Health Insurance Blog

Making a connection with the elderly and the homebound is what motivates Brenda Johnson, the manager of Visiting Nurses at Nantucket Cottage Hospital.

November is “National Home Care Month” and for Johnson, who has worked in the hospital’s emergency room, dialysis, obstetrics and orthopedic departments, her greatest passion is in homecare.

“My grandmother’s best friend was Goldie Howes and Goldie was the director of nursing,” said Johnson, who grew up on the island and moved away during her senior year of high school. “I became a nurse, because Goldie was a nurse.”

After she finished nursing school, Johnson returned in 1975 and started working at the hospital.

“I feel like I make a connection with the patients more in homecare,” said Johnson, whose husband Paul is a caretaker and property manager. Johnson met him when he was a technician in the hospital’s radiology department.

“When a patient is in the hospital, they tend to lose their identity. They are in a strange bed with a hospital gown on,” she said. “In the home, you get to see how they live,” she added. “You meet their caretakers, you meet the family. It’s a better environment for people to recover in.”

A couple of years ago, the hospital changed the name of the Home Health Department to Visiting Nurses.

Last year, the Visiting Nurses made 8,000 visits to 500 clients, up from 7,000 visits over the past year.

“People are understanding more of what we do. I believe that there is a bigger referral base,” said Johnson. “Most of our referrals come from physicians, but sometimes we get self-referrals. About 60 percent of the people who call us might think they need help with simple things, like a bath, but they actually need more services. The reverse is also true. People call thinking they need multiple services, but once an evaluation has sorted things out, they find a simpler solution.”

The Visiting Nurses Department is Medicare/Medicaid certified as well as accredited with the Joint Commission on Accreditation of Healthcare Organizations.

“You need to be homebound to be eligible for Medicare,” said Johnson, who oversees a staff of about 10 full- and part-time visiting nurses, some borrowed from other departments at the hospital. “We serve community members of all ages who require at-home, skilled care from registered nurses; physical, occupational, speech and language therapists; medical social workers or home health aides.”

“If there is an elderly person at home and all of a sudden he or she has a change in functionality, for example, a hard time getting out of the chair, or things have slowed, or the memory has declined a bit, that person might have an infection,” said Johnson. “An older person shows different signs of infection. They don’t get fevers and chills.”

One of the challenges of running a home-care agency on the island is following the rules and regulations which are developed for larger agencies serving thousands of clients.

“We have fewer staff members doing many functions to make it happen,” said Johnson. “I have an excellent group of people who work with us. They are highly qualified and competent and compassionate people.”

“When you are in the home-care business, you are a guest in someone’s house. You get to see the whole mix. You can work with the patient, it becomes a real team effort,” she added.

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The gap between rich and poor remains huge, but a survey of global health finds that significantly fewer people in poorer countries say they have had to go without food or health care because they lacked the money to pay for it.

The phenomenon was evident in almost two dozen of 35 countries in which trends were available in both low-income and middle-income countries, the Kaiser/Pew Global Health Survey, released Thursday, found. It credited improved national economic conditions since a similar survey in 2002.

In 23 of the countries, fewer respondents reported they had not missed health care because of money. Respondents in 20 of the countries reported similar results regarding food as well.

Jordan reported the largest percentage reductions in both categories, with 23 percent fewer missing health and 30 fewer missing food. Ghana and Russia also had large reductions in both categories.

“Declines in reported deprivations notwithstanding,” the report said, speaking of the entire sample, “the gaps between rich and poor nations in reports of hunger and lack of health care remain enormous. In nearly half of the nations surveyed, at least 40 percent of the public reports that they did without health care for lack of money.”

Respondents in all countries of sub-Saharan Africa, for instance, consider HIV/AIDS as a “very big problem” that their governments should be dealing with. In the other regions, crime, corruption, terrorism or pollution ranked as the biggest problem.

“Despite this variation, concern about health as a personal and family issue is high in most countries and across all regions,” the study said. “When asked to name, in their own words, the most important problems facing their families today, health issue rank second only to financial concerns in 33 countries (and are the number one concern in Germany and Sweden).”

On aid, the report found that people in countries that receive major amounts of aid tend more than others to say that rich nations are doing enough to help poorer ones. In Indonesia, for instance, more than half the respondents felt that way; the report speculated that was colored by the international response to the tsunami that hit Indonesia in 2004.

The poll involved telephone and face-to-face interviews with 45,239 people in 46 countries plus the Palestinian territories, conducted in April and May. All samples were national except for Bolivia, Brazil, China, India, Ivory Coast, Pakistan, South Africa, and Venezuela, where they were mostly or completely conducted in cities.

The numbers of people interviewed in each country varied from 500 each in Spain, Bulgaria, Ukraine and Kuwait to 3,142 in China. The margin of sampling error in each country ranged from plus or minus 2 percentage points to 4 percentage points.

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A genetic mutation known to increase the odds of breast cancer in some Jewish women has been found in significant numbers of Hispanic and African-American breast cancer patients as well, underscoring the need for genetic testing across ethnic lines to determine who is at risk.

A large multiracial study released Wednesday estimated that 3.5 percent of Hispanic women with breast cancer have a mutation in the BRCA1 gene. That compares with 8.3 percent of female Ashkenazi Jews (those of Eastern European ancestry), 2.2 percent of other non-Hispanic whites and 0.5 percent of Asian-Americans.

The researchers, from the Northern California Cancer Center and Stanford University, said they hope their data prompts genetic counselors to develop materials for discussing breast cancer risk in a culturally sensitive way and in languages other than English.

“Traditionally, studies have focused on white women,” said Esther John, a research scientist at the cancer center and lead author of the study. “There is a great need to study racial minorities in the United States.”

“A lot of young women die of breast cancer because they’re not even aware that lump in their breast could be cancer,” said Olopade, who wrote an editorial accompanying the paper in this week’s Journal of the American Medical Association. “If you know you’re at high risk, you’ll get that evaluated.”

Women who carry a BRCA mutation can have their ovaries removed, which greatly reduces the risk of both ovarian and breast cancer. They also can have mastectomies as a preventive step. Even if they choose not to take such drastic measures to prevent cancer, Olopade said, they can be more vigilant about detecting it earlier.

The policy is also short-sighted, Olopade argues. “The cost of treating cancer is much higher than the cost of preventing it,” she said. “So dollars should be spent on identifying high-risk individuals and preventing them from getting cancer.”

Everyone carries the BRCA1 gene, which makes a protein that helps cells repair DNA, but people who inherit a mutation in the gene are less able to fix DNA damage and tend to accumulate mutations that lead to cancer. Women with a BRCA1 mutation have about a 65 percent chance of getting breast cancer in their lifetime (compared with 12 percent for the general population), and their risk of ovarian cancer is about 39 percent.

Doctors are generally aware that Ashkenazi Jewish women are more likely to carry a genetic mutation predisposing them to breast cancer, so they frequently refer these women for genetic counseling. There is little or no awareness, however, that women and men of other racial backgrounds might also benefit from counseling and testing.

Men who carry a genetic mutation are more likely to develop cancer and can pass the mutation to their children.

The new study looked at 3,181 women diagnosed with breast cancer in the San Francisco Bay area between 1996 and 2003.

The Hispanic women tended to carry the same mutation as the Ashkenazi Jews. Other ethnic groups carried a wide range of mutations.

The researchers hypothesized that Hispanic women may have that mutation because of their Spanish ancestry. Spain was home to Sephardic Jews, who could have shared the mutation with Jews of Eastern European origin. As a result of persecution before and after the Spanish Inquisition, many Sephardic Jews officially converted to Catholicism but secretly continued to practice Judaism. Some of these “conversos” migrated to the New World.

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It used to be that getting a quote on life insurance felt like you were pre-determining your life expectancy. Sure, they called it a life insurance quote, but it seemed more like a death insurance quote. After answering each question, the insurance salesperson would give you that look that says, How could you do that? Don’t you know it cuts ten years off your life??

Well it’s not that bad today. Life insurance quotes are now easier than ever, thanks to the time saving technology from the online world. You can get a term life insurance quote from several companies and compare them without ever talking to a representative.

Get a whole life insurance quote in a matter of seconds instead of days. And you can do it all from the comfort of home. Some Things to Remember When you Compare Life Insurance Quotes 1. Be Accurate: The more accurate your information is, the more accurate your life quote will be.

Never hide information like whether or not you smoke. Remember, this would set life insurance companies free from their obligations in the event of your death, so it wouldn’t even make sense to have insurance if you’re not as accurate as possible. 2. Never Base Your Choices on Price Alone: Low prices are always attractive, but find out for sure that a policy will suit your needs.

Ask for the details involved in term life insurance and whole life insurance plans. Don’t take anything for granted. And research the insurance companies. Find out how long they’ve been in business and how fast their usual turn around is for pay-offs. 3. Compare from at Least Three Companies: There’s no reason to limit yourself to one or two quotes, not when obtaining a quote is so easy.

Shop around and find out what insurance companies have to offer. 4. To Compare Life Insurance Quotes, Start with the Same Set of Answers: If you’re comparing different quotes, make sure they’re not for different policies. Type of life insurance policy, time periods for term policies, and the insured amount can all have a huge impact on a quote, so make sure the answers to questionnaires are the same from company to company.

The Difference between Whole Life Insurance and Term Life Insurance For the most part, there are two kinds of life insurance: whole life insurance and term life insurance. While there are variations of both of these, the biggest difference between the two is that one is for long term coverage and one is for short term coverage, and your life insurance quotes will be very different for each one. Whole Life Insurance (generally for long term coverage) has a set premium and doesn’t change (except for some variations) throughout the policy term.

You pay your premiums, and when you die, your beneficiary receives the pay-off. Your whole life insurance quote will specify the premium amount. As you pay into the policy, it builds equity, which you can withdraw or borrow against. Term Life Insurance (usually used for short term coverage) only lasts for a certain amount of time. That time is defined in the term life insurance quote.

At the end of this term, the policy ends and the policy is re-evaluated for a new quote. Using Online Life Insurance Quotes Use a website that connects you to several life insurance companies. Add them to your favorites menu so you can find them again. As you receive your quotes, print them out for easy comparison.

In no time at all, you’ll find the perfect company for your life insurance needs without ever feeling like you’re the one being examined.

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In the business of supplying blood, Labor Day is the last hurdle of the donor-dry summer. We are in dire need of blood donors,” said Audrey Lundey, communications manager for the American Red Cross Southwest-Texas region and spokeswoman for the East Texas region.Throughout the summer, the Texas region of the American Red Cross has been on a blood appeal, informing communities that the blood shortages are so severe that there is less than a day’’s supply of blood available.

“It’’s so important for people to understand that you never know when yourself, your family, friend or neighbor is going to be in need of blood,” Lundey said. The general public presumes that nobody’’s going to bleed to death because there’’s not enough blood,” said Jeffrey McCullough, a professor of laboratory medicine at the University of Minnesota and an expert on the nation’’s blood supply. But finding donors, “is more and more difficult, and the reforms make it more and more expensive,” he said.

An average adult has about 10 pints of blood, and a major trauma victim can need up to 100.Generally, the public’’s concern is blood safety, not supply. That’’s been the case since the 1980s, when HIV-tainted blood infected more than 12,000 patients nationwide through transfusions. Today, a battery of tests screen blood for HIV, hepatitis, West Nile virus and other pathogens.

A series of questions excludes donors who have visited countries with malaria or mad cow disease”The blood supply is extraordinarily safe,” said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania and a former member of a federal advisory committee on blood safety.

“But you have to remember that having blood available is part of safety, too, particularly if you have some kind of disaster and you need a lot.” The blood-bank system began during World War II as a way for citizens to help wounded soldiers on the front lines. Dr. Charles R. Drew discovered how to preserve and store blood, and organized the first blood drive.

Neither subsequent generations nor immigrants have embraced the donor habit as enthusiastically as the war generation. “We don”t have a blood supply problem, we have a blood donor problem,” said Teresa Solorio, spokeswoman for American Red Cross Blood Services of Southern California. “It’’s easier to get people to donate money than to donate blood.”

Even with the development of blood-conserving surgeries, the need for blood has risen because of medical advances and an aging population that needs hip replacements, heart surgery, cancer treatment and kidney transplants.

Blood shortages occur in pockets across the nation, especially in Los Angeles, New York and other large metropolitan areas, which tend to be faster-paced and have less of a sense of community than parts of the Midwest and South, blood experts say. But natural disasters, such as the recent floods in Oklahoma, can mean less blood from states that usually have enough to export. Blood type, like eye color, is inherited.

About 45 percent of whites have type O blood; an estimated 65 percent of Hispanics have it. People with type O blood can receive only type O, and demand is growing as the Latino population grows.

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A recent study states that for the first time the dollar impact on private health insurance premiums when doctors and hospitals provide health care to uninsured people. In 2005, premium costs for family health insurance coverage provided by private employers will include an extra $922 in premiums due to the cost of care for the uninsured.

Premiums for individual coverage will cost an extra $341. Nearly 48 million Americans will be uninsured for the entire year in 2005. What happens when some of these 48 million Americans get sick? Research has shown that the uninsured often put off getting care for health problems or forgo care altogether.

When the symptoms can no longer be ignored, the uninsured do see doctors and go to hospitals. Without insurance to pay the tab, the uninsured struggle to pay as much as they can. More than one-third (35 percent) of the total cost of health care services provided to people without health insurance is paid out-of-pocket by the uninsured themselves.

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Partners for healthy livingWith overweight and obesity rampant in this country, a cultural shift to more healthful living is in order, many experts say, but patients don”t always know how to do that on their own.

“Physicians are just sort of in this model of prescribing medications,” said Sallis, who would like to see doctors prescribing exercise to patients. “I think they”re much more comfortable prescribing medication than with lifestyle intervention.” His group, which is the world’’s largest sports medicine and exercise science organization, is in the process of launching a program called Exercise IS Medicine to encourage physicians to make a change.

“I think that every physician ought to inquire about a patient’’s level of physical activity, and then if they are doing less than 30 minutes, five days a week, they ought to inform them of the risks of inactivity and the benefits of doing 30 minutes of moderate exercise five days a week, said Sallis, a family physician at Kaiser Permanente Medical Center in Fontana, Calif. “It ought to be assessed at every visit by every physician … and similarly, smoking needs to be addressed as well, and obesity. Those three problems, to me, are the big three.”

A change in lifestyle Though some patients would prefer a magic pill instead of exercise and eating right, it’’s worth it to try to make lifestyle changes, said Veeneman, who emphasizes a combined approach of exercise and dietary changes to her patients. “Even a small amount of weight loss can impact lots of things like the blood pressure … or the cholesterol or the sugars,” she said. “So a 10 to 15 pound weight loss can be significant in people.” Delaney, who lives in the South End, has not been exercising because of arthritic pain but said she hopes to in the future.

Meanwhile, she’’s lost about 12 pounds and seen her condition improve by changing her eating habits and getting her medication adjusted by the doctor. Doctors can help patients by guiding them away from unwise strategies, such as unproven weight-loss supplements, and helping them choose better foods and better portions, Veeneman said.

They also can provide some objectivity when it comes to things like crash diets, Haney said. “As a general rule, we”re not trying to sell a product,” he said. “Virtually every one of these other diet systems is trying to sell some product or some gimmick to make money. … Some of those things are downright unhealthy.”

A program that fits Doctors also can be helpful in tailoring programs to fit patients” specific needs. “There are some patients that want to set up a program with personal trainers, so sometimes I do give them some written instructions to sort of go over with their personal trainer just with some general recommendations on management of their weight and general calorie goals,” Haney said. “There are so many things that have to be taken into consideration with each person.” Haney’’s approach resonates with Nanci Brill, 51, of Oldham County, who is not only a longtime patient but also participates in a step aerobics class that he teaches.

“He really stresses the importance of your health and promoting the longevity of that and the importance of it in terms of what you eat and how you exercise,” said Brill, an emergency room nurse at Baptist Hospital East. Brill said taking care of herself has always been a priority for her but feels that, as you age, it’’s important to have someone to motivate and monitor you like Haney does.

If anything starts to go wrong, “I know that we”re going to sit down and we”re going to discuss it,” she said.

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Political interference often prevents the nation’’s top public health official from dispensing unvarnished medical opinions, two powerful Democratic lawmakers want to make the position of surgeon general more independent by giving the president less of a free hand in selecting nominees.

Sen. Edward Kennedy, chairman of the Senate Health, Education, Labor, and Pensions Committee, and Rep. Henry Waxman, chairman of the House Oversight and Government Reform Committee, introduced their measures in the wake of testimony last month by former Surgeons General Richard Carmona, David Satcher, and Everett Koop that the position is becoming too politicized. Carmona, who served from 2002 to 2006, accused top Bush administration officials of censoring his speeches and preventing him from speaking out on embryonic-stem-cell research, sex education, and emergency contraception.

Satcher, a Clinton appointee who served from 1998 to 2002, and Koop, a Reagan appointee who held the post from 1982 to 1989, joined Carmona before Waxman’’s committee on July 10, but testified of less severe meddling during the Reagan, Bush I, and Clinton administrations. Waxman, D-Calif., told the three, “The position of surgeon general is a revered post in our government. Fixing what’’s wrong and making the office work again should be a bipartisan priority.”Carmona, Satcher, and Koop contend that the best way to strengthen the surgeon general’’s hand is to make the nomination process less political and to give the office an independent budget and staff.

With a budget of $19 million and a staff of 115 employees, the Surgeon General’’s Office has the responsibility of spotlighting important health concerns by issuing statements that promote public health education, analyze health policy, and identify research priorities for health professionals.

The surgeon general also advises the president and the secretary of Health and Human Services, and directs the 6,000-member Commissioned Corps of the Public Health Service. Waxman and Kennedy based their legislation on the notion that the best way to safeguard the surgeon general’’s objectivity is to begin by making the selection process less overtly political.

As of now, the president is free to nominate anyone to be surgeon general. If confirmed by the Senate, the appointee serves a four-year term. But until the late 1960s, surgeons general were required to come from the Commissioned Corps of the Public Health Service. Under Waxman’’s bill, a surgeon general’’s report or call to action (a report that outlines steps that need to be taken to address an urgent health problem) could be blocked only by the HHS secretary, who would then have 10 days to notify Congress of that decision and its rationale.

Waxman would also change the chain of command so that the surgeon general would report directly to the secretary, instead of the assistant secretary, and his bill would make it harder for a president to get rid of a surgeon general because of ideological differencesIn 1994, after 15 months as surgeon general, Joycelyn Elders resigned at President Clinton’’s request after making controversial statements about masturbation and sex education and being criticized as too liberal.

With the Elders example still fresh in observers” minds, Waxman says that fear of losing the job could lead surgeons general to be inappropriately circumspect when the time comes to deliver hard-hitting health care messages. The Bush administration is predictably cool to the Waxman and Kennedy proposals. “We are reviewing the legislation, and we believe that the Office of the Surgeon General functions very well,” says White House spokeswoman Emily Lawrimore. Michael Tanner, director of health and welfare studies at the Cato Institute, says that the Republicans who wanted to get rid of the position in 1995 and the Democrats who want the surgeon general to be less under the thumb of the White House are missing the point. “The surgeon general has no real nonpolitical purpose,” Tanner said. “This is a political appointee put in a position that is primarily designed to espouse political policies.” Because the position is inherently political but is expected to produce health care advisories that are objective and scientific, he says, there will always be critics pushing for pointless reforms.

“This is a silly debate — and one we”re doomed to every couple of years,” Tanner says.

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Life insurance (Life Assurance in British English) is a type of insurance. As in all insurance, the insured transfers a risk to the insurer, receiving a policy and paying a premium in exchange. The risk assumed by the insurer is the risk of death of the insured.

There are three parties in a life insurance transaction: the insurer, the insured, and the owner of the policy (policyholder), although the owner and the insured are often the same person. For example, if John Smith buys a policy on his own life, he is both the owner and the insured. But if Mary Smith, his wife, buys a policy on John’’s life, she is the owner and he is the insured.

Life insurance companies are never required by law to underwrite or to provide coverage on anyone. They alone determine insurability, and some people, for their own health or lifestyle reasons, are uninsurable. The policy can be declined (turned down) or rated.

Rating means increasing the premiums to provide for additional risks relative to that particular insured discovered in the underwriting process. Term life insurance (Term Assurance in British English) provides for life insurance coverage for a specified term of years for a specified premium.

The policy does not accumulate cash value. Term of life insurance quote is generally considered “pure” insurance, where the premium buys protection in the event of death and nothing else. See Theory of decreasing responsibility and buy term and invest the difference.

Permanent Life insurance is life insurance that remains in force until the policy matures, unless the owner fails to pay the premium when due.

Whole Life insurance provides for a level premium, and a cash value table included in the policy guaranteed by the company.Universal Life insurance is a relatively new insurance product intended to provide permanent insurance coverage with greater flexibility in premium payment and the potential for a higher internal rate of return.

Variable universal life insurance is the same except that the rate of return on the cash account is related to separate accounts that work like mutual funds. Another type of permanent insurance is limited-pay life insurance, in which all the premiums are paid over a specified period after which no additional premiums are due to keep the policy in force.

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Mammograms are the best way to detect breast cancer, but the number of Florida clinics performing the procedure has dropped by 10 percent in the past six years. Since 1999 the total number of mammography clinics has declined by more than 1,200, a decrease of 12 percent, according to a report released last week by Democratic U.S. Rep. Anthony Weiner of Brooklyn, N.Y.Weiner plans to introduce an “Assure Access to Mammography Act” this week, which would raise Medicare reimbursement rates for mammograms.

That should help existing clinics stay open and, Weiner said, “reverse the decline in the number of . . . women seeking these life-saving exams.” Since 2001, the number of certified mammography clinics in Florida has declined from 505 to 456, according to the American Cancer Society. Entrekin worries that longer wait times for mammograms will discourage women from getting them.When an annual mammogram becomes “a once-every-18-months mammogram,” it can lead to frustration and women skipping them altogether, particularly if their previous mammograms have shown no problems.

While there is no definitive statewide data on mammogram-screening rates, Entrekin said there is no question that national mammogram-screening rates have declined during the past five years. The director of the Women’’s Center for Radiology in Orlando said several new mammography centers have opened in Orlando within the past year.

According to the American Cancer Society’’s statewide registry, the number of certified mammography facilities in Metro Orlando has inched from 36 to 37 since 2002.But a slight increase hasn”t eliminated the problem for many Central Florida women. At the Women’’s Center for Radiology, for example, the waiting time for screening mammograms is short — less than a week, Belmont said. But the average wait time for a diagnostic mammogram is six weeks.Since diagnostic mammograms are for women with symptoms of breast cancer, having to wait any length of time can be agonizing.

The wait times for diagnostic mammograms are far shorter — one to two weeks — at the Kissimmee Outpatient Center — but a woman who calls today for a screening mammogram won”t get in until March 2008, said the center’’s administrator, Polly Rodeffer. “As a service provider, I hate that the service I”m providing is seven months away,” Rodeffer said.

She explained those shorter wait times can be costly because insurance networks often exclude hospital-based imaging centers for mammography coverage. Checks with imaging centers connected to M.D. Anderson, Florida Hospital and Osceola Regional

Medical Center found wait times of two weeks or less for diagnostic mammograms, and a much wider range for screening mammograms: two to three days at Osceola Regional, two to eight weeks at M.D. Anderson. Elise MacCarroll, who oversees mammography services for Florida Hospital’’s seven Metro Orlando campuses, said wait times in Central Florida had improved considerably in the past three years. “We used to have a tremendous backlog, the same thing New York is going through now: So many [mammograms] to do and not enough sites to do them.”If you”re a woman who feels something in her breast and can”t get in for an exam, be persistent.

If one place doesn”t have a time, call another.”

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