Conquering Health Plans: HMO, PPO, & EPO

Health Maintance Organization (HMO):

With an HMO plan, you pick one primary care physician. All your health care services go through that doctor. That means that you need a referral before you can see any other health care professional, except in an emergency. Visits to health care professionals outside of your network typically aren’t covered by your insurance.

For instance, if you were to get a skin rash, you wouldn’t go straight to a dermatologist. You would first go to your primary care physician, who would examine you. If your primary care physician can’t help you, he or she will give you a referral to a trusted dermatologist in your network that will. 

One exception to this is that women don’t need a referral to see an obstetrician/gynecologist in their network for routine services. (aka: Pap tests, annual well-woman visits and obstetrical care). Coordinating all your health care through your primary care physician means less paperwork and lower health care costs for everyone. 

Preferred provider organization  (PPO): 

PPO plans give you flexibility. You don’t need a primary care physician. You can go to any health care professional you want without a referral—inside or outside of your network. Staying inside your network means smaller co-pays and full coverage. If you choose to go outside your network, you'll have higher out-of-pocket costs, and not all services may be covered. 

Exclusive provider organization (EPO):

EPO plans combine the flexibility of PPO plans with the cost-savings of HMO plans. You won't need to choose a primary care physician, and you don't need referrals to see a specialist. But you'll have a limited network of doctors and hospitals to choose from.

EPO plans don't cover the care you get outside your network unless it's an emergency. (Note: It's important to know who participates in your EPO plan's network. If you go to a doctor or hospital that doesn't accept your plan, you'll pay all costs.)

Thoughts:

HMO's tend to be more affordable, but the patients usually have less coverage and more restrictions. Although PPO's are more expensive than HMO's and there is a chance of deductible, the patient has more flexibility and greater care.  

Both HMO and PPO have access to a network of doctors, hospitals and other healthcare providers. Only PPO gives the patient the ability to see the doctor you want without PCP to authorize treatment or referral from a PCP to see a specialist. PPO has also the possibility of coverage for medical expenses outside of the plans network.  HMO has a low or no deductible with generally lower premiums. 

When deciding between these plans one should consider income, availability/type of plan in your area, and most importantly your medical needs.

 If you’re looking at an HMO, take a close look at the network to determine if the choices of doctors and medical facilities are enough to meet your needs. A PPO gives you more freedom, including the potential to be covered for medical bills outside the network, but your costs may be higher.

I prefer having the flexibility of seeing specialists whenever I want without having permission of my primary doctor. Therefore, the PPO plan works best for me. However, depending on your finacial status and preference you could chose HMO or EPO. 



Links:


*I do not own any of these images, they were found on various tumblr sites. If any are yours please let me know so that I can give you credit for them

Controlling Health Care Costs in the US

The major problem in controlling costs in the health care industry in the United States is that there is no competition in this market. Another major problem is that people do not know what their options are or how to make an educated decision from the options that they are given of which they should choose.
 
Since there is no competition in the market there is an increase in demands and because of this the prices of supplies will increase along with these ever increasing demands. Politics has a direct influence on these prices due to increased regulations as well as additional taxes. There are also many law suits occurring in health care which also strongly influence these prices. How is this possible? Well, these lawsuits influence the cost of malpractice insurance for medical practitioners. (B) 

The ever increasing health care inflation causes insurance companies to raise their premiums. In November 2013, JAMA or better known as 'the Journal of the American Medical Association' stated that the major reason as to why these health care costs within one year (year 2000 to 2001) was at 91% due to the increase in drug prices, medical devices, and hospital care. (B). Therefore, the over-regulation, excessive taxation, and a few additional issues are the source of the problem.  
 
Even more devastating is the fact that experts have informed the public with is that 1/6th of the U.S. economy is devoted to health care costs. These costs are about 20 to 30 percent of spending (aka. $800 billion a year) which is wasteful and inefficient. (A) 

So, HOW do we control these costs?

Health care, just like any other company needs competition to push prices lower. Since each policy must cover essential health benefits of which there are 10 of, insurance companies have no room to create innovative and customized polices for people. (B) There also needs to be a way in which citizens can be informed about their options and aid in deciding which is best for them and their families.

To make coverage more affordable to its citizens, there needs to be a greater focus on the main drivers of medical cost growth which include expensive prices for medical services, new costly prescription drugs, costly medical technologies, unhealthy lifestyles, and an outdated fee for service system that pays for volume rather than value. (A) Reducing health care costs include the promoting healthy living, improving patient safety, and promoting transparency on medical costs as well as medical quality, while reducing health disparities. These types of approaches will help to distance ourselves from a free-for-service system and towards a improved up-to-date health care system. (A)

Therefore, the solution to controlling health care costs in the US is avoid shifting the costs onto consumers, making them pay more out of pocket since the enormous waste and expense of the US health care system is NOT driven by consumers.  Medicare payment reforms, that have been recently changing the incentives that encourage the delivery of expensive, wasteful, as well as inefficient care. This will make even greater progress under the requirements of the Affordable Care Act. As stated before, these reforms include paying for value rather than paying for volume and promoting the use of integrated medical practices. Medicare for All would be another great way to controlling these costs. 

*None of these images belong to me, they were found on various tumblr sites! If any are yours please let me know and I will give you credit within the blog post. Thanks so much :)
Links: 
(A) https://www.ahip.org/Issues/Rising-Health-Care-Costs.aspx
(B) http://www.forbes.com/sites/mikepatton/2015/06/29/u-s-health-care-costs-rise-faster-than-inflation/

Standard vs. Alternative Medicine

According to MedicineNet and other online medical sources, standard medicine is how the average provider, such as medical doctors, osteopathic doctors, other health professionals such as nurses and therapists, in a given community practice.(C) Along with standard medical care, complementary medicine is used to help patients. Complementary or in other words alternative medicine (CAM) are medical products or practices that are not part of standard care. Some examples of CAM include acupuncture which help with side effects of cancer treatment or treatment of heart disease with chelation therapy (which removes excess metals from the blood stream). (A)

The National Center for Complementary and Alternative Medicine (NCCAM) states that whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine are all considered as alternative. These methods use human touch to move or manipulate a specific part of your body. These methods can be used in almost any branch of medicine.(B) 

Some CAM practitioners believe in energies such as chi, prana, or life force to describe the invisible energy force that flows through the human body. When and if this flow is 'blocked' or 'unbalanced' the individual becomes sick. Therefore, making the goal of such therapies to unblock this energy force. These therapies include qi gong, therapeutic touch, reiki and magnet therapy.(A) Many practices center on the idea that the power of nature or energy that lives in the body. Examples of whole medical systems include:

• Ancient healing systems. These healing systems arose long before conventional Western medicine and include ayurveda from India and traditional Chinese medicine.

• Homeopathy. This approach uses minute doses of a substance that cause symptoms to stimulate the body's self-healing response.

• Naturopathy. This approach focuses on noninvasive treatments to help your body do its own healing and uses a variety of practices, such as massage, acupuncture, herbal remedies, exercise and lifestyle counseling.

Mind-body connection techniques such as meditation, prayer, relaxation and art therapies, strengthen the communication between the mind and body. This harmony should keep the individual healthy, according to CAM practitioners. The ingredients used along with this specific type of treatment includes dietary supplements and herbal remedies that can be found in nature. Some herbs that are used are ginseng, ginkgo, and echinace. For dietary supplements, selenium, glucosamine sulfate, and SAMe are used. All the above can be taken in a wide variety of forms such as teas, oils, syrups, powders, tablets or capsules.(B)

As doctors themselves are embracing CAM treatments and therapies, about 40 percent of adult patients have reported using complementary as well as alternative medicine. Physicians are often combining them with mainstream medical therapies which are now called 'integrative medicine'. (B) Many doctors practicing today haven't received training in CAM or integrative medicine so they might not feel comfortable in making recommendations or addressing questions in this area. They are also very cautious with these types of treatments because conventional medicine values therapies that have been demonstrated that they are safe and effective through much research and testing. Although there is some scientific evidence for some of these CAM therapies, there are many who do not.(B) Physicians primary goal is to heal their patients and avoid anything that could possibly possess a threat to their patients health. With this in mind, some CAM practitioners make exaggerated claims about curing diseases and tell patients to forget about treatments that your doctor gives you. These are just some of the reasons as to why doctors are extremely careful about recommending these types of therapies. (B)

The reason as to why there is so little research done in alternative treatments is because carefully controlled medical studies are very expensive. Such research in this field are usually funded by big companies that develop and sell drugs. Therefore, it is easy to see why there are fewer resources available to support trails of CAM therapies. NCCAM was established so that research for CAM therapies can begin and that their findings would become public. (B)

Although CAM treatments sound promising, researchers are not sure how safe these treatments are or how well they work. To minimize the health risks of a CAM treatment one should talk to a physician about the side effects, find out what research say, choose CAM practitioners carefully, and to tell all of your doctors and practitioners which CAM and standard treatments you use. (NIH: National Center for Complementary and Integrative Health) (A). It is especially important to let your doctor know if you are pregnant, have medical problems, or take prescription medicine. Keep your doctor updated on the alternative therapies that you are using (including herbal and dietary supplements). (B)

Links:

(A)http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html

(B) http://www.mayoclinic.org/alternative-medicine/ART-20045267?p=1
(C) http://www.medicinenet.com/script/main/art.asp?articlekey=33263
*None of these images are owned by me. They were all found on various Tumblr webpages.

Euthanasia

Euthanasia:

Physicians have to make many life or death decisions. Sometimes the most difficult ones include the possibility of euthanasia, which is known as the practice of intentionally ending a life in order to relieve pain and suffering. This usually happens in the event of a patient being in a coma, having been retrieved from a tragic accident, or even a long term illness that is slowly and painfully killing off the patient. Whether, physicians have empathy for the situation or experiences great sympathy for the patient and the family members for their misfortune, it is always a difficult position to be in.

One survey in the United States recorded the opinions of over 10,000 medical doctors and found that sixteen percent would consider stopping a life-maintaining therapy at the recommendation of family or the patient. Fifty five percent would never do such. The study also found that 46 percent of doctors believe that physician assisted suicide should be allowed in some cases. (A)

Around the World: 

The laws regarding euthanasia varies world wide. The British House of Lords have selected a committee on medical ethics that define euthanasia as, "the deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering". In the  Netherlands and Flanders, it is defined as the ‘termination of life by a doctor at the request of a patient'.

Categories of Euthanasia:

With voluntary euthanasia the person is mentally competent and is informed of his/her outcomes including the choices and desires that his/her life be ended humanely. Voluntary euthanasia is legal in USA and Canadian provinces. It is typically performed when a person is suffering from a terminal illness and is in great pain. When the patient performs this procedure with the help of a doctor, the term 'assisted suicide' is often used. This practice is legal in Belgium, the Netherlands and Luxemburg. It is also legal in the state of Oregon, Washington, and Montana. In cases of involuntary euthanasia the person has made an informed choice to refuse assistance to die (i.e. condemned criminal who opposes his sentence). Other than performed by the government, this form of euthanasia is legal everywhere. (This type of euthanasia is also known as 'active' and 'passive' forms of euthanasia.)

 

Therefore, active euthanasia is known as the administration of some substance or lethal drug that will actively kill that person. Passive euthanasia, on the other hand, is withholding treatment that could be necessary to support life in patients or terminating a medication that is keeping a patient alive. For example, if a patient was terminally ill he or she would not take antibiotics, initiating IV fluids, or providing nutrition to a dying patient who is unable to eat. Assisted suicide or euthanasia is legal in the Netherlands, Belgium, Luxembourg, Switzerland, Estonia, Albania, the US states of Washington, Oregon, and Montana, and, starting in 2015, the Canadian Province of Quebec. *Non-voluntary euthanasia is illegal in all countries and involuntary is considered murder.

How Euthanasia is Performed: 

Voluntary euthanasia can be performed by the patient or by someone else.  The patient may use some previously prescribed medications to end his life therefore enacting euthanasia on his or herself. Another way would be to ask someone such as a spouse or friend to provide some medication that would end his or her life. (With the case of capital punishment, the government will provide and administer drugs that will end the life of the condemned individual which is considered involuntary euthanasia. Similarly, this could be done as a form of non-voluntary euthanasia).

Controversy: 

The controversy surrounding euthanasia involves many aspects of religion, medical, and social sciences. The moral and social questions surrounding these practices are the most active fields of research in Bioethics today. Proponents of euthanasia rights emphasize alleviating suffering bodily integrity, self determination, and personal autonomy. Those against Euthanasia argue for sanctity of life. Many Christians believe that taking a life, for any reason, is interfering with God's plan and is comparable to murder. The most conservative of Christians are against even passive euthanasia. Some religious people do take the other side of the argument and believe that the drugs to end suffering early are God-given and should be used.

According to New York Times article by A. Hartocollis, a group of doctors and terminally ill patients are asking New York Courts to declare doctor assisted suicide as legal. Under state law, a doctor who helps a terminally ill patient die with a fatal dose can be persecuted with manslaughter. Since doctors are already allowed to help terminally ill patients die in some circumstances, such as when they remove life support, prosecutors claim, that the fact that they cannot hasten death for other terminally ill patients violates the equal protection clause of the State Constitution.(D)

Thoughts: 

My position in such a circumstance would be to provide reliable and honest information based on studies and statistics on survival on health circumstances, but most importantly to support and help the family members in any way possible. Besides doing my official duty as a doctor, I will respect the patient and the family’s choice in whatever they decide to do.

Links:
(A)http://www.debate.org/euthanasia/
(B)http://www.bbc.co.uk/ethics/euthanasia/infavour/infavour_1.shtml#section_3
(C) http://americablog.com/2015/02/euthanasia-2.html(D)http://www.nytimes.com/2015/02/04/nyregion/lawsuit-seeks-to-legalize-doctor-assisted-suicide-for-terminally-ill-patients-in-new-york.html?ref=topics&_r=0

*I do not own these images, they were found on various tumblr sites. Please let me know if any are yours and I will give you credit for them. Thanks so much!

Health & Reform

Those who are economically at a disadvantage are also at a disadvantage medically. The poor find themselves dependent on public care rather than private. Therefore the poor have no regular relationship with a physician and are treated by a doctor on duty who does not know their patients making the possibility of great quality care to being less than those who have private care.

The poor are also more likely to live in rural areas where access to quality care is minimal and are more likely to be treated by foreign medical school graduates. Many of these rural areas that the poor live in have shortages of doctors because many American trained physicians prefer to work in wealthier areas and in cities. 
  
Health care reform is a government policy that affects health care delivery in a given place. It's main aspirations is to give more general care to its citizens by expanding the array of health care providers and health care specialists that consumers can choose from, improve the quality of health care to its citizens, as well as making it more affordable.

On the polar end of 'Health & Reform',  those in wealthy, gated communities have the highest quality of care because they build their own system where they hire physicians to live withing the community. These physicians are on call 24/7 for all the members who live and contribute to the physicians salaries. This allows these very wealthy individuals to get instant quality care without the hassle of waiting in a doctors office, but in the comfort of their own homes. Nor do they have to worry about traveling to clinics and hospitals to get cared for. These individuals get the highest quality of care in a moments notice. 

 David Mechanic a medical sociologist says, “..that if we brought the country’s most talented health experts together and asked them to design a health care system that gives as little value for money as possible, they would have trouble coming up with a system that does any better than the one we have now.” He also states that, “there is no getting around the reality that having forty-six million people uninsured in the most affluent health system in the riches country in the world is unacceptable and shameful.”

Health care for Americans can seem as a commodity best improved through a competitive marketplace with minimal regulation.

I strongly believe that health care is a public obligation and an individual right rather than a form of service for profit mating in an unregulated market place.

*I do not own these images, they were found on various tumblr sites. Please let me know if any are yours and I will give you credit for them. Thanks so much!

PGD the New Eugenics

Different men are biologically attracted to different types of women of wide variety of qualities such as body shape, appearance, intelligence, and any other characteristics that they value. The selection process between women with such desirable qualities and men with resources to provide for their young is the main determinant of the traits their children will ultimately inherit.

If possible, parents will always chose the best education that they can afford, best available resources, and if in any way possible, provide their children with the best opportunities in life that will increase their chances of survival and success in the world. Increasing the chances of their child being born healthy is something every parent tries to achieve by any means available.

PGD gives parents the opportunity to select the most desired embryo after all genetic screening has been performed in several times. No matter where such selection occurs, within a woman’s womb or in a test tube, the process involves discarding “unwanted embryos”.

Although, eugenics restricts people’s freedom of reproduction through government control, PGD is now the new form of eugenics born from the view of technological advancements. It makes it possible for the government and other entities to have power to choose which embryo to kill which is morally wrong and unethical.

 The answer to the question as to why such selections are unethical depends on the purpose and technologies used. If science and technology make it possible for genetic testing and determination of certain traits over others in offspring that could detect possible disorders, then the goals are noble and wise. However, if such determinations are made in an embryo with unwanted traits (such as hair color, eye color, height, etc) and parents decide to kill it; this is unethical. Likewise, I consider unethical the selection of the “best” embryo and discarding the others.

Those who decide to use PGD with the expectations of having a child with no risk of development of future diseases such as diabetes 2 or cardiac heart disease is thinking too highly of this process and ignoring environmental influences, and the mere fact that we do not have a full understanding of all the genes in our body especially the ones that could someday be at higher risk for developing a disease.

In the end, no matter how hard people can try, there will always be mutations in the germ line, unexpected defects, and unknown diseases that will occur.  With time, new diseases will be discovered and there can always be errors in genetic screening.

Those who tarnish or possess a threat to people’s perception of a Utopian society would not be accepted and subsequently become socially isolated. I feel as though PGD is a new form of eugenics in that it would damage our society.  Through PGD, we as a society might become too focused in creating the ‘perfect’ embryo and disregarding the others for missing a desired gene, that we will lose a sense of compassion and that sensitivity that makes us human.

Individuals with fragile X syndrome, down syndrome and other genetic disabilities make the world a better place to live in. They are living proof that life can be fulfilling although they are not the same as everyone else. Should we have killed them as embryos if we had known that they possessed such diseases? Would we have loved these children any less?

It is not wrong for a parent to want the best for their child whether it is in genetic advantages or tangible resources in the world, rather it is something very noble. However, the lengths to achieve these genetic advantages through PGD and killing embryos is not something that should be done unless screening for a known disease in family history.

*I do not own these images, they were found on various tumblr sites. Please let me know if any are yours and I will give you credit for them. Thanks so much!

Curse or Blessing:Technology's Affect on the Doctor Patient Relationship

The Struggle of Knowledge and Power:

 Nowadays people have access to all sorts of medical resources and information. Cell phones, iPods, television shows, medical sites, and other sources serve as unlimited access to medical related topics such as illnesses, cures, and common procedures. Although these sources are created to educate and encourage people to become aware of their health, health risks, and what’s going on in the medical field today, they sometimes serve as a catalyst for conflicts and disagreements between patients and their doctors. After reading about their illnesses in a magazine, book, or site patients are more likely to be resistant to their doctors’ orders or diagnosis. 

These sources give patients power to choose the procedures and treatments doctors want them to go through. Patients can now be better prepared with questions for their doctors in time limited appointments. Not only does this help physicians in better treating and diagnosing their patients but reassures physicians that they are covering all of their patients concerns about their health. Meeting the patients needs and expectations are very important to doctors and this is one way in which this is possible.  In this aspect, both parties win. 

However, sometimes with so much information out in social media it can conflict with many of the recommendations that doctors make for their patients. Many times, information in the media is generalized to the most common cases and may not apply to every individual as every case is unique. What do you think? Do you think that these sources are causing more harm in the medical field than progress in people’s health?

 *I do not own these images, they were found on various tumblr sites. Please let me know if any are yours and I will give you credit for them. Thanks so much!

Medical Residents: Overworked Overloaded Overbooked

Residency is meant to train and prepare future doctors about a wide variety of cases, time pressures, and the unexpected aspects that comes with medicine. Many people argue that residents are being overworked in hospitals, leading to complications and mistakes made by sleep deprived residents who are overworked and underpaid.

 If we were to cut these hours- how prepared will our future doctors be to care of us and our families? Here, the patient's health and quality of care are being put into jeopardy as well as the hospitals reputation. Traditionally, residents were allowed to work between 30-24 hours without a break.

 In 2011, the Accreditation Council for Graduate Medical Education, implemented new rules to cut back the number of hours to consecutive hours or in other words 80 work hours per week in hospitals. This was implemented so that patients would be better protected from errors of fatigued residents. However, the severe cut in work hours, has its consequences as interns are expected to perform the same amount of work in half the time.

 A system needs to be created so that the number of doctors in training increases but one that also lightens their workload. Although work hours went down in 2011, depression symptoms stayed the same according to JAMA Internal Medicine (B).

 

 “In the year before the new duty hour rules took effect, 19.9 percent of the interns reported committing an error that harmed a patient, but this percentage went up to 23.3 percent after the new rules went into effect,” he says. “That’s a 15 to 20 percent increase in errors -- a pretty dramatic uptick, especially when you consider that part of the reason these work-hour rules were put into place was to reduce errors.”(B)

Recently, I read a very interesting article online from the Times, that asked a very good question, "Are Today's New Surgeons Unprepared?" By Pauline W. Chen M.D. Where she wrote about her experience in the field how a doctor's performance in the OR changed her perception of residency. This exceptional physician performed an operation that would have taken most surgeons three or four hours with few complications, just an hour for him to complete. After watching this remarkable doctor breeze through such a challenging surgery, she had to asked him his secret. And his secret was just practice, practice, practice.

“It’s doing the operations over and over and over again,” he said. He described the hundreds of operations he had participated in during his residency and the final years of training when he felt as if he were “living, breathing and eating surgery. I could have done these operations with my eyes closed,” he said grinning. (A)

Previous generations of residents participated in at least one operation a day, nowadays residents are lucky to be involved in two or three operations each week. Subsequently, the bond between a surgeon's operative skill, the number of operations performed and patient outcomes, is a strong one.

These new time limits are creating more problems as they are giving physicians unreasonable workloads in a short period of time that has consequently lowered the quality of care to patients tremendously. Majority of new residents have reported that they have indeed committed medical errors that harmed patients due to the 2011 time rules. 

“You can’t keep asking these young doctors to do more and more work in less time without affecting patient care,” Dr. Goitein said. “Until we address the problem of overwork, we’re just playing a shell game.”(B)

Links:
(A) http://well.blogs.nytimes.com/2013/12/12/are-todays-new-surgeons-unprepared/?ref=health&_r=1
(B) http://www.uofmhealth.org/news/archive/201303/paradox-young-docs-new-work-hour-restrictions-may-increase
(C)http://well.blogs.nytimes.com/2013/04/18/doing-the-math-on-resident-work-hours/

 *I do not own these images, they were found on various tumblr sites. Please let me know if any are yours and I will give you credit for them. Thanks so much!