality and safety of going abroad for technical and complex medical care, and how to get post-operative care once they return home. All of the hospitals mentioned here use the latest equipment and are either internationally accredited facilities or have U.S.-trained physicians on staff. Some U.S. health plans also provide an in-state network of physicians who will treat a patient who's gone abroad for medical care. The one thing that sets these hospitals apart from many of their U.S. counterparts is their attention to customer service -- they are professional and courteous in a way you rarely see anymore at home.

According to 2005 statistics from the University of Delaware, Escorts Heart Institute in Delhi and Faridabad, India, performs nearly 15,000 heart operations every year, and the death rate among patients during surgery is only 0.8 percent -- less than half that of most major hospitals in the United States. India also has top-notch centers for hip and knee replacement, cosmetic surgery, dentistry, bone marrow transplants, and cancer therapy. Virtually all of these clinics are equipped with the latest electronic and medical diagnostic equipment.

Sounds good, but what's the cost?
Even though you get high-quality care at these hospitals, prices are quite a bit lower than what you'll find in the U.S. Several sources report big cost savings in recent years for many procedures. For example, coronary angiography in Bangkok costs less than $900. A metal-free dental bridge that runs $5,500 in the U.S. costs about $500 in India, and a knee replacement in Thailand with six days of physical therapy costs about a fifth of what it would in the States. Cosmetic surgery savings are even greater. A full facelift that might cost $20,000 in the U.S. runs about $1,250 in South Africa.

The attraction is straightforward. The costs for everything from facelifts, dental implants, or hormone therapy to reverse the effects of aging can be one-half or less for comparable procedures in the States. Have your surgery, then recover and recuperate in a beautiful mountain setting or at a resort hotel.

Most procedures can be found online, letting you know what's included in the cost. The figure quoted to you will cover everything, including follow-up visits. There are no hidden charges, and the price includes the room, doctor, and staff.

If you'd like to retire soon, but you're held back by health-care issues, or if you've got the health-care blues and need a holiday break, why not do some research online and take a vacation?

And when it's time to recover, don't forget your suntan lotion.

Lack of school nurses puts kids at risk

2008-08-09T04:16:00.000-07:00

By Susan Abram, Staff Writer

Article Last Updated: 08/08/2008 04:31:25 AM PDT

NORTH HOLLYWOOD -- The backpack Evangeline Arafiles slings across her shoulder each morning holds the tools of her trade: a lilac-color stethoscope, thermometer, oximeter, penlight and stopwatch.

There isn't a Band-Aid in sight.

As a school nurse at Lowman Special Education Center, Arafiles oversees about 150 students, and there often is another registered nurse with her on site.

And despite having to insert catheters, inject insulin, treat seizures and monitor asthma, because she only has to look after 150 kids, she's one of the lucky ones.

"If you were to compare a school nurse from 40 years ago, she was someone who usually waited for a student who needed a Band-Aid," said Nancy Spradling, executive director of the California School Nurses Association.

Once known as "Band-Aid Queens," Arafiles and other school nurses have increasingly become a safety net for thousands of children.

But as their roles have changed, the nurse-to-student ratios haven't, a concern among industry groups who say complacency, budget cuts, a personnel shortage within the profession and an overall misperception of what school nurses do all collide to place children at risk.

Federal guidelines require one nurse for every 750 students. But California ranks 44th in the nation, with a ratio of 1:2,300. Of the nearly 1,000 school districts statewide, half have no school nurses at all, Spradling said.

Within the Los Angeles Unified

School District, the second-largest in the nation, there are 600 registered nurses for nearly 700,000 students - or a ratio of 1:1,167, school officials said.

But in some parts of the city, that ratio can swell to 1:4,000.

The shortage comes at a time when children's health issues are grabbing more headlines:

The leading cause of absenteeism among LAUSD students with chronic diseases is asthma, which afflicts some 63,000 students.

Of children born in 2000, about one-third of the boys and 39 percent of the girls will develop type 2 diabetes, according to the California Center for Public Health Advocacy analysts' estimate.

Less than 21 percent of LAUSD students met all the criteria considered to comprise a healthy lifestyle, according to California's statewide fitness exam.

A school nurse's job already was challenging because of a federal mandate in 1975 that required schools to accommodate disabled students.

"We welcome those kids. We want them to come to school and they have that right," Spradling said. "But today, school nurses are managing kids who need pharmaceuticals, children with cardiac problems, cancer, kidney treatments."

Burden of care

The lack of nurses has placed a burden on teachers, office workers and other staffers, but many don't want to be in a position to give first aid, said A.J. Duffy, president of United Teachers Los Angeles.

"The ratios are too high," he said. "Teachers have been told in the past that they would have to do certain things. At one point, the district wanted teachers to give shots. Our nurses were up in arms."

The California chapter of the American Nurses Association filed a lawsuit last week against the state's Department of Education, which is calling on unlicensed volunteer school employees to administer insulin to students with diabetes.

"Not only is the California Department of Education breaking state law with this directive by violating the established scope of nursing practice, but by negating the need for licensed nurses to administer insulin, they are placing the children at risk," Rebecca Patton, president of the ANA, said in a prepared statement.

Duffy said even though the nurses could train teachers, the district training would likely fall short of what teachers need to know in a medical emergency.

"We have a certain degree of student population that are at risk and they have a right to have a medical professional to be there for their needs," Duffy said.

Last year, the LAUSD was ordered to pay $7.6 million to the family of an epileptic boy who suffered a seizure at a North Hollywood elementary school, according to published reports.

The boy's family said the response to his seizure in 2005 was inadequate because several minutes passed before CPR was administered by a playground supervisor. There was no nurse on campus that day. The district argued that adults responded as best they could.

Grants are sought

Federal legislation was introduced again in June by Rep. Carolyn McCarthy of New York and Rep. Lois Capps, D-Santa Barbara, once a school nurse herself. They are asking the secretary of health and human services to make grants available to eligible states to help reduce the nurse-to-student ratio.

"We're all very concerned about access to health care in the federal government," Capps said. "When kids come to school and they've never had a checkup, they come with a lot of health problems and it's a real challenge."

Still, in its most recent budget, the LAUSD cut funding for nurses to early childhood education classes or preschool.

"That, to me, is a challenge because how do we meet those needs of those in early education?" said Connie Moore, the district's director of nursing services.

"Through early detection, we can see if a child needs a pair of glasses or has an ear infection. If we just had a nurse in every school, we would be available to follow up with these children."

The district is now filling a dozen vacancies and has been able to hire 100 nurses in the past two years, especially for schools near downtown.

But there is competition for registered nurses from hospitals, and other health settings also are facing shortages.

Meanwhile, Arafiles considers herself lucky. She remains on campus all day. There is a second school nurse on staff. And she oversees fewer students than most of her peers.

Still, the job can be challenging.

"The work is rewarding," she said, "but we are stretched to the limit."

susan.abram@dailynews.com

http://www.dailynews.com/breakingnews/ci_10133395

Faces Of The Health-care Crisis

2008-07-28T22:59:00.000-07:00

By Chris Frates

Jul 28, 2008

The National Federation of Independent Business is on the Hill today, distributing a new booklet to congressional offices titled, “The Faces of the Healthcare Crisis: Small Business in America.”

The compendium details the difficulties small business owners face in getting health care. The effort is designed to send a message to Congress and the next president that “small businesses are demanding solutions to rising health care costs and they expect reform that works for them.”

One fairly typical vignette, Rich Gallo, owner of Office Outlet in Indiana, Pa., said he cannot afford to offer his employees health-care coverage.

And while he was searching for individual coverage, Gallo had a heart attack and put off going to the hospital because he didn’t have insurance – a delay that could have killed him. The $200,000 trip, he said, “makes me realize how we really need reform to make sure that small business people can get the coverage they need at the price they can afford.”

The push is part of NFIB’s Solutions Start Here campaign to pass health care reform that benefits small businesses.

Legislator wants legal review of GVSU's live-in partner health insurance benefit

Posted by Nardy Baeza Bickel | The Grand Rapids Press July 28, 2008 21:34PM

Categories: Breaking News

ALLENDALE -- A West Olive legislator has requested the state Attorney General's opinion on the live-in partner health insurance benefit Grand Valley State University approved for its employees earlier this month.

The benefit applies to gay couples, as well as any other live-in partner or friend who has lived with a staff or faculty member for 18 months or more. It does not cover relatives or tenants.

Republican state Rep. Arlan Meekhof sent the request last week, said his legal assistant, Bob DeVries.

It has been received by Attorney General Mike Cox, and it will be reviewed, said his spokesman Matt Frendewey, who declined to give a timeline on the issue. Cox has not been asked to review any similar policies that other universities have implemented, he said.

Other universities offering the partner benefits include the University of Michigan, Michigan State University, Central Michigan University and Michigan Tech.

GVSU trustees have said the change was necessary for the university to remain competitive in attracting talent. School officials also have said it is not same-sex benefits repackaged under another name. Same-sex plans are banned under state law.

DeVries said they are taking up the issue now that it has been enacted in West Michigan.

"Grand Valley is in (Meekhof's) district and is a more immediate interest by us.

"It's our opinion ... that these benefits are against the law, especially at a time when Grand Valley increased tuition by 13 percent. There's no reason they need to institute a new program that's going to cost them $180,000 a year."

As they have with other criticism of the change, GVSU officials remained polite but firm in their stance.

"Last Monday, Representative Meekhof advised the university of his plan to request an opinion from the Attorney General, a right that is available to all members of the Legislature. Grand Valley's trustees believe that the program they adopted complies with Michigan law," vice president Matt McLogan said.

Meekhof's request came at the same time fellow state Rep. Dave Agema, R-Grandville, said he would push for universities to lose 5 percent of their state funding if they spend taxpayer dollars to provide unmarried partner benefits.

http://blog.mlive.com/grpress/2008/07/legislator_wants_legal_review.html

Scrap Medicare Fee-For-Service System, Doctor Says

2008-07-24T12:55:00.000-07:00

Posted by Jacob Goldstein

They way Medicare pays doctors encourages excessive testing and discourages spending time with patients, a doctor argues today on the New York Times op-ed page.

The fee-for-service system reimburses doctors not only for their time, but also for overhead — which includes the costs of expensive machines used to run tests such as CT scans.

This is why doctors who own their own imaging equipment order far more scans than doctors who refer patients elsewhere for scans, argues the author, Peter B. Bach of Memorial Sloan-Kettering Cancer Center. He writes:

Any first-year business school student can see the profit opportunity here. The cost of a CT scanner is fixed, but a doctor earns fees each time it is used. This means that a scanner becomes highly profitable as soon as it’s paid for.

Patient visits, on the other hand, don’t incur the overhead of fancy machinery and so aren’t big moneymakers in the current system.

Getting rid of this payment system would trim excessive use of expensive tests and encourage docs to spend more time with patients instead, argues Bach, who is a former adviser to Medicare’s top brass.

He suggests paying doctors a fixed amount for each patient, with higher payments for more complex patients to discourage cherry picking. Payment for overhead should be based on the typical costs of tests and treatments for a patient’s condition — similar to how Medicare pays hospitals.

Implementing such a program would be pretty complicated — you could run the risk of giving doctors incentive to under-treat patients, and you’d have to do a good job of setting fees to avoid cherry picking.

Still, it’s worth considering alternatives to the current system. The recent debate in Washington over Medicare payments to doctors is sure to be back next year. And the health-policy gurus we’ve been talking to say financial pressures mean some kind of radical restructuring of the payment system is coming sooner or later.

Photo by Associated Press

http://blogs.wsj.com/health/2008/07/24/scrap-medicare-fee-for-service-system-doctor-says/

Southlake doctor pleads guilty to possession of child pornography

2008-07-24T12:54:00.001-07:00

12:42 PM CDT on Thursday, July 24, 2008
By WENDY HUNDLEY / The Dallas Morning News whundley@dallasnews.com

A Southlake doctor pleaded guilty this morning to one count of possession of child pornography.

Dr. James Shin, 46, faces up to 10 years in prison and a $250,000 fine, and will be required to register as a sex offender.

Dr. Shin, also known as Young Jin Shin and James Young-Jin Shin, resigned in May from the staff of John Peter Smith Hospital in Fort Worth, where he had been the chairman of the internal medicine department in 2004, according to his attorney, Bob Webster.

The U.S. Attorney’s Office said that when Dr. Shin allowed Immigration and Customs Enforcement agents to search his home computer in September 2007, he acknowledged that he used the Internet to download images and videos of minor children engaged in sexually explicit conduct.

“Some of the images of child pornography contained images of real children that have been identified through other law enforcement investigations throughout the nation,” according to a press release from the U.S. Attorney’s Office.

http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/072408dnmetchildporn.88cfa3cb.html

Medical tourism needs 5k-10k professionals in 5 years

2008-07-23T11:35:00.001-07:00

NEW DELHI: With medical tourism in India expected to grow 30% annually till 2012, the demand for talent is going up at a brisk pace even as it opens up a whole gamut of job opportunities in the sector. Little wonder then that a full-time course in medical tourism launched by the Indian Clinical Research Institute (ICRI) has generated a great deal of interest in the medical fraternity.

India’s medical tourism is expected to be a $2.2-billion industry by 2012, up from the current $1.2 billion. Encouraged by the growth momentum, the government has launched medical visas to be given on a priority basis.

Estimates suggest that there would be a demand for 5,000-10,000 professionals specifically catering to this industry segment in the next five years. These would include international marketing professionals, patients relation managers, backoffice employees.

However, analysts believe there’s an acute need for infrastructure to train people in these functions. And there are no institutions offering such niche courses. “There is a great demand for such modules as the manpower requirement goes up and the need for specialised roles arises,” says ICRI HEALTH director, health service, major general (Dr) M Srivastava.

The course from ICRI would offer training in hospital services, financial management, marketing, OR techniques, costing and budgeting. Pricing techniques, hospitality & patient relation & conflict resolution, healthcare laws & regulations, health insurance & regulations, business ethics & corporate governance are also part of the course. A major requirement, say experts, would also be for patient relation managers who can understand the needs of people from other geographies, their food habits, language and their comfort level.

Soft skills would be in great demand. Currently, individuals with a background in medicine deliver such services. As the need increases and the doctors become more engaged with the medical procedures, a different pool of people would be required to man those positions.

“Till now no institute offered such courses and the hospitals survived only on in-house resources and training,” says Apollo Healthcare and Lifestyle CEO Ratan Jalan.

http://economictimes.indiatimes.com/News/News_By_Industry/Jobs/Medical_tourism_needs_5k-10k_professionals_in_5_years/articleshow/3261173.cms

Healthcare Issues in the World Today

2007-10-01T14:35:00.000-07:00

Despite incredible improvements in health since 1950, there are still a number of challenges, which should have been easy to solve. Consider the following:

One billion people lack access to health care systems.
Around 11 million children under the age of 5 die from malnutrition and mostly preventable diseases, each year.
In 2002, almost 11 million people died of infectious diseases alone, far more than the number killed in the natural or man-made catastrophes that make headlines. (These are the latest figures presented by the World Health Organization.)
AIDS/HIV has spread rapidly. UNAIDS estimates for 2005 that there are roughly:
- 40 million living with HIV (most in Africa, 25.8 million)
- 4.9 million new HIV infections in 2005 (mostly in Africa, 3.2 million)
- 3.1 million AIDS deaths in 2005, (mostly in Africa, 2.4 million)
There are 8.8 million new cases of Tuberculosis (TB) and 1.75 million deaths from TB, each year.
Malaria causes more than 300 million acute illnesses and at least 1 million deaths, annually.
More than half a million people, mostly children, died from measles in 2003 even though effective immunization costs just 0.30 US dollars per person, and has been available for over 40 years.

Source: WHO

US healthcare burden

2007-10-01T12:40:00.000-07:00

In America, coping with sickness is all about making someone else cough up. To a degree, General Motors’ deal to shift retiree healthcare obligations into a trust managed by the United Auto Workers is a victory for both sides. GM has to fund a voluntary employees’ beneficiary association upfront, but at a discount. The UAW takes on responsibility for its retired members’ healthcare costs, but this protects them from the risk that those very costs destroy the company that was funding them. This circularity boosts the Veba’s appeal: its creation raises future cash flow expectations, boosting the shares of the company concerned, in theory making it easier to fund the structure.

Does that portend a rash of new Vebas? Goldman Sachs estimates that even as the S&P 500’s collective pension deficit has, on one measure, disappeared, unfunded retiree healthcare obligations are about $289bn. That is, however, just 2 per cent of the index’s market value and exposure is very uneven: GM and Ford account for a quarter of the total amount. Certain other sectors, such as telecoms, also have big deficits. But they do not necessarily share Detroit’s other problems: a greying, unionised workforce and fear of bankruptcy.

America’s public sector, where unfunded healthcare obligations might top $1,000bn, also looks unlikely to embrace Vebas wholesale. Try convincing a civil servant that the government might go bust. And in the absence of listed stock, the Veba’s circular attraction disappears.

Fund managers hoping for a sudden windfall of new assets to be put to work, therefore, may be disappointed. Still, those Vebas that are created will need star performers: healthcare cost inflation is running in double figures. Might that prompt a big weighting towards riskier asset classes such as private equity? If so, it raises the intriguing possibility of retirees one day acquiring their former employers.

Why Medical Tourism? A growing 10 Billion Dollar Industry

2007-07-31T12:25:00.001-07:00

Medical tourism is the practice of traveling to another country to obtain health care. The provider and patient use informal channels of communication-connection-contract, with less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed. Services typically include elective procedures as well as complex specialized surgeries such as hip and knee joint replacement, cardiac surgery, dental surgery, and cosmetic surgeries.

Due to the high costs of medical treatment and surgery in the United States, the waiting lists in the United Kingdom, Australia and Canada and the lack of high tech medical procedures in many third world countries, medical tourism is expected to blossom into a ten billion dollar business world-wide. Recognizing this trend governments, large corporations, hospitals, and doctors are flooding the medical tourism market with choices, and prices are dropping in many countries world-wide.

The concept of medical tourism is not a new one. The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism.

Medical tourists can come from anywhere in the world, including Europe, the UK, the Middle East, Japan, and the U.S. This is because of their large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.

Additionally, patients are finding that insurance either does not cover orthopedic surgery (such as knee/hip replacement) or imposes unreasonable restrictions on the choice of the facility, surgeon, or prosthetics to be used. Medical tourism for knee/hip replacements has emerged as one of the more widely accepted procedures because of the lower cost and minimal difficulties associated with the traveling to/from the surgery. Colombia provides a knee replacement for about $5,000 USD, including all associated fees such as FDA approved prosthetics and hospital stay over expenses. However, many clinics quote prices that are not all inclusive and include only the surgeon fees associated with the procedure

As the number of uninsured Americans grows, medical patients are now becoming consumers of medical care in record numbers. Many of these medical consumers are taking part in medical tourism i.e., people who leave the country primarily for medical treatment.

When a medical consumer searches for a provider, they tend to focus on the credentials of the doctor and forget about other important factors. Possibly the most important other factor is the country where the doctor and hospital are located. The country determines many things about the quality of care you will receive.

A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. The time spent waiting for a procedure such as a hip replacement can be a year or more in Britain and Canada; however, in Singapore, Hong Kong, Thailand, Colombia, Philippines or India, a patient could feasibly have an operation the day after their arrival. In Canada, the number of procedures in 2005 for which people were waiting was 782,936

Factors that have led to the recent increase in popularity of medical travel include the high cost of health care or wait times for procedures in industrialized nations, the ease and affordability of international travel, and improvements in technology and standards of care in many countries of the world.

To understand the phenomenon of medical travel, we can compare the average costs of cosmetic surgeries between the industrialized nations and Latin America countries where medical tourism and cosmetic surgery tourism are becoming popular, such Argentina, Bolivia, Brazil, Costa Rica, Colombia, Philippines, Mexico. Prices quoted in the table below are from offices affiliated with the ministries of health in the U.S., Europe (France, Spain, Switzerland), Argentina, Bolivia, Brazil, Costa Rica, India, and Mexico.

Medical tourism carries some risks that local medical procedures do not. Should complications arise, patients might not be covered by insurance or able to seek compensation via malpractice lawsuits, though it should be noted that malpractice insurance is a considerable portion of the cost in the Western countries such as the US that allow doctors to be sued. The most outspoken critics of medical tourism are U.S. malpractice lawyers who see this emerging trend as a threat to their livelihood. Some countries currently sought after as medical tourism destinations provide some form of legal remedies for medical malpractice. However, this legal avenue is unappealing to the medical tourist. Advocates of medical tourism advise prospective tourists to evaluate the unlikely legal challenges against the benefits of such a trip before undergoing any surgery abroad.

Those involved in medical tourism should seek a hospital in country where government inspections of the hospital are mandated and the standards are high. But just this mandate is not enough. After all the results of the inspections may be known to only a few. Government should also mandate that the results be made public. Such a practice is now law in Germany for German hospitals and other countries in Europe. Wouldn't the medical tourism consumer want to know the results? After all, hospital infection rates vary widely and give the consumer a good idea about how well the hospital is managed.

Healthcare In Crisis?

2007-07-31T12:02:00.000-07:00

Baby boomers are quickly approaching retirement age, and as they do, there are a number of concerns that need to be addressed, particularly in the area of healthcare. Unfortunately, there appears to be no easy answers to the healthcare problems that baby boomers, and the population in general, will face in the very near future.

The United States faces a medical emergency. Costs of the nation's healthcare system are growing so fast they are out of control. Many employers are dumping escalating healthcare expenses for both employees and their retired workers as fast as they can manage, fearing a loss of competitiveness. Currently, the average American consumes $6,420 worth of healthcare services a year. That's more than $12,200 a year for the average family. It's the most inefficient medical system among industrial nations. US healthcare costs have reached $1.6 trillion a year. That's 15 percent of the nation's economy, up from 5 percent in 1963. Other industrial nations devote less than 10 percent of gross domestic product to healthcare.

Advancements in medical technology and science means that people are living longer. This does not always mean that there is a high quality of life for those that are living longer though. Many of these people who would have died from a medical condition two decades ago can now live for a long time to come. These people often require a great deal of long-term care, whether it is at home or in a long-term care facility.

Those receiving long-term care at home require nurses to help them with their day-to-day tasks. The following is a quote taken directly from the Medicare website (http://www.medicare.gov/LongTermCare/Static/Home.asp)

"Generally, Medicare doesn't pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn't pay for this type of care called "custodial care". Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring."

There is also a great deal of talk about whether or not Medicare will even be around in the coming decades. Consider the fact that 28% of the population will no longer be contributing to Medicare via taxes, while at the same time that 28% will be using more of the resources.