Let’s Talk About Health

Dr.v.sudhakaram asked:


Health sector Reforms in Andhra Pradesh

    A review on Health sector reforms in India   The health sector reforms in India were started way back in 1970s .The Govt. of India identifies the need HSR and stated in the eighth five year plan. The Eighth Five Year Plan (1992-1997) was the first plan document to state the need for re-structuring of economic management systems, following the macro developments of the 1990s. During this period in the health sector, the concept of free medical care was revoked and people were required to pay, even if partially, for the health services (1). The Ninth Five Year Plan (1997-2002) emphasized the need to review the response of the public, voluntary and private sector health care providers as well as the population themselves to the changing health scenario, to reorganize health services to bring about greater efficiency and effectiveness and to introduce health system reforms to enable the population to obtain optimum care at affordable cost The Ninth Plan sought to increase the involvement of voluntary, private organizations and self-help groups in the provision of health care and ensure inter-sectoral coordination in implementation of health programmes and health-related activities as well as enable the Panchayati Raj Institutions (PRI) in planning and monitoring of health programmes at the local level so as to bring about greater responsiveness to health needs of the people and greater accountability; to promote inter-sectoral coordination and utilise local and community resources for health care(2) .The Tenth Five Year Plan (2002-2007) touches upon reforms at primary, secondary and tertiary level(3).                         Politics influence health systems in significant manner. The goals, priorities, and the strategies, variations in the commitment are largely decided through the political contingencies. There are competing demands on the health systems. The evolution of the health systems is largely shaped by the culture, history, and norms. Client satisfaction is very high. As per NFHS-2 data, an overwhelming majority of clients are satisfied by the services delivered by the public systems. May be the expectations are low or may be our people are so courteous. But on the hand, we have the report from Transparent International, ranked the health system in India is the most corrupt system (4)   The Government has taken several steps for improving the public health care institutions and Strengthening the primary health care infrastructure. However, the situation is compounded by severe resource constraints - financial, technical and human power related, which has resulted in policy makers as well as programme managers at differing levels being faced with difficult choices. In such a situation, attempts are being made through various reform initiatives to ensure that the health needs of the people are met One of the major reform initiatives underway is the Secondary Health System Strengthening Project funded by the World Bank in seven states (Andhra Pradesh, Karnataka, Punjab, West Bengal, Maharashtra, Orissa and Uttar Pradesh). The projects include strengthening FRUs/CHCs and district hospitals so as to improve the availability of emergency care services to patients, to reduce overcrowding at district and tertiary care hospitals, construction works, procurement of equipment, increased availability of ambulances, drugs; improvement in quality of services following skill up gradation training in clinical management, changes in attitudes and behavior of health care providers; reduction in mismatches in health personnel / infrastructure; improvement in hospital waste management, disease surveillance and response system. It is essential to assess both progress and problems in implementation of the reforms in each state and to appropriately modify the content and pace of implementation. Such an overview and analysis of all related issues is necessary to provide evidence to policy makers and other stakeholders in terms of the various dimensions and impact of health sector reform.(5) In the Indian Constitution, health is a state responsibility. During Adjustment, many state governments in India had recourse to Health Systems Development Project loans from the World Bank for carrying out health sector reforms (HSR), of which one of the key policies has been to raise public spending on health care from the abysmally low levels seen up to then. The Health Systems Development Project seeks to develop strategic management capacity; strengthen performance, accountability, and efficiency; and build implementation capacity. Further, it seeks to improve clinical service quality by renovating and expanding district, sub district, and community hospitals and improving access to services. In all seven reforming states, around 15% of the total project cost is borne by the state governments. All the project documents note the low levels of funding for secondary hospitals in the reforming states. This is attributed to the small share of overall public spending allotted to health, the limited portion of total health spending going to hospitals, and, within this, a skewed distribution of funds in favour of the tertiary hospitals. After analysis of the problems of the health sector, the governments of the reforming states have agreed-using terminology ranging from “assurances” to “commitments”-to several undertakings. These are: (i) to enhance the overall size of the health budget; (ii) to redress imbalances in public expenditure between secondary and tertiary care levels; (iii) to safeguard the operations and maintenance components of current expenditure allocations for the secondary health-care sector; (iv) to charge user fees for selected services; and (v) to address workforce issues. The Health Systems Development Project initiated in the seven states recognizes the need for enhanced public spending on health and identifies it as the foremost policy reform to be pursued. Nevertheless, such assurances and conditions have not succeeded in enhancing health sector budgets in states implementing HSR. Worse, HSR has not been able to arrest the decline in the share of health spending within total government spending. The Indian system is especially complicated, as the larger tax resources are controlled by the central government but the major responsibility for health-care spending is bestowed on the states (6).Andhra Pradesh is the first state to go with the HSR.               Health sector reforms in Andhra Pradesh   The state of Andhra Pradesh was formed on 1st November, 1956 under the States’ reorganization scheme. It is the fifth largest State with an area of 2, 76, 754 sq. km, accounting for 8.4 % of India’s territory and also the fifth most populous state with a Population of 75 crores. The state has varied physiographic features ranging from high hills, undulating plains to a coastal deltaic environment. Administratively, Andhra Pradesh is divided into 23 districts, 79 revenue divisions, 1123 mandals, about 27000 villages and 264 towns. AP’s economy grew at 7.2% during 2006-07 — the fourth consecutive year of 6% plus growth. The latest poverty headcount ratio stands at 16%, compared to 23% for India . the third-highest credit rating among the major Indian states; the third best investment climate in the country; and the fourth-lowest corruption level among Indian states Andhra Pradesh was the first Indian state to receive a multi-sector Bank operation - the Andhra Pradesh Economic Restructuring Program for US$ 550 million in 1997 - aimed at helping the state accelerate policy and institutional reforms across a wide range of sectors under a common fiscal framework. It is also the only Indian state where the Bank has disbursed three budget support operations - the First Andhra Pradesh Economic Reform Loan (APERL-1) in March 2002, the Second APERL in February 2004, and the Third APERL in January 2007 - that sought to support the state’s development program.(12) Within AP there are regional, social and gender disparities. Health outcomes are worst among Scheduled Castes (16% of population) and Scheduled Tribes (7% of population), especially those living in underserved areas in North tribal and South drought prone districts, and for women. Effective delivery of quality basic health services is hampered by demand and supply side issues, including poor health infrastructure and staffing.(15)     The reform history in health sector in the State can be traced to Andhra Pradesh First Referral Health System Project, one of the first World Bank aided health system projects in the country. This project, launched in 1995 had been implemented by AP Vaidya Vidhana Parishad (APVVP). Agencies like World Bank and DFID are supporting the reform process in the State. The Bank supported the AP Economic Restructuring Project which included improvement of primary health care as one of the component.(7) The priority reforms focus on improved access to quality and responsive health services, strengthened governance and management in health sector, improved institutional mechanisms for community participation and systems for accountability; and strengthened financial management systems.(15)  The government of Andhra Pradesh [GoAP 1999] Vision 2020 document identifies a seven-point set of priorities for health sector reform: providing universal access to primary healthcare; encouraging private investment in tertiary healthcare; focusing on specific programmes to promote family planning; focusing on improving health levels in disadvantaged groups and backward regions; ensuring a strong prevention focus; enhancing the performance of the public health system; and formulating a state information education and communication (IEC) programme to broadcast information on preventive healthcare.(13) The Government of Andhra Pradesh is embarking on a major health sector reforms to improve health care delivery in the State. D.F.I.D. has expressed its willingness to support these initiatives with a grant of 100 Million pounds over the next five years (2006-2011). The reform initiative will include measures to improve the effectiveness and accountability of public health services, measures to focus on community centric preventive healthcare system and enhance access to quality healthcare for the poorer sections of the population(14) DFID will provide up to £40 million health sector budget support to the DoHMFW, GoAP, over 3 years 2007 - 2010. The sector support will build synergy with National Rural Health Mission (NRHM) which is a health sector reform program of the central government for decentralisation, pro-poor focus, strengthening service delivery(15)     The health sector support will be provided over three years (2007-08 - 2009- 10). It aims at increased use of quality health services, especially by the poorest people and in underserved areas.(16) The main outputs will be: a) Improved access to quality and responsive services, especially in remote and interior areas; b) Governance and management of health sector strengthened; c) Institutional mechanisms for community participation and systems for accountability in functioning; and Financial management systems strengthened and improved public expenditure on health.   The performance of health services would be measured against(17)

* greater effectiveness and improved outcomes of existing programs;

* improved efficiency in the allocation of resources;

* greater access and equity; and

* consumer satisfacfion

Reforms underway in health sector   The major reforms underway are classified under these categories and the activities are noted below and we will look each of them in detail    (I) Reorganization and restructuring of existing government health care system

Establishment of Andhra Pradesh Vaidya Vidhana Parishad Strengthening of referral institutions and fixing of service norms Improvement in drug supplies Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC) Strengthening of PHCs as 24-hour MCH centers Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres

(II) Changes in health system organisation, delivery and Management

Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals Provision of free travel bus passes to pregnant women for antenatal check ups Public Private Partnership

(III) Changes in financing methods

Sukhibhava Scheme (Improvement of Institutional Delivery Services Scheme) User fees

(IV) Reforms related to human resources

Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department

(V) Involving community in health service delivery and Provision

Women Health Volunteers Scheme

(VI) Reforms to quality of care

Performance indicators for grading the PHCs Performance rating of secondary hospitals

    1.Reorganization and restructuring of existing government health care system   A)Andhra Pradesh Vaidya Vidhana Parishad   AP, has created the Andhra Pradesh Vaidya Vidhana Parishad (APVVP) by enacting an Act in the Legislative Assembly in 1986(8) This was done with the objective to lay greater emphasis on development of both preventive as well as curative health care  and to strengthen necessary linkages at appropriate levels to ensure comprehensive medical and health care services. APVVP has undertaken World Bank assisted Andhra Pradesh First Referral Health Systems Project (APFRHSP) in 1994 for a period of seven years. This has been one of the major projects undertaken by APVVP. The objectives of the project included improvement of efficiency in the allocation and use of health resources through policy and institutional developments and enhanced performance of health system by improving the quality, effectiveness and coverage of health services at the first referral level.   B)Strengthening of referral institutions and fixing of service norms   basic service norms for various categories of hospitals under the administrative control of APVVP have been fixed thereby creating a hierarchy of hospitals according to services and facilities. This system of service norms and referral linkages had been developed with a view to optimise utilisation of resources, avoid duplication and wastage of resources, regulate patient flow and reduce cost of treatment by reduction of patient burden at tertiary hospitals. the district hospital has been prescribed to provide services in eleven specialties for which 9 civil surgeon specialists, 18-20 civil assistant surgeons, 54-84 paramedical staff and other supporting staff have been Posted. C)Improvement in drug supplies To ensure regular supply of drugs at all times and in all situations, a system of three sources of drug supply has been put in place for the hospitals under APVVP: (a) centralised drug procurement system under which the institution has been allotted drugs worth a particular amount based on bed strength (Rs 2000 per bed per quarter); (b) an emergency provision for drugs (Rs 100 per bed per month) has been made to every institution from where emergency procurement of drugs is made; (c) drugs which are in short supply and for which regular rate contract suppliers are not available have been stocked at the office of District Coordinators of Health Service. Under the APFRHSP, const-ruction and repair of 160 hospitals including 81 CHCs, 58 area hospitals and 21 district hospitals had been undertaken.(10)         D)Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC)   a separate corporation has been set up in 1987 exclusively for developing housing and other infrastructure for medical and paramedical staff and constructing sub centers, PHCs, hospitals, dispensaries, clinics and other health care centers One of the major projects undertaken by APHM&HIDC has been the World Bank assisted India Population Project-VIII launched for improving the medical care facilities in urban slums in 74 municipalities.   E)Strengthening of PHCs as 24-hour MCH centers   In a move to make available maternal and child health care at all times, 470 PHCs in backward districts have been designated as round the clock Mother and Child Health Centre (earlier called women health centres). One staff nurse, one ANM and three support staff have been appointed in each centre on contractual basis. Staff nurses have been trained to conduct normal deliveries and refer emergency cases. Additional facilities like telephone and vehicle have been provided to the PHCs in order to assist communication and transport for referral of emergency cases. Provision has been made to conduct fortnightly specialist clinics of gynaecology and paediatrics in these centres to detect high risk pregnancies and neonates for referral to FRUs.   F)Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres   The State Government has decided to establish 108, CEmONC centres spread across every district so that pregnant mothers requiring emergency care do not have to travel more than 40-50 kms to receive specialist care. Training of MBBS doctors in anaesthesia, neonatal care and blood transfusion is also planned to support this scheme.   2)Changes in health system organisation, delivery and Management A)Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals   Hospital Development Societies have been constituted in all tertiary hospitals under the control of Directorate of Medical Education.(18) and after implementing NRHM rogi kalyam samithi at every PHC were formed to ensure the adequate participation of local institution,with an aim to improve effective and efficient services with allowed flexible financial powers. These societies are examples for decentralization . Activities of the society include maintenance of the hospital (including sanitation & water supply, electricity, building & civil works and equipment), purchase of drugs & medicine supplies and equipment. The government has set norms and limits for undertaking these works which are to be adhered to by the Society. The ‘system works’, observed an Unicef team which assessed the impact of RKS towards the end of 2000. The system, however, is not without any lacunae. For, it was pointed out that “overall control of the local RKS bodies remain in the hands of the collector and if he is not interested in health care then the whole thing might just drift(13)   B)Provision of free travel bus passes to pregnant women for antenatal check ups(19)   The Government of Andhra Pradesh has started an innovative scheme in order to enable pregnant women in rural areas to avail antenatal check ups at the nearest PHC/area hospital or FRU. It has tied up with the State Road and Transport Corporation to issue free transportation bus tickets pass to be utilised for three visits. The ANM issues the bus passes to the pregnant women on her house visits.       C)Public Private Partnership(20)   ·         Management of Urban Health Centers by NGOs   Under the World Bank assisted Andhra Pradesh Urban Slum Health Care Project (APUSHCP), 192 urban health centers (UHCs) have been established in 74 municipal towns in 21 districts covering 1848 slums. After withdrawal of support by the World Bank, the project has been funded by the state government since 2002. The outcomes of the project show marked improvement in ANC coverage, institutional deliveries, post natal care and immunisation in the slum population.   ·         108 emergency services                           Govt. has tied up with satyam computers to provide emergency transportation which proved to a most successful programme and many states are following the same like Gujarath. The objective of 108 Ambulances is to save people in life emergency . One ambulance is given for three mandals. Each ambulance fitted with equipment worth Rs.17 lakhs renders its services in life emergencies, road and fire accidents (22)   ·         Rajiv arogya sree    The innovative Govt. insurance scheme to serve people of  poor from the serious ailments now attracting the nation as this programme succeeded. this scheme provides financial support to families of BPL upto 2 lakhs per anum for treating serious ailments. it is proposed to cover the entire state by 2nd October 2008 with the govt. paying the insurance premium for all the beneficiaries .an amount of rs.450 crores are provided to implement the scheme during 2008-09. (21)       3)Changes in financing methods   A)Sukhibhava Scheme(23)   Under the Scheme, a cash assistance of Rs.300 (Rs 200 towards transportation charges and Rs 100 for food and incidental expenses) is paid to pregnant women belonging to below poverty line families who come to government hospitals/APVVP hospitals/ teaching hospitals/PHCs/CHCs for delivery serv-ices. This assistance is payable only to those women with no living children or with one living child.   B)User fees:-   If user fees are charged their main use may lie in optimization of expenditure patterns and better allocation between facilities and within facilities(24). Reddy and Vandemoortele (1996), based on a comprehensive review of user financing of basic social services carried out for UNICEF, point to three other discouraging features of user fees: (1) user financing can result in a sharp reduction in the utilization of services, particularly among the poor; (2) gender biases, seasonal variations and regional economic disparities can aggravate the effects of user financing on equity; (3) user financing  quires adequate capacities, effective decentralisation and continued government support; and (4) user financing can undermine political support for the goal of universal coverage of basic social services. In 2001, the Commission on Macroeconomics and Health (2001) also reached a similar conclusion that user fees end up excluding the poor from essential healthservices, in 2005, the Millennium Project’s recent Report to the UN Secretary General (2005) titled “Investing in Development - A Practical Plan to Achieve the Millennium Development Goals” also forcefully argues for abandoning user fees. The health sector in India has acquired a notorious reputation for inefficiency and corruption at all levels. There is little accountability in both the public and private sectors. Quality standards are practically non-existent as are performance measures and honest reporting. A recent report on human resources for health brought out by Harvard University’s Global Equity Initiative (2004) argues that it is people - health workers alone - who can produce an effective health system and deliver good ealth.(25) 4)Reforms related to human resources Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department At district level, District Health Coordination Committee (DHCC) has been constituted to ensure proper planning, implementation and monitoring of all programmes/activities of HM&FW Department in the district.  The Committee has been entrusted with the primary responsibility of planning, finalizing, implementing and monitoring the District Health Action Plans and institutionwise health plans in a participatory manner including all concerned officials, other concerned departments and NGOs.   5)Involving community in health service delivery and Provision  

Women Health Volunteers Scheme

  One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist - ‘ASHA’ or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Following are the key components of ASHA(26) A woman, usually a daughter-in-law of a house who has studied upto 7th class and preferably from SC/ST community has been selected as WHV by the Gram Panchayat Health Committee. The selected WHV has been given one month training in health care aspects of pregnancy, antenatal, delivery, post natal and new born care, immunisation, diarrhoea, acute respiratory infections, first-aid and treatment of minor ailments. The training has been provided at Telugu Mahila Pranganams for three weeks and one week field level training at PHCs. Academy of Nursing Studies has been designated as the nodal agency for providing training to WHVs.   6)Reforms to quality of care   A)Performance indicators for grading the PHCs   One of the components of World Bank assisted AP Economic Restructuring Project is improvement of primary health care. In order to improve the quality of primary health care services, a system of performance rating has been developed to rate PHCs and CHCs. The grading has been accorded A to C in descending order   B)Performance rating of secondary hospitals   A performance rating system for secondary hospitals under APVVP has been  introduced. The indicators related to general services (outpatients, inpatients, bed occupancy), emergency services (emergency-OP, emergency-IP, emergency major operations, emergency minor operations), clinical services (major/minor operations, tubectomy, deliveries) and diagnostic services (X-ray, ECG, lab tests and USG) have been developed for the purpose. Normative targets for each type of hospital (district hospital, area hospital, community health center) have been fixed against which the performance is measured and rating assigned. Highest grading is A while lowest grading is C.(27)   Conclusion:-   Introduction of user charges and subcontracting of services to the private sector are the main elements of health sector reforms. The health sector reforms are only a part of drastic reforms in other major sectors undertaken as a part of Andhra Pradesh Economic Restructuring Project (APERP) and the overall impact on the health conditions of people and their access to medical care depend more on the changes proposed outside the health sector. For instance, while exempting the white ration card holders i.e. the poor from the user charges in the government hospitals, it proposes to drastically reduce the number of white card holders to half in the state. The net affect would be to reduce the percent of population eligible for free treatment.(29)   On the other hand the success of 108 EMRI services and overwhelming response from Rajiv Arogya sree scheme are the examples for HSR success. Just like every thing has gots its own pros and cons HSR should be done in such a way where the need exist and according to necessities .   Referances:-   (Note:-most part of the article was taken from ref.no 28 otherwise reference specified)

 

(Government of India, Eighth Five Year Plan, (1992-1997) Planning Commission, New Delhi.) (Government of India, Ninth Five Year Plan, (1997- 2002) Planning Commission, New Delhi ) ( Government of India, Tenth Five Year Plan (2002-2007) Planning Commission, New Delhi) ( D. Agarwal Health Sector Reforms: Relevance in India, Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006) Health Sector Reforms in India, Initiatives from Nine States ( http://www.idrc.ca/en/ev-118491-201-1-DO_TOPIC.html.The international development research centre) http://www.worldbank.org.in  (The Andhra Pradesh Vaidya Vidhana Parishad Act 1986 (Act No. 29 of 1986 with Amendaments upto 31.03.1989  Dr. MCR Human Resource Development Institute of Andhra Pradesh (Undated). “Andhra Pradesh Vaidya Vidhana Parishad Departmental Manual”  6http://www.aponline.gov.in/apportal/departments/ departments.asp?dep=16&org=98 GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. http://www.worldbank.org.in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:20970681~pagePK:141137~piPK:141127~theSitePK:295584,00.html#Ongoing_projects Grish kumar,promoting PPP in health services,EPW commentary,july19,2002  (G.O.Ms.No.130, HEALTH MEDICAL AND FAMILY WELFARE (K2) DEPARTMENT. Dated the 24th April, 2006)  ANDHRA PRADESH HEALTH SECTOR REFORM PROGRAMME (APHSRP) Terms of reference for Technical Cooperation (TC) to DoHMFW, GoAP  PRESS INFORMATION BUREAU GOVERNMENT OF INDIA, HEALTHCARE PROJECT IN AP FUNDED BY DFID, New Delhi, March 5, 2008) http://lnweb90.worldbank.org/oed/oeddoclib.nsf/DocUNIDViewForJavaSearch/0CFD6217A8A5BDA2852567F5005D32BD  G.O.Ms.No.403, dated Sept 7th 1998  GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. Power Point Presentation of Govt of AP at the 2nd Regional Workshop on Health Sector Reforms: Experiences of Select States at Hyderabad, 14-15th February 2005 and ECTA Working paper 2002/61 Public-Private Partnership: Operational Framework used in Andhra Pradesh and Assam http://www.scribd.com/doc/2208678/AP-Budget-Speech  http://pibhyd.ap.nic.in/er27070702.pdf  Dept. of Health Medical Family Welfare, GoAP (undated), “Sukhibhava (Improvement of Institutional Delivery Services Scheme): Implementation Guidelines to PHC/Hospital  http://mohfw.nic.in/NRHM/Documents/CRM_report_full_report_version.pdf   (A.K.Shiv Kumar,,Budgeting for health ,some considerations) Economic and Political Weekly April 2, 2005  http://mohfw.nic.in/NRHM/asha.htm#abt http://health.ap.nic.in/apvvp/apvvp_stat.html  (http://www.whoindia.org/linkfiles/health_sector_reform_hsr_vol_ii_-_andhra_pradesh.pdf)  (Impact Of Health Sector Reforms On Hospital Services In Andhra Pradesh - A Study Of Trends In The Structures Of Provision And Utilisation Pattern)(centre for economic and social studies) (http://www.cess.ac.in/cesshome/research6b.html)

       

 



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mindygallo22 asked:


I have to a do a nutrition project for nursing school and I have to write something on the following question but I can’t figure out what the 2 public health concerns may be. Any help?

What are 2 public health concerns that have a bearing on nutritonal status?

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prizice24 asked:


I own a business (LLC) with two other people. It is only us three; we do not have any additional employees. We pay for our health insurance through our business. Based on these facts, I was wondering how much I stand to save on my personal taxes. Is this a standard write off like any other business expense or does the IRS treat health insurance differently?

Create a video blog…instantly.

Maria asked:


New York Health Insurance

Health insurance is insurance that pays for all or part of a person’s health care bills. A health insurance policy is an annually renewable contract between an insurance company and an individual. With health insurance claims, the individual policy-holder pays a deductible plus co-payment (for instance, a hospital stay might require the first 1000 dollar of fees to be paid by the policy-holder plus 100 dollar per night stayed in hospital). Usually there is a maximum out-of-pocket payment for any single year, and there can be a lifetime maximum.

The purpose of health insurance is to help people cover their health care costs which usually include doctor visits, hospital stays, surgery, procedures, tests, home care, and other treatments and services.

According to the latest United States Census Bureau figures, around 85% of citizens have health insurance. 59.5% of these people receive their health insurance coverage through an employer, and about 9% purchase it directly from the market. Government sources cover 27.3% of the population. Those without health insurance coverage are expected to pay privately for medical services.

Types of New York Health Insurance (http://new-york.ixs.net/General/New-York-Health-Insurance/index.aspx ) The types of health insurance in New York are group health plans, individual plans, and government health plans such as Medicare and Medicaid. In the United States, government-funded Medicare programs help to insure the elderly and end stage renal disease patients.

Group Health Plans

A group health plan offers health care coverage for employers, student organizations, professional associations, religious organizations, and other groups. The employer may pay for part or all of the insurance cost (premium).

Individual and Family Health Insurance

Individual and family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to employer groups or organizations. These types of health care plans are sold directly to individuals. For those of you who are unemployed or self-employed, an individual health insurance policy is always an option. Unfortunately rates for these policies are high and the coverage is usually less comprehensive than a managed care plan. The good news is that, in many cases, your insurance premium will be tax deductible. Of course, if you’re married, you can always try to catch a ride on your spouse’s group health insurance benefits plan.

Health insurance can be further classified into fee-for-service or indemnity (traditional insurance) and managed care. Both group and individual insurance plans can be either fee-for-service or managed care plans.

Managed Care Health Insurance

These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.

There are three main types of managed care plans:

• Health Maintenance Organizations (HMO)

• Point-of-Service (POS)

• Preferred Provider Organizations (PPO)

All of these plans offer substantial health insurance benefits to members and their families. If you’re fortunate enough to have a choice of plan, consider the advantages, and disadvantages, of each. Compare the cost of care, the difference in premiums, deductible amounts and your freedom to choose a doctor outside the plan. There are numerous other coverages to compare as well — from prescription drugs to dental to alternative therapies. Be sure you understand the fine points of each.

Indemnity or Fee-For-Service Plan

Normally it covers the same expenses as managed care. The difference is your doctor is paid for each visit with the claim filed by either the patient or the medical provider. A big advantage– unlike some managed care plans, Fee-for-Service allows the patient a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.

However, you’ll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.

Short-Term Health Insurance

Short-term health insurance plans are designed to protect against unforeseen accidents or illnesses, rather than to provide comprehensive coverage, and, as such, typically do not include coverage for preventive care, physicals, immunizations, dental or vision care. It covers for a limited period of time, and may be an ideal solution for those between jobs or those waiting for other health insurance to start. Typically, short-term plans offer coverage up to six months, although some plans may offer coverage up to 12 months. Purchasing a short-term medical insurance plan will make you ineligible for any guaranteed issue individual health plans commonly referred to as HIPAA (Health Insurance Portability and Accountability Act) Plans. HIPAA plans are usually very expensive and are generally intended for people with pre-existing medical conditions who would have trouble getting health insurance otherwise.

Medical Savings Account (MSA)

Medical savings account (MSA) is the most recent development in the area of health insurance. The principle behind the MSA is to take the bulk of the financial risk, and premium payments, away from the managed care and indemnity insurers, and allow individuals to save money, tax free, in a savings account for use for medical expenses. Individuals or their employers purchase major-medical policies, medical insurance policies with no coverage for medical expenses until the amount paid by the patient exceeds a predetermined maximum amount, such as 2500 dollar per year. These policies have extremely high deductibles and correspondingly low monthly premiums and the participants take the money that they would have spent on higher premiums and deposit it in an MSA. This money accrues through monthly deposits and also earns interest, and can be spent only to pay for medical care

What’s The Best Health Insurance Plan?

There is no one “best” plan for everyone. The best match for you and your family may be different than the best match for someone else. In order to help you answer this question, here are a few things to consider:

1. Are you going to need long-term coverage or just something for the short-term?

If you’re between jobs for 1-6 months, you may want to go for short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.

2. Are you looking for basic coverage or more comprehensive coverage?

Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness. Other insurance plans that offer more comprehensive coverage may include benefits such as preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.

3. Would you pay for your services before you use them or when you use them?

If you choose a health insurance plan with a low monthly premium, you’re likely to have a higher co-payment or deductible. If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.

4. How important to you is easy access to specialists?

Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. So, if you prefer easier access to specialists, you may wish to consider a different type of plan.

5. Do you have a specific doctor or hospital that you would like to visit for healthcare?

Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.

6. What is the most you could pay out in case of a serious illness or injury?

Health insurance plans typically place limits on how much a member is required to pay out per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you’ve contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. If you’re concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you’re considering.

No matter what insurance plan you may choose, educate yourself and understand all the basics of the health insurance before finalizing anything.

For more information about New York Health Insurance visit: http://new-york.ixs.net



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Health Spa Guru asked:


Yoga is not a recent practice. It is a practice which through time, has developed and increased in significance and appeal worldwide. The rationale behind the appeal is greatly to do with the physical and psychological benefits experienced when integrating yoga into one’s daily schedule. Yoga can be viewed as a breath of fresh air in this fast paced lifestyle that we live in.

The word yoga comes from the Sanskrit language and means “to integrate”. Yoga promotes a harmonious working together of the body’s components leading to both physical and mental training. Despite the fact that there are numerous forms of yoga; Hatha Yoga is still presently seen as one of the more commonly practiced yoga styles. Hatha Yoga consists of non strenuous physical exercise which aids in strengthening, stretching and balancing the body’s joints. Regular breathing is performed at the same time which aids in providing oxygen to the muscles, and in turn positively affects bodily structures and organs. The awareness required during yoga practice, ensures that mind and body have to work together to create a mind-body harmony which in turn promotes healing.

Yoga will not be a quick fix for all your aches, worries and pains. However, with regular yoga practice your body will rebalance slowly and steadily, leaving you discovering the results for yourself. Physical benefits which you can anticipate are improved efficiency of the lungs, better use of your respiratory muscles, improved flexibility of the joints, improved coordination and muscle tone, maintenance of bone density, reduced risk of injury as well as the prevention of weight gain. Psychological benefits can also include an increase in self-confidence, decreased cravings for tobacco and food, better sleep, an increased ability to relax, improved concentration as well as a reduced likelihood of depression. Yoga differentiates itself from other exercises as it draws on the entire person as a whole.

Half an hour of yoga a day, or 15 minutes of yoga twice a day, can easily be incorporated into any daily schedule. Some breathing techniques can even be practiced while working or driving home after a long day. A short routine for those of you spending hours staring at a computer screen is to take a few moments every day to glance at a distant object. This allows your eyes a moments rest from glare and a change of focus. Look left and right, up and down at least 5 times, blink at least 8 times to moisten your eyes and if it is at all possible, rest your elbows on a comfortable surface and close your eyes whilst covering them with the palm of your hands. If you can incorporate this with or without some breathing exercises, you will already be on the way to a healthier and possibly more focused lifestyle.

Baby steps everyone…no one expects you to transform overnight.

Find spas and more wellness related information at: http://healthspaguru.com



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JLLHokieLavaDog*isaRETARDhahaLOL asked:


Hi, I have never bought health insurance before, and I would like to know how I could find out if a particular health insurance provider would cover the costs of me going to a dermatologist and getting Accutane. Can anyone help me?

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Barclay Win asked:


When comparing health insurance quotes, make sure you are comparing similar plans. Health insurance comes in two basic forms – indemnity plans and managed care plans. Both indemnity and managed care health insurance are further broken down into several different types of health insurance so it is important to take the time and compare health insurance plans to determine what best fits your health care needs.

Indemnity Health Insurance

Indemnity health plans put you in charge of choosing your doctors, hospitals and other health care providers. You pay a set monthly premium and your health insurance pays your medical care, often after you pay a deductible and possibly a percentage of the bill.

A common employer-sponsored form of health insurance is a cafeteria or flexible spending plan. This type of health insurance allows employees to create a benefit package taken from a number of options. You need to contact the employee benefit department at your company for more information on the exact mix of choices available to you.

If you are looking for lower cost health insurance, a “basic and essential” plan may be the best option. Do keep in mind this type of health insurance is limited in what services may be covered so it is important to carefully read the policy so you understand what treatments the plan does cover. Another type of health insurance known as catastrophic health insurance or high-deductible health plans do just what it sounds like they would. The deductible is high, but this type of health insurance protects you against catastrophic illness with a very high total cost.

Health savings accounts are fairly new and an alternative to traditional health insurance. This plan involves putting money into a tax-free savings account to cover your medical expenses.

Managed Care Health Insurance

The two most common types of managed care health insurance are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs give you access to a group of participating doctors, hospitals and health care providers. HMOs come with fewer out-of-pocket expenses, but visits to the doctor, prescriptions and other services usually come with a co-pay or fee.

PPOs are fee-for-service health insurance and medical services are paid by the insurer on a negotiated and discounted fee schedule. PPOs allow participants to choose medical providers outside the plan’s network, although this can result in higher out-of-pocket costs.

One other type of health insurance is point-of-service (POS) plans. This type of health insurance is similar to indemnity plans, and your primary care physician can refer you outside of the plan without any extra costs to the insured. If you refer yourself outside a POS plan you will be charged a co-pay.



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Onirbochonio asked:


I got a postdoctoral fellowship in University of Toronto for two years. The job offer did not mention anything about benefits just about my yearly salary. Even the UT does not pay benefits for my kids, will Ontario government support any health related benefits for my family? I dont have a PR, will my kids get child allowance?

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Morgan Q. Moran asked:


Florida Health Insurance Rate Hike

Florida Health insurance premiums have touched new heights! Every Floridian has the common knowledge that most annual health insurance contracts will endure a rate increase at the end of the year. This trend is not new and should be expected. Every time this issue pops up it seems as though the blame game starts. Floridians blame Health insurance companies; Health insurance companies blame Hospitals, Doctors and other medical care providers, Medical care providers blame inflation and politicians, well, we really don’t know what they do to help the issue… No one seems to be interested in finding the real cause of the health insurance premium rate increase. Most individuals, self employed, and small business owners have taken Florida Health Insurance Rate Hikes as the inevitable evil.

Hard Facts

What are various reports telling us? Why do Health insurance premium have annual rate increases?

Rate of inflation and heath insurance premium rate increase.

America’s health expenditure in the year 2004 has increased dramatically, it has increased more than three time the inflation rate. In this year the inflation rate was around 2.5% while the national health expenses were around 7.9%. The employer health insurance or group health insurance premium had increased approximately 7.8% in the year 2006, which is almost double the rate of inflation. In short, last year in 2006, the annual premiums of group health plan sponsored by an employer was around $4,250 for a single premium plan, while the average family premium was around $ 11,250 per year. This indicates that in the year 2006 the employer sponsored health insurance premium increased 7.7 percent. Taking the biggest hit were small businesses that had 0-24 employees. There health insurance premiums increased by nearly 10.4%

Employees are also not spared, in the year 2006 the employee also had to pay around $ 3,000 more in their contribution to employer’s sponsored health insurance plan in comparison to the previous year, 2005. Rate hikes have been in existence since the “Florida Health Insurance” plan started. In covering an entire family of four, a person will experience an increase in premium rate at every annual renewal. If they would have kept the record of their health insurance premium payments they will find that they are now paying around $ 1,100 more than they paid in the year 2000 for the same coverage and with the same company. The same item was found by the Health Research Educational Trust and the Kaiser Family Foundation in their survey report of the year 2000. They found out that the premiums of health insurance that is sponsored by the employer increases by around 4 times than the employee’s salary. This report also stated that since 2000 the contribution of employees in group health insurance sponsored by employer was increased by more than 143 percent.

One business man predicts that if nothing is done and the Health insurance premiums keep increasing that in the year 2008, the amount of health premium contribution to employer will surpass their profit. Professionals within and outside the field of Florida health insurance, think that the reason for increase in Florida health insurance premium rates are due to many factors, such as high administration expenditure, inflation, poor or bad management, increase in the cost of medical care, waste etc.

Florida health insurance rate hikes affect whom?

Rising rates of Florida health insurance generally affects most of the Floridians who live in our beautiful state. The highest affected individudals are the minimum wage and low wage workers. Recent drops in the renewal of health insurance are mostly from this low income group. They just can’t afford the high premiums of Florida health insurance. They are in the situation where they can not afford the medical care and they can not afford the medical insurance premiums that are assosiated with adequate coverage. Almost half of all Americans are of the opinion that they are more worried about the high health insurance rate and high cost of health care, over any other bill they have on a monthly basis. A survey also finds that around 42% of Americans can not afford the high cost of health care services. There is one very interesting study conducted by Harvard University researchers. They found out that 68% of people who filed bankruptcy covered themselves and their family by health insurance. Average out-of-pocket deductibles for people filed bankruptcy were around $ 12,000 per year. They also found some co-relation between medical expenditure and bankruptcy. A national survey also reports that main reason for people not to take health insurance is the high premium rate of health insurance.

How to reduce Florida’s high health insurance cost? Nobody knows for sure. There are different opinions and experts are not agreeing with each other. Health professionals believe that if we can raise the number of healthy people by improving the lifestyle and regular exercise, good diets etc. than naturally they will need less medical care services which decreases the demands of health care and hence the cost.( This year in Florida the smoking rate has increased by 21.7 percent) One Floridian sarcastically suggested that there are ‘highs’ and ‘lows’ in health care that are needed to reversed. That the state of Florida is to ‘high’ in cost of medical care compare to other States and ‘low’ in the quality of health care.

Florida Health insurance rate hike has attracted many frauds. These frauds float many bogus insurance companies and offer cheap health insurance rate which attract many people to them. These companies usually through assosiations that are based in other states.

Meanwhile reputable Florida health insurance companies provide different types of health insurance like employer sponsored group health insurance, small business health insurance, individual health insurance etc. to vast number of employees and their families. Still there are many people in Florida that lack any health coverage. Today the employer also has found it challenging to decide how to offer employer sponsored group health insurance to their employees, so that both of them arrive at some point of agreement.

For Floridians it is very important to shop around for a quality health insurance program that doesn’t break the bank.

You need to find an agent or web portal like Florida Health Insurance Web, www.FloridaHealthInsuranceWeb.com that offers a variety of products. There you will most likely be able to get quotes, compare plans, and apply online.

Florida Health Insurance Consultants can help you!



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United asked:


First, I do not have insomnia, I can sleep just fine, I am just choosing not to because I can. I can stay up for two days at a time without any trouble, and I don’t use any drugs to keep me awake. Now, I am not even tired when I go to sleep at the end of the 2nd day, but I go to sleep anyway because I know I should. I have been doing this for about a month, and it appears to have no effect on my health. I exercise every day and eat right, I just think that this may somehow effect my health in the long run. Is there anything I need to worry about?

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