Posted on Jun 30, 2008 under General, health |
The United States has experienced the presence of corporate wellness programs for several years now. Despite that most employees display a peculiar trait of not relying on these programs despite employers offering varied kinds of benefits. Usually perks range from discounted prices at wellness centers (like gyms, spas etc.), cholesterol screenings at no extra cost and even free passes to special events like movie premieres and screenings. This approach does not do anything either for employees or their employers.
In recent times though, employers have actually waken up to the fact that ‘extras’ on wellness programs cannot really be the key to draw employees to pay better attention to their health and living. This has prompted them to take more serious measures where employees either participate in wellness programs or feel the crunch on their paychecks. Incentive- based programs slap heavy punishment on members if they fail to act in the interest of their health and the interest of the organization. Penalty can be quite high and can be a deterrent to erratic employee behavior concerning health and wellness.
The reason behind the employers’ new way of viewing and reviewing corporate wellness is simple- they want healthier employees to enhance work atmosphere and overall productivity. Honestly this is no unfair demand because healthier residents will make a healthier America. At least that’s how a new study sees it. According to that if programs focus more on prevention and less on cure, overall health costs will be halved in one sweep.
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Posted on Jun 07, 2008 under health, health insurance |
Being an American if you’re not worried about the state of health here there are some statistics that can get your head reeling for sure! Despite being right up there economically America faces innumerable health risks and not for nothing. According to a study, United States is the only nation that’s gone through industrialization without paying much heed to its health insurance system. A UN Health Development report takes one further into the details. According to that, the uninsured have a real tough time dealing with health disorders simply because they’re uninsured. Hospitals and medical centers do not take it into their stride if they find uninsured persons seeking care and the latter end up with less than their fair share. Additionally, their chances of receiving quality outpatient care also go down a few notches.
Other studies reveal how Americans are more prone to diseases. Even a child born to this nation does not have as many chances of survival as a baby born in El Salvador has! Canada who is one of the closest neighbors records better health amongst commoners. At least that is what a report claims when it says Canadians, on an average, have a longevity of about three years more than Americans. And believe it or not Cuba also wins when it comes down to average longevity!
The final one should come as a surprise- more than 90% of Americans feel the health insurance system will either have to undergo dramatic change or it will have to be discarded completely for a set- up that’ll serve the people better!
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Posted on Jun 07, 2008 under arthritis, health |
Despite the prevalence of prescriptions everywhere in America, elderlies fail to get what they deserve- care for osteoporosis. This is a rather sorry state of affairs since osteoporosis or bone degeneration occurs in almost all aging adults. According to a recent survey a little over 11% of elderlies have received adequate care after being admitted to a nursing home for fractures. Which means about 90% of them still are not given necessary medication despite experts stating the need for medicinal drugs beyond calcium and Vitamin D.
The Brigham and Women’s Hospital had researchers claiming that most nursing homes have female patients who have arthritis and the percentage is as whopping as 80%. This problem is perhaps a peculiarity with the nursing home structure of care giving. This has further been proved by the researchers’ study based on intervening years between 1995 and 2004. While this decade saw a rise in the use of osteoporosis medicine overall, the statistics got worse in case of nursing homes.
Talking of improvement, osteoporosis medication found its place of pride only between the years of 1995 and 2001 after which there was a steady decline. And the situation only seems to be getting worse with each passing day with patients receiving no treatment at all (a revelation made by a new study).
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Posted on May 15, 2008 under health |
The application of Web 2.0 technologies to the healthcare industry is changing the world of care delivery. With the availability of new technologies, innovative services are rapidly and radically revolutionizing how healthcare is offered and consumed. Healthcare is finally catching up with other industries, such as travel, entertainment and retail, to bring care online. In this exclusive Web conference, Lynne Dunbrack from Health Industry Insights, an IDC Company, presents a fresh market overview of Health 2.0, outlining the state of the market and its key players. Roy Schoenberg, CEO of American Well Systems, defines online care and introduces the Online Healthcare Marketplace, an innovation at the cutting edge of Health 2.0.
This exclusive Web conference will provide attendees with an understanding of the changing landscape of healthcare:
- Where is Health 2.0 today?
- How is healthcare catching up with other industries?
- What innovations are transforming the industry?
- What is online care?
- What is the health plan’s role in this transformation?
Join us for this live interactive session combining in-depth knowledge of industry experts who will share predictions and insights about the impact that Health 2.0 will have on the life of all Americans.
Speakers:
Lynne A. Dunbrack – Program Director, Health Industry Insights, an IDC Company
Roy Schoenberg, MD, MPH – CEO, American Well Systems
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Posted on May 15, 2008 under health |
Pricing health insurance is a complex process in which many factors are taken into account. An insurer must set a premium amount that both makes the coverage advantageous and attractive to the insured and also enables the insurer to cover its costs and make a profit (for stock companies) or add to surplus (for mutual companies).
However, we can identify four basic principles that an insurer must follow:
- Adequacy: The amount of the premium for any policy must be adequate to cover the benefit payments the insurer makes on the policy and the costs of administering the policy. For a stock company, the premium must also provide a reasonable amount of profit. For a mutual company, it must also provide a contribution to the surplus the company needs to guarantee its obligations and to fund growth and development. If an insurance company’s premiums are not adequate, the company will not be able to meet its costs, it will not be able to make a profit or add to surplus, and it will eventually go out of business.
- Reasonableness: Premium amounts must be reasonable in relation to the coverage provided. In other words, people must feel that the coverage they get from a policy is worth the premiums they pay for it. If an insurer charges too much for its coverages, few people will buy them and the insurer could go out of business.
- Competitiveness: The premium an insurer charges for a coverage must not be significantly higher than the premiums charged by other insurers for the same coverage. If an insurer charges more than its competitors, few people will buy its policies and it could go out of business. (Competitiveness is similar to reasonableness in that they both relate to what consumers consider a “good price.” However, there is a difference: a price is reasonable if it is a good price in terms of the benefits it buys; a price is competitive if it is a good price compared to the prices of similar products offered by others.)
- Equity: Some insureds make more claims than others, and consequently the cost of providing coverage is different for different insureds. The premium amount each insured pays must reflect the expected cost of providing coverage to that insured. Why? Suppose an insurer charged some insureds less than the expected cost of providing coverage to them. That insurer would have to charge other insureds an extra amount to make up for those paying less than cost. Those insureds paying extra would go to other insurers that would not charge them extra. The original insurer would be left only with insureds paying less than costs and could go out of business. (Of course, it is impossible to predict precisely what the cost of providing coverage to any insured will be, and consequently premium amounts cannot exactly reflect actual costs, but insurers must strive for equity to the extent possible.)
The Components of a Premium Amount
The principle of adequacy requires that a premium amount be sufficient to cover costs and provide a profit. The amount of a premium is based on the estimated amounts of different kinds of costs, plus profit. Thus, profit and the main types of costs can be thought of as components that added together make up the necessary amount of a premium. The cost components are:
- claims (benefit payments);
- reserves (to cover outstanding and future benefit payments);
- margin (an amount included to cover an unexpectedly large amount of benefit payments); and
- expenses (operational and administrative costs).
Another component is investment income, the revenue that insurers derive from investing the premium payments they receive. Investment income is not added but rather subtracted from the necessary amount of a premium, since it is not a cost that the premium must cover but rather a financial gain that partially offsets the need for premium payments.
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Posted on May 15, 2008 under health |
In February 2006, Congress approved legislation clearing the way for expanded, nationwide public-private long-term care (LTC) insurance partnerships. The law authorizes changes in state law to allow individuals to purchase private LTC insurance that coordinates with Medicaid. Specifically, in states adopting the Partnership approach, individuals can purchase private LTC insurance policies with the assurance that Medicaid will cover LTC costs incurred beyond the terms of the private coverage. In these states, under the terms of the Partnership, people with private insurance are not required to “spend down” their remaining assets to qualify for Medicaid.
As a result of the new law, many Americans who would have relied exclusively on Medicaid for LTC will have a new alternative that coordinates private coverage with Medicaid in a mutually beneficial way. First, consumers will have a greater opportunity to preserve their assets or be spared the awkward (but common) practice of transferring their assets to relatives in order to qualify for Medicaid. Second, widespread state adoption of the Partnership approach could lead to significant costs savings for both state and federal budgets
Background: Understanding the Interaction between Public and Private LTC Coverage
Currently, about 10 percent of Americans over the age of 55 have private insurance protection for LTC costs. One might expect far more Americans to buy LTC insurance, given the financial risks associated with long-term care. Indeed, under the right circumstances, private insurance for LTC costs could give many risk-averse households the financial security they desire in their retirement years, with predictable disposable income regardless of their LTC needs.
Part of the explanation for low demand for LTC insurance may be lack of accurate information. Many people believe that they have private LTC coverage through their employers or public coverage though Medicare and Medicaid. In fact, however, they are not covered for extended LTC or nursing home stays.
Medicaid, the joint federal-state health-financing program for low-income individuals, pays for long-term care — but only for those who have exhausted nearly all of their own resources first. Because Medicaid is a means-tested program, qualifying for assistance requires recipients to prove they are impoverished, or nearly so. To receive coverage, individuals must “spend down” their assets and demonstrate that virtually all of their income is being used to pay for their care.
To better understand why more Americans do not purchase LTC insurance, Jeffrey Brown and Amy Finkelstein, economists at the University of Illinois at Urbana-Champaign and the National Bureau of Economic Research, respectively, estimated the financial consequences for consumers who buy or forego LTC insurance.
Brown and Finkelstein’s approach assessed consumers’ financial conditions based on income and asset data, probabilities of long-term care episodes derived by actuaries, and premium and coverage assumptions drawn from prevailing standards in the marketplace.
Brown and Finkelstein concluded that the primary barrier to further expansion of private LTC insurance was the presence of last-resort public insurance — namely the Medicaid program.
The disincentive for purchasing private insurance is tied, in part, to the fact that when a consumer buys private LTC insurance, the assets protected under that policy are not, in general, protected under Medicaid. This lack of public-private insurance coordination means that buying private insurance, for most near seniors, does not guarantee a certain level of asset protection because there remains the risk that they will need LTC beyond the terms of the private insurance. If that is the case, all of the premiums they paid to get private coverage would have been wasted, as Medicaid would require their assets to be used to offset the initial LTC costs beyond the private insurance coverage before Medicaid would begin paying the bills.
Brown and Finkelstein quantified the impact of this disincentive — essentially, the amount by which private LTC coverage would duplicate coverage that would be provided by Medicaid, once the person’s assets were depleted. Medicaid would be duplicative of more than half the private LTC coverage purchased by men in the lower half of the wealth distribution. Three-quarters of private LTC insurance would be duplicative for women with assets in that range.
Many middle-class elderly Americans, facing the prospect of high long-term care costs, willingly transfer their assets to family members in order to qualify for Medicaid prematurely. In essence, Medicaid’s LTC coverage, which was intended only for the poor or those with no more assets to draw from, has evolved into a middle-class entitlement, allowing those willing to transfer assets among family members to “qualify” for public coverage.
The Long-Term Care Partnership Program
Over the years, the rise in inter-family asset transfers has contributed to rapid spending increases in state Medicaid programs. States have implemented a variety of cost containment measures in the Medicaid program, and in the 1980s, they began experimenting with private LTC insurance options. The Robert Wood Johnson Foundation joined the effort by funding a demonstration program, starting in 1988, called the “LTC Partnership Program.”
The Partnership was initiated to test how better coordination between private insurance and Medicaid might improve insurance protection for consumers and reduce costs for federal and state governments.
State Partnerships encouraged the purchase of private LTC insurance for a given level of asset protection and LTC duration. The critical innovation of the Partnership program was that Medicaid covered LTC costs incurred beyond the terms of the private coverage, and assets protected by the private LTC policies also were exempt from the Medicaid asset test.
In 1993, Congress imposed a moratorium on new states entering the demonstration project, a moratorium that remained in effect until 2006. As a result, only four states — California, Connecticut, Indiana and New York – have been allowed to run Partnership programs for the past 13 years
Modeling the Federal Budget Impact of the Partnership Legislation
Because LTC costs are among the fastest growing components of the Medicaid budget, the Partnership approach to LTC financing could be an important strategy to lower long-range government costs while providing new opportunities for consumers.
Partnership programs would allow middle-class Americans to set aside funds in advance to cover long-term care, without worrying that they were buying coverage partially duplicative of Medicaid. As more people who otherwise would rely exclusively on Medicaid instead purchase private LTC Partnership coverage, costs to federal and state governments will be reduced.
Allowing all states to establish Partnership programs thus removes a significant barrier to consumer demand for private LTC insurance coverage. As states expand Partnership programs over time, federal and state cost savings also will increase. These savings could be re-allocated to individuals most in need, or they could help reduce federal deficits and bolster state budgets.
Estimating the savings from the expanded Partnership program primarily requires the examination of the Medicaid savings and costs for two different groups of people:
First, there are those older Americans who, in the absence of the Partnership, would forego insurance and depend entirely on Medicaid if they needed LTC. For this group, increased sales of LTC insurance should reduce Medicaid costs, because private LTC policies would cover much of the care that would otherwise be paid for by Medicaid. The model assumes that these people could cover about one year’s worth of LTC costs from their personal savings.
As of 1997, the average length of a nursing home stay was well over two years. So, if a person were relying entirely on Medicaid for coverage, they would become eligible for Medicaid financing at the end of one year. With the Partnership and the certainty of asset protection, more consumers, particularly those risk-averse households looking for more predictability in their financial situation, will find it attractive to protect their assets with insurance. If the private LTC insurance typically covers about two years’ worth of care, then encouraging more insurance purchases could produce a year’s worth of Medicaid savings for each nursing home resident who ends up needing extended LTC.
Second, there are those persons who would have purchased private LTC insurance even if the Partnership legislation had not been enacted. For some of these people with extended LTC stays, Partnership coverage would speed up Medicaid coverage and increase federal costs, as people in this group would not be required to spend down all of their assets to qualify for Medicaid after their private LTC benefits were exhausted.
For simplicity, people are assumed to purchase private insurance at age 60 and begin to access LTC services in large numbers beginning at age 80.
The key to modeling the expansion of Partnership programs is estimating: (1) the number of new Partnership policies sold to people who otherwise would not have had private LTC insurance; and (2) the number of people who would have had non-Partnership LTC coverage had the Partnership program not been available.
The baseline for non-Partnership coverage is assumed to be 500,000 new policies sold per year, with no growth in the annual sales rate over time. The model assumes sales of new Partnership plans of 750,000 per year initially and increasing about 2 percent per year through 2020.
These assumptions are, if anything, quite conservative. Prior to the February 2006 legislation, industry observers had been predicting a slowdown in new LTC insurance purchases. Sales had grown steadily for several years, reaching 900,000 in 2002, but have fallen ever since, with just over 500,000 policies sold in 2005.
However, analysts now are optimistic that the Partnership law will enhance choice in the private LTC insurance market and stimulate greater demand for private LTC policies.5 A slower phase-up to a higher level of consumer demand than assumed in the model would not significantly change the estimated government savings.
Moreover, as the baby boom generation retires, even modest increases in LTC insurance purchases would have a significant impact. The set of assumptions described above for increased demand for Partnership plans implies that approximately 35 million people would be enrolled in LTC insurance by 2050, compared with a baseline of fewer than 20 million.
With these assumptions and this approach to modeling the cost savings, it is estimated that the legislation Congress passed in 2006 could reduce government costs by growing amounts, in real terms, after about 2025, with savings exceeding $6 billion (in constant 2005 dollars) annually in 2050.
Modeling New Policies to Encourage Even More LTC Insurance Enrollment
This estimating model allows adjustments to test different policies or assumptions regarding how the program will evolve over time. For instance, to further stimulate demand for Partnership insurance, policymakers could consider providing tax assistance or direct premium assistance for the purchase of Partnership plans. Adding subsidies to the model would increase federal budget costs in the short term. However, such a change ultimately would produce larger savings in the long run, because more people would be relying on private LTC insurance than on Medicaid for the initial months of their long-term care.
These estimates are calculated assuming that a relatively small annual premium subsidy would be sufficient to raise the number of new purchasers of Partnership insurance by about 150,000 in the first year.
Other policy options could include: providing incentives to encourage private LTC Partnership insurers to use chronic care tools such as health coaching and intensive case-management — which could reduce costs – and converting the remaining stock of non-Partnership policies into Partnership plans — which would increase costs.
Assuming that widespread use of chronic care and case management programs by private LTC insurers reduced the annual real cost growth by half a percentage point annually, this alternative scenario would increase costs through about 2033, at which point the additional savings from higher Partnership enrollment would exceed the premium subsidies and the costs of “grandfathering” current plans.
Conclusion
Nationwide adoption of the LTC Partnership concept, together with effective education and clear financial incentives to purchase private LTC coverage, would create a more robust market for private LTC insurance. This change would benefit consumers, whose assets would be protected even if they needed extended long-term care services and required assistance from Medicaid. It also would be good for U.S. fiscal policy, helping to limit growth in Medicaid spending and thus reducing pressure on federal and state budgets.
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Posted on May 15, 2008 under health |
A health insurance plan may not cover prescription drugs that are not administered in a hospital or other facility. Health plans also do not generally cover vision exams, eyeglasses, and contact lenses. What supplemental coverages meet these needs?
Prescription Drug Insurance
Prescription drug insurance covers drugs and medicines prescribed by a physician. Most plans are offered through an employer on a group basis. There are two types of prescription drug plans: reimbursement and service.
• In reimbursement plans, the insured pays a pharmacist for prescribed drugs, the pharmacist completes a claim form, the insured submits the form to the insurer, and the insurer reimburses the insured. Reimbursement is based on usual and customary charges.
• In service plans, the insured obtains prescription drugs from a pharmacist who participates in the plan. The insured does not pay the pharmacist or pays only a copayment. The insurer then reimburses the pharmacist.
Service plans require extensive networks of participating pharmacies and involve a large number of small claims. Third-party administrators generally manage the plans for insurance companies because their high volume of business allows them to minimize administrative costs and negotiate discounts with participating pharmacies.
Service plans include mail-order prescription drug programs. These plans serve those who use maintenance medication and find it convenient to order 60- or 90-day supplies.
The benefits paid by prescription drug plans are generally subject to certain exclusions and limitations:
• Drugs that are dispensed while the individual is confined in a hospital or extended care facility are usually excluded, as they are normally covered by regular medical expense insurance.
• Prescriptions are usually limited to a specified number of days’ supply of a drug. The limit is typically a 30-day supply for drugs obtained from a regular pharmacy and a 90-day supply for drugs obtained from a mail-order pharmacy.
• Devices of any type, such as hypodermic needles or syringes, and bandages, are usually excluded.
• Contraceptive drugs or medicines are normally excluded, but may be covered at the policyholder’s request for an additional premium.
Vision Care Insurance
Vision care insurance provides benefits for routine preventive and corrective vision care. This coverage is usually offered on a group basis as a complement to other group coverages. Vision care insurance normally provides reimbursement for:
• Eye examinations (including refraction);
• Single vision, bifocal, and trifocal lenses;
• Contact lenses;
• Other aids for subnormal vision (such as lenticular lenses); and
• Frames
Under most vision care programs, the services covered require the authorization of an ophthalmologist or optometrist.
Vision care benefits are usually subject to limitations and exclusions:
• Policies often limit coverage to one examination and one pair of lenses in any 12 consecutive months and one pair of frames every two years.
• Expenses for frames are usually limited to a certain amount. This amount covers average frames; those who choose luxury frames must pay the added cost. Other nonessential items such as sunglasses, tinted lenses, and safety glasses are generally excluded, as is duplication needed because of breakage or loss.
• Medical or surgical treatment is commonly excluded, as this is covered by medical expense plans.
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Posted on May 15, 2008 under health |
Health officials outline plans to expand kids’ insurance program
The Spitzer administration proposes lowering insurance premiums, creating a hot line and hiring outreach workers to encourage more children to enroll in the insurance plan.
The state Child Health Plus program, or SCHIP, is government-subsidized health insurance for children of working families
State Health Officials wants to enroll as many children to enroll in these insurance plans.
Spitzer wants to lower the co-premiums families pay. The current system requires a family to pay monthly co-premiums of $9, $15, $105 or $150 per child, depending on their income. The large gap between $15 and $105 has an unintended effect, child advocates say.
Spitzer’s proposed budget sets the monthly premiums at $15, $35, $55, $75 and $150, based on income. The governor’s plan also sets the maximum number of children at three, meaning a family of five children would have coverage for all children but pay only for three.
Spitzer is asking the Legislature to approve an additional $37 million to expand income limits from 250 percent of the federal poverty level, about $52,000 for a family of four, to 400 percent of the poverty level, or $82,000 for a family of four.
About 70,000 uninsured children would become eligible under the expansion plan, although $37 million would only cover about 17,000. More money would have to be allocated as more children enroll in future years.
At present, 396,000 children are enrolled, and the state pays $663 million.
Spitzer’s plan calls for creating a state hot line to help families navigate state health insurance programs and dedicating $7 million for community-based outreach. Spitzer also wants to expand Child Health Plus to cover foster children between ages 18 and 21, which would cost the state $250,000 annually
The main goal is to help the families to get their child insured, which is very much necessary. State Health is trying their best to help these families.
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Posted on May 07, 2008 under health |
More than 10 million children aged less than five die every year in developing countries in the continent of Asia. The number is astounding, alarming and more specifically its true. For more than three decades now developed nations have held summits to understand the severity of the matter and consequently attempted to come up with achievable solutions. But according to records, all efforts have been in vain since only three nations seem to have experienced tangible improvement in terms of child health care and welfare. Philippines, Indonesia and Vietnam are the only three nations that have been successful in bringing down the infant mortality rate to less than 70 deaths in about 1000 children. For other countries the figures are not as impressive but they definitely do much to deliver hope- Bangladesh and Nepal have seen reduction in infant mortality rate in a sustained way but the case is definitely not so with India. This country is still way behind in ensuring a lower infant mortality rate and if the current progress is sustained, the country will have no hopes of securing a better life for its children in the near future.
If factors behind this general failure is assessed three major factors will come to light- health care during childbirth, nutrition and child immunization. As far as health care during childbirth goes, the state of developing nations is pathetic not so much for the lack of medical facilities as for poverty. Despite maternal programs being launched widely, the number of women delivering their babies without professional help is still large in developing countries in Asia. In fact, the only two nations that can boast of the maximum number of professional deliveries are Phillipines and Vietnam. In this respect, Nepal and Bangladesh seem to be at the the end of the line.
Every four out of ten children in most Asian countries are undernourished. In this case even nations that are ahead in other criteria fall short.
Child immunization, as a standard, should be ensured against six deadly diseases namely tetanus, tuberculosis, diphtheria, measles, poliomyelitis and pertussis. Not a single Asian country has achieved all six targets. Unfortunately, the existence of these diseases on a large scale means infant mortality rate will not lessen and will probably see a rise.
The statistics prove to be a dampener for consequent generations. But are the authorities listening?
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