Tag Archives: health care

Odisha vaccination.

India just launched the largest health insurance scheme on the planet

India announces massive health-insurance program amid cheers and criticism

Odisha vaccination.

A community health worker administering a vaccine in the Odisha state, India.
Image credits Pippa Ranger /DFID – UK Department for International Development.

This Sunday, Prime Minister Narendra Modi announced that India wants to offer free coverage for over half a billion of its poorest citizen. The new insurance scheme — dubbed “Modicare” — will cover 100 million of the country’s lowest-income families (the bottom 40% bracket). Each will receive services equivalent to the sizeable sum of 500,000 rupees (roughly $6,900) per year to treat serious ailments.

The program mainly addresses secondary and third healthcare. For primary care — basic services usually provided by general practitioners or nurses — the government plans to open 150,000 “health and wellness” centers, staffed by nurses, traditional medicine healers, and other health workers, by 2020.

Modi handed medical cards out at the launch in Ranchi, capital of the eastern state of Jharkhand, calling it a historic day for India.

Healthcare, or votecare?

“Indian healthcare is poised for a great leap forward with Ayushman Bharat – which will insure over 50 crore [500 million] citizens,” tweeted Health Minister Jagat Prakash Nadda, referring to the program by its official name, “Long Life India”.

The initiative is without a doubt very good news for India, whose public health system experiences systematic shortages of facilities and doctors, forcing many to opt for private healthcare. A private consultation, however, can cost up to 1,000 rupees (about $15), which is a very high bill for the millions of locals living on under $2 a day. Government estimations also show that around 60% of the average Indian family’s spending goes towards buying medicine and wider healthcare services.

Many of the country’s poorest, thus, make do without visiting a doctor, with disastrous consequences. For these people, Modicare could be a game- (and life-) changer.

“We want to strengthen the hands of the poor and stand shoulder to shoulder with them in pursuit of good health,” Modi posted on Twitter.

The British medical journal Lancet praised the ambitious scope behind the program in a recent editorial, writing that “setting up such a program has undoubtedly required heroic efforts.”

The initiative, however, is not without its critics. There are fears that increased demand created by Modicare would place an even greater strain on India’s already-faltering health infrastructure. It also is expected to drain the central and 29 state governments $1.6 billion per year in total. Funding will also be gradually increased should demand increase.

Cost is one of the central points of discussion around the scheme. Critics are skeptical that the government will be able to actually fund such a huge system, accusing Modi’s government of trying to use Modicare to draw in votes ahead of the next elections, which will be held in May.

In their eyes, Modi plans to coast along to a second term on the back of a pro-poor policy platform, of which Modicare will play a central part.

Healthcare providers themselves are concerned over Modicare which, they say, severely underestimates the cost of certain treatments. What’s more, they are worried that private insurance companies will rake in the benefits while the public and the public health system will be left to bear the costs:

“This is going to be another scam. It will benefit only private insurance companies. The citizen of the country will realise later that it is nothing but an election gimmick,” said Sanjay Nirupam from India’s Congress Party, the main opposition party.

Prathap Reddy, chairman of private hospital chain Apollo Hospitals, believes the private sector is “rightly worried” about pricing and reimbursements.

“While we all work together to ensure the success of this scheme, there are areas that need focus and fine tuning,” he said.

Still, others say that Modicare should have aimed to provide day-to-day healthcare for the people, instead of focusing just on secondary and tertiary care for more serious and long-term treatment as it does now.

“Modicare does not extend to primary healthcare, which, we believe, is the weakest link in the provision of public health in India,” Rajiv Lall and Vivek Dehejia of the IDFC Institute think-tank said in a column for the Mint newspaper.

While some of the criticisms raised at the program are more worrying — and could have dramatic consequences, should they prove true — the fact remains that Modicare is, for the most part, uncharted territory for the Indian government. Modi himself has gambled hugely on the program and has essentially signed a blank cheque to make it work — the government has allocated $7.2 billion for now but has committed to providing more on request, says Vinod K. Paul, the program’s creator. The final budget, he explans, is difficult to pin down because nothing like this has been attempted before.

Hopefully, Modicare surprises everybody and enjoys a resounding success. A recent study showed that substandard healthcare was responsible for an estimated 1.6 million deaths a year in India, the highest number anywhere in the world.

Neanderthals were compassionate caregivers, researchers suggest

Homo neanderthalensis, adult male. Reconstruction based on Shanidar 1 by John Gurche

Neanderthals are seen as brutish and uncaring, but a new archeological study has shown that Neanderthals benefited from an effective and knowledgeable healthcare system.

Researchers from the University of York revealed that Neanderthal healthcare was uncalculated and highly effective, even though we tend to think of about them as crueler than modern-day humans. The study suggests that Neanderthals were very compassionate caregivers.

The scientific community knows very well that Neanderthals sometimes provided care for the injured, but the team at York re-analyzed Neanderthal behavior and they suggest ‘our cousins’ were genuinely caring of their peers regardless of the level of illness or injury, rather than helping others out of self-interest.

Lead author, Dr. Penny Spikins, senior lecturer in the Archaeology of Human Origin at the University of York, said, “Our findings suggest Neanderthals didn’t think in terms of whether others might repay their efforts, they just responded to their feelings about seeing their loved ones suffering.”

The individuals researchers know about had a severe injury or disease, with detailed pathologies highlighting a range of debilitating conditions and injuries. Sometimes, the injuries occurred long before the time of death and would have required monitoring, massage, fever management and hygiene care, researchers suggest.

Researchers analyzed a male around 25-40 years old at time of death that showed a catalog of poor health, including a degenerative disease of the spine and shoulders. His degrading physical state would have sapped his strength over the final 12 months of life and severely restricted his ability to contribute to the community. The authors of the study believe he remained part of the group since his articulated remains were subsequently carefully buried.

Dr Spikins added, “We argue that the social significance of the broader pattern of healthcare has been overlooked and interpretations of a limited or calculated response to healthcare have been influenced by preconceptions of Neanderthals as being ‘different’ and even brutish. However, a detailed consideration of the evidence in its social and cultural context reveals a different picture.

“The very similarity of Neanderthal healthcare to that of later periods has important implications. We argue that organised, knowledgeable and caring healthcare is not unique to our species but rather has a long evolutionary history.”

The paper was published in the journal World Archaeology.

Why the US spends so much on healthcare, but doesn’t get the benefits it should

The US spends almost twice as much as other high-income countries on health care, and yet has consistently poorer results in many areas, with the lowest life expectancy and highest infant mortality rate of all developed countries. A new study analyzed why this happens, and what can be done to improve it.

The US spends about three times more on healthcare, per capita, than the UK. Image credits: Papanicolas et al, 2018 / JAMA.

Despite this, the US still lags behind all other developed countries when it comes to the quality of said healthcare. Image credits: Papanicolas et al, 2018 / JAMA.

With only 2.9 beds per 1,000 people, the US falls way below other developed countries, especially compared to Japan’s 13.2 and Germany’s 8.2. Similar figures pop up for many metrics relating to healthcare availability and efficiency. However, on a per capita basis, the US spends much more than any other country: $9451 in 2015, compared to Germany’s $5267.

The US is also the only developed country which doesn’t offer universal healthcare.

Of course, much ink has been spilled over health care in the past decades, and the causes are complex and difficult to thoroughly assess. But in a new study, Harvard researchers took on that gargantuan task. This is what they found:

  • In 2016, the US spent nearly two times more than other high-income countries on healthcare.
  • Despite this, the country had significantly poorer health outcomes in many areas. Out of all the developed countries, the US had the lowest life expectancy and highest infant mortality rate,
  • Contrary to popular belief, high utilization of healthcare services and low spending on social services are not the main reasons for the costs and lack of efficiency.
  • Instead, the main drivers of higher healthcare spending in the U.S. are generally high prices, particularly for medical devices and pharmaceuticals. The US spends much more than other countries on planning, regulating, and managing health systems and services.
  • Other causes of unneeded spending are the overuse of expensive health services, low social spending, and the lack of an adequate number of primary health physicians.
  • The US also pays higher salaries for nurses and physicians (on average).
  • The good news is that despite poor overall outcomes, when people are sick, the quality of delivered healthcare is quite high.

The main problem, researchers say, is that most policies regarding health care have focused on utilization. However, the authors write that “efforts targeting utilization alone are unlikely to reduce the growth in health care spending”. Instead, an effort to reduce prices and administrative costs is needed.

“We know that the U.S. is an outlier in healthcare costs, spending twice as much as peer nations to deliver care. This gap and the challenges it poses for American consumers, policymakers, and business leaders was a major impetus for healthcare reform in the U.S., including delivery reforms implemented as part of the Affordable Care Act,” said senior author Ashish Jha, a professor at the Harvard Global Health Institute (HGHI).

“In addition, the reasons for these substantially higher costs have been misunderstood: These data suggest that many of the policy efforts in the U.S. have not been truly evidence-based.”

Several studies have already found that counterintuitive measures, such as increasing social spending, can actually reduce expenses in the long term. However, while the US spends a bit less on social care than other countries, it’s not necessarily an outlier. The study also contradicts several common beliefs, such as the idea that America uses more healthcare services than peer countries (it actually has lower rates of physician visits and days spent in the hospital than other nations) and that the quality of healthcare is always lower than in other countries. The US actually has excellent healthcare for those who have heart attacks or strokes but is below average in avoidable hospitalizations for things like diabetes and asthma.

The problem is that despite investing heavily in health care, Americans don’t have access to the quality they’re paying for. This is an old, systemic problem for the country, but the good news is that it can be fixed, researchers conclude. What’s needed is a reduction in unnecessary costs and an investment in the areas where the country is still lagging behind.

“As the U.S. continues to struggle with high healthcare spending, it is critical that we make progress on curtailing these costs. International comparisons are very valuable–they allow for reflection on national performance and serve to promote accountability,” said first author Irene Papanicolas, visiting assistant professor in the Department of Health Policy and Management at Harvard Chan School.

Journal Reference: “Health Care Spending in the United States and Other High-Income Countries,” Irene Papanicolas, Liana R. Woskie, Ashish K. Jha, JAMA, online March 13, 2018, doi: 10.1001/jama.2018.1150

Healthcare not wealthcare sign.

Want better, cheaper health care? Pay doctors a flat salary, not per procedure, behavioral economists say

Paying doctors on a fee-for-service basis affects their work performance, the number of (often superfluous) procedures they order, lowers their job satisfaction, and makes the health care system all-around awful for the patients.

Healthcare not wealthcare sign.

As seen in Zuccotti Park: Occupy Wall St 1st Anniversary.
Image credits Waywuwei / Flickr.

There has been a lot of debate over the issue of conflict of interest in medicine. Not surprisingly, this is one sector of our capitalist economies where everyone hopes the patient, not profits, come first. A lot of the talks and a majority of the research is centered around the interplay between physicians and the pharmaceutical or medical device companies that supply the health care industry. But that’s only part of the story.

More is more

A paper published by George Loewenstein of Carnegie Mellon University and Ian Larkin from the University of California, Los Angeles approaches the issue from another angle: how the dynamic between physicians and patients changes depending on how the former are paid. The team outlines the inherent issues in using a fee-for-service system for doctors, arguing that it incentivizes them to order more, and often different, services than the patient needs.

All things considered, this payment system has “adverse consequences that dwarf those of the payments from pharmaceutical companies and device manufacturers,” according to Loewenstein, the Herbert A. Simon University Professor of Economics and Psychology at CMU and a leading expert on conflicts of interest. How come? Glad you asked.

“These payments and the method or formula that determines them — the “business model” of the practice in which a physician operates — create unavoidable conflicts of interest because the services physicians select for a patient can and do directly affect a physician’s income,” the team writes.

They estimate that an average primary care physician sees roughly 2000 patients per year who are billed on average US$5000. This puts the physician at the center of “a web of payments estimated to account for an estimated approximately $10 million annually.” At the same time, only a minority of physicians receive direct payments from industry.

The extra bulk of needless procedures also ‘clogs up’ the available resources, such as MRI machines, making certain procedures more expensive or time-consuming. While patients may not necessarily have to carry the costs of these procedures if there’s an efficient, inclusive health insurance system in place (as opposed to say, the AHCA), this conflict of interests will still negatively impact the quality of the care they receive and their quality of life while receiving treatment, as many of these “tests and procedures cause pain and discomfort, especially when they go wrong,” Loewenstein explains.

“[…] Patients […] often incur larger co-payments or coinsurance, as well as the effect on insurance premiums and government spending on programs such as Medicare and Medicaid,” they explain.

“But even these large sums significantly understate the true financial and nonfinancial implications of these conflicts. Patients also experience nonmonetary costs from unneeded testing and procedures because nearly every medical procedure carries medical risks, has adverse effects, generates opportunity costs of patient time, and can carry psychological costs in the form of worry as well as anguish, depending on the results of the tests or procedures. These nonfinancial ancillary costs are likely several orders of magnitude greater than financial costs, yet are difficult to quantify.”

What can be done about it

The vanilla way of dealing with conflict of interests is to have the party under question (in this case, the doctors) disclose their financial interests for the procedures in question. Disclosure of the conflicts has been shown to have limited — or even negative — effect on the patients. So the duo proposes that instead of going this route and hoping for the best, we simply switch physicians’ payment systems to a straight-up salary basis.

They argue that several of the most high-quality health care systems out there, such as the Mayo Clinic, the Cleveland Clinic, or the Kaiser group in California, pay their physicians flat salaries without offering any incentives for the volume of services performed. Even better, these centers are also known for their comparatively low cost of a wide range of services.

And it’s good for the doctors themselves, too — the team writes that physicians’ reported “high levels of job dissatisfaction” stem in part from the need to work within the fee-for-service systems. Instead of focusing on how to best care for their patients, they’re forced to factor in how their decisions affect the number on the paycheck.

Nobody’s saying that doctors will throw their patients to the curb for a wad of cash — generally speaking “physicians care first and foremost about their patients,” the team notes, but “incentives can and do influence decisions in ways not recognized by decision makers.” In other words, their brains factor in the economic side of the issue and influence their decisions even without physicians being consciously aware of it.

A salary-based system would allow health care specialists to focus on their patients’ needs while knowing that they themselves will be financially cared for at the end of the month — regardless of how many procedures they order, or how many pills they sell. And I think that’s something we can all agree on is a good thing.

It’s also worth noting that what this paper is describing is, to a large extent, a state medical system, as is the case in most of Europe. In that case, doctors in the state system receive a fixed salary and pretty much everyone is ensured — quite opposite of what the US is doing, and with much better results.

The full paper “Business Model–Related Conflict of Interests in Medicine: Problems and Potential Solutions” has been published in the journal JAMA.

metrosexual_large

The rise of the Metrosexual Singaporean man

metrosexual_large

Photo courtesy of changeparade.com

Botox, afternoon facials and jewellery – the preserve of image-conscious Singaporean females, right? Think again. The modern Singaporean man takes pride in his appearance too, and isn’t afraid to show it (or spend money on it).

Blogger Albert Robinson noted years ago the trend for Singaporean men wearing jewellery, such as ear studs and necklaces on his blog while male grooming products like moisturiser and even foundation have been flying off the shelves of pharmacies for years now. But men are starting to go to even greater lengths to look the part and are embracing surgical procedures.

Local dermatologists, surgeons and the National Skin Centre have all reported seeing more and more enquiries from men about aesthetic procedures. So what exactly are these local men having done?

Buff up that bod

Men, just like women, are effected by media images of toned torsos in magazines or competitions like Manhunt (http://www.manhuntsingapore.com), and many are getting increasingly worried that their own bodies don’t match up.

Not content with hitting the gym after work, Singaporean men are increasing going under the knife or laser in an effort to hone their body. Liposuction is still popular, but lots of men who are too busy for a long recovery tine and don’t want anyone suspecting they’ve had work done are opting for less invasive procedures like Coolscupting which can help them sculpt the six-pack they’ve always dreamed of.

Look well-rested

The pace of life in Singapore can be lightning fast and many men feeling under pressure are starting to notice the effect it’s having on them when they look in the mirror. Just look what President Obama’s time in office has done to his looks and it’s clear that a stressful job can age you prematurely.

But men who work in an environment which favours youth can’t afford to look older than their years, or appear to be cracking under the pressure. Many men in Singapore are having Botox injections during their lunch breaks to banish dreaded frown lines. Others are faking a good night’s sleep by having excess skin, muscle and fatty tissue under their eyes removed to tackle eye bags.

Don’t sweat it

We’ve all been there: you take a shower, apply deodorant, put on a crisp white shirt and head for the office. But just a few minutes walking to the car or MRT can leave your dripping with sweat in the Singaporean heat. If you’ve got a big meeting or an interview, wet patches under your arms or stinky body odour can be a nightmare.

So when even the strongest anti-perspirant fails them, Singaporean men are taking matters into their own hands and are getting Botox injections under their arms to stop them sweating for the next few months. If you know a guy who never seems to break a sweat, however sweltering the weather gets, regular Botox injections could well be his secret.

Grooming for grooms

While Singaporean brides are known to fork out huge amounts before their big day on beauty treatments, it seems the grooms are starting to follow suit.

Wanting to look good standing next to their glowing brides in the wedding photos, Singaporean men are using their wedding as an opportunity to address problems like facial scarring, uneven skin tone, a receding hair line or excess weight with treatments like microdermabrasion or skin peels. Some even go as far as having their eyebrows tinted to make them look fuller and more masculine.

No more taboo?

While even just a few years ago the sight of men undergoing surgery might have raised a few eyebrows, it’s much less of a big deal now. Celebrities like Simon Cowell (who’s not stranger to Botox injections) and Michael Douglas have paved the way for others and men have been encouraged by the great results women have been achieving for some time now and want a piece of the pie. It looks like the metrosexual Singaporean man is here to stay.

radiology

Some 90% of radiology services in the U.S. hospitals are outsourced. Moving health care overseas?

radiology

Photo credit: qbradiology.com

Generally, you can view services like any other commodity and apply strict goods economics. So if the same type of service is available elsewhere, even in another country, at a cheaper price it makes sense, economically, to outsource. Is health care a different matter, however? Apparently, if you took an X-ray in the past decade, there’s a 90% chance it was read by somebody elsewhere in the world, let alone in your hospitals’ vicinity.

“How may I help you?”

In the past two decades or so, outsourcing of US services has risen dramatically, in part lending to the weakening of the economy in the long term. Who hasn’t called customer support to be greeted by a non-native speaker who sympathizes with your problem even though he’s six thousand miles away. There are so many Indian outsourcing jokes that’s hard to keep up, but is there anything to joke about outsourcing health care services? How dangerous really can this be, and do the benefits outweigh the downsides?

The short answer is: it depends, according to  Jonathan Clark, assistant professor of health policy and administration at Penn State. Clark points out that besides radiology services, most hospital in the U.S. today outsource a variety of other medical services as well including anesthesiologist staffing and emergency physician staffing.

“Hospitals outsource the management of physicians from a physician management company. In other words, they buy physicians’ time from a management company. In this way, they get dedicated physicians who, for the most part, only work for their hospital. This is not necessarily the same thing as outsourcing radiological services, where hospitals send images out and it could be read by one of 1,000 radiologists,” Clark says.

Benefits of health care outsourcing

One can understand why hospitals would want to do this in the first place, and after all there are some overall benefits to the practice.

“Anytime health care organizations can get better at what they do, whether that involves outsourcing or not, that’s a good thing for our economy,” he says. “When it comes to U.S. health care — an industry with serious access problems — if we can become more efficient and thereby reduce those access problems, that is a good thing.”

Clark warns however that health care services can’t be outsources in the same way you would manufacturing, for instance.

“One of the assumptions people make is that outsourced services are like commodities in which one unit of service is the same as another unit of service,” he says. “With regard to radiological services, this would mean that providing a radiological read for a patient in Stockton, California, isn’t any different from providing a read for a patient in Miami, Florida.”

Can you outsource patient relationships?

After closely examining radiology performance, Clark found that the accuracy with which a radiologist reads an X-ray or MRI is directly dependent on how much experience the person has with the hospital the patient came in and not with the overall number of reads the radiologist made.

“Our results suggest that there is some customer specificity,” he explains. “If that is the case, someone might say why should we outsource? Shouldn’t we just employ them? But we found that customer specificity may also be transferrable to the outsourcing firm as a whole. So over time the outsourcing company may be able to turn that specificity into an organizational capability rather than a capability that’s embedded in one radiologist’s experience with a hospital.”

Overall, Clark believes there are some benefits to outsourcing radiology services in particular, but believes other health care services are more troublesome to outsource and should be closely followed.

“If you’re mixing and matching anesthesiologists and emergency physicians in a way that’s not permitting them to develop relationships with people at a specific hospital or to become familiar with the culture of the hospital and the team dynamics of the organization, that creates a little more concern, especially with professionals like anesthesiologists or emergency physicians who frequently deal with life and death situations,” Clark notes.

world-health

Leveling global health within a generation could bring economic benefits 20 times the program’s cost

A new report made by a team of Harvard researchers proposes a set of measures aimed at leveling the health ground in the world by 2035. The authors envision a grand convergence, namely closing the most egregious equity gaps we still have between poor and rich populations around the world. Isn’t offering the same health benefits to everyone, indifferent of their income, too expensive? The authors conclude that the resulting changes could save 10 million people and bring economic benefits between 9 and 20 times the initial cost, as a result of people living longer and healthier.

Bridging the health gap between the poor and the rich

world-health

Photo credit: The Guardian

Some of the measures proposed include doubling investments for health-related research and development, a better family planning strategy, and increased taxes on certain harmful substances like tobacco, alcohol and even sugar. The latter would have a double benefit; increasing taxes would provide additional income for health investments while at the same deter people from consuming unhealthy substances. A 50 percent tax on tobacco, for example, could prevent 20 million deaths in China alone over the next 50 years, and generate $20 billion, the report said.

“This is a once-in-human-history opportunity,” said Harvard economist and Charles W. Eliot University Professor Lawrence Summers, lead author of the report. “It used to be that life expectancies were quite similar around the world, and very short. Then there’s been very substantial divergence in different parts of the world, in mortality rates and life expectancy. Now we have an opportunity for a reconvergence at very favorable levels.”

“Once-in-human history opportunity”

The report, titled “Global Health 2035: A World Converging within a Generation,” is nothing short of ambitious but the authors claim it’s totally feasible if the world governments’ wish it so. The annual price tag for the project to meet its target goal is estimated at $70 billion – nothing short of a huge sum, however the scientists involved in the report claim that the figure is between 1 and 3 percent of the estimated developing nations’ economic growth that would result.

“The basic message … is that good investments in health, are good in themselves, but they also promote economic growth,” Frenk said. “The main idea is that by 2035 we can achieve what’s called a grand convergence, namely closing the most egregious equity gaps we still have between poor and rich populations around the world.”

Concerning research and development, these should target  infectious diseases, such as AIDS, tuberculosis, malaria, as well as ailments common in developing countries referred to as “neglected tropical diseases”, according to the report.

Overall, Summers and colleagues conclude that while some technical challenges remain these are far from being intractable and that the major roadblocks to improving global health are political and practical.

“As we’ve been reminded in the United States over the last six weeks, it’s not all about policy design, it’s also about policy execution,” Summers said. “It is a great opportunity, but nothing good happens automatically.”

The report was published  today in The Lancet.

Things To Consider Before Choosing A Health Career

People often overlook health care career possibilities that go beyond clinical work.  The health care field offers opportunities in many areas including:

  • Careers in medical research
  • Administrative and customer service positions
  • Careers in academia
  • Various clinical positions

Like with most careers, getting the right training is the best starting point.  Technical trade schools with clinical and administrative tracks designed to prepare students for entry-level positions upon completion. So rather than blindly investing ample time and money into a lengthy academic program, start off right by learning about the industry first-hand.

Common Roadblocks in Health Care Careers

Most people know that school is not the same as actually working in a health care setting.  Get the right training that puts you on the fast track and helps you avoid common roadblocks seen today within the health care industry.  One of the most common problems people experience after investing in a career in the health care industry is an initial lack of direction.  It is important to know your strengths, your interests, and your weaknesses.  Many medical professionals are devastated after investing close to a decade in medical school only to find out that they do not enjoy working in a hospital setting.  It is important to know the following:

  • Do you work better during three long night shifts per week or 8-5, Monday-Friday?
  • Do you prefer fast-paced clinical work or less stressful administrative work?
  • Do you prefer to work in a hospital setting or in a private practice?

Although things such as work schedules and places of employment might not seem like a big deal at first, many people report higher levels of job satisfaction and career sustainability after taking the time to experience what certain work schedules and environments are like.

Get the Training you Need to Start a Career in the Health Care Industry

One of the best ways to know what career in the health care field is right for you is to get started.  Get the right training for a job that can help show you what you want your career to look like ten of fifteen years from now.  It is important to keep in mind that your first job in the industry might not be the same job you have when you retire.  Instead of thinking of a health care job as only a good way to be hired, try thinking about your first health care job as a jumping off point.  With more applicable work experience, you can reasonably expect more opportunities for vertical or horizontal career advancement.

Will the Same Health Care Jobs Be Available in the Future?

Many common health care careers today such as EEG technicians did not exist twenty years ago.  As medical technology advances, different and exciting job opportunities are projected to increase over the next seven years – see more at http://www.bls.gov/ooh/About/Projections-Overview.htm. It is important to get the right training as soon as possible.  When new opportunities arise, the people that are often the best job candidates are those that have experience in the field and a demonstrated interest in the health care industry.

An Exciting and Challenging Career has to Start Somewhere

No matter what your end goals will be—from a medical technician to university faculty—your career in health care has to start somewhere.  Get the right training, get the right experience, and let your career do the rest.

Image source

patient_care

Understanding Patient Care Ethics

patient_careThere are few careers that are more rewarding than one that is in the medical sector. While healthcare professionals are able to care and offer support to countless individuals, however, they are also faced with challenging ethical questions each and every day. It is because of this that those working in the medical field have subscribed to a body of ethical statements which work to benefit their patients. In examining the “Four Principals” approach to patient care and healthcare ethics, as well as some of the other standards adopted by medical professionals, you can gain a more comprehensive understanding of how to provide the best care for the patients that you encounter while on-the-job.

The “Four Principals” 

One of the most common frameworks utilized in the analysis of patient care ethics is the “Four Principals” approach. These moral principals were originally developed by Tom Beauchamp and James Childress. As a rule, in order for a medical practice to be deemed “ethical”, it needs to respect all four statements, which include:

  • Autonomy – This principal states that patients have total autonomy of thought, intention, and action with regards to making decisions about health care and the health care procedures being presented to them. In other words, patients have the right to choose or refuse their particular treatment. In order for autonomy in the decision-making process, patients must be able to make their choice without any coercion or coaxing from a medical professional. The patient must also be provided with all of the information required to assist them in making a completely informed decision. This includes an explanation of all risks and benefits, as well as the likelihood of a procedure’s success.
  • Justice – The idea of justice pertains to the fair distribution of health resources. Simply put any of the burdens or benefits of new, experimental, or scarce medical treatments must always be equally distributed among all groups in society. These treatments or procedures must also uphold the spirit of existing laws.
  • Beneficence – Here, healthcare professionals are required to always act in the best interest of a patient. Another way of saying this is that all procedures and treatment plans must be provided with the intent of doing good for the patient involved. This requires physicians and other medical workers to develop and maintain all of the skills and knowledge to provide the best care for patients. As such, continued education and training would fall under the umbrella of this concept.
  • Non-Malfeasance – The final of the “Four Principals” requires that a procedure or treatment does not cause any harm to the patient involved, or to any others in society. All factors, including the physical, emotional, and psychological effects of the procedure must be carefully considered.

Additional Key Ethical Values for Patient Care

In addition to the “Four Principals”, many healthcare providers put emphasis on numerous other values for the ethical treatment of patients. Some of these principals may include:

  • Respect – All patients are entitled to competent care that provides compassion and respect for basic human rights and dignity.
  • Honesty – Medical professionals must be dedicated to upholding the standards of professionalism through being honest in all patient interactions and striving to report any healthcare providers who may prove to lack in character or competence by engaging in fraud or deception.
  • Privacy – Those working within the medical sector are required to respect patient confidences and privacy within constraints of the law.
  • Citizenship – Healthcare professionals shall respect the law, while also recognizing their responsibility to seek changes in laws which may be contrary to the best interest of patients.

The Role of Ethical Principals in Patient Care

Unfortunately, values and principals like those mentioned in the preceding sections do not provide medical workers with absolute answers for handling any particular situation. Instead, these values act as a guidebook, and create a useful framework for understanding moral conflicts that may arise. When situations occur that cause a conflict in moral ethics, you may find that there is no solution that is 100% correct.  In fact, there may be cases in which the moral values of health care providers may actually be in conflict with one another, or wherein a physician’s ethics clash with a patient’s family members. Here, the basic pillars of the medical ethical code will help you to find the most reasonable and morally upright way to address the problem. Although it can be frustrating for medical professionals to make decisions outside the realm of absolutes, a thorough understanding and evaluation of patient care ethics can help you to make choices with more confidence.

For healthcare workers, growth and learning never end. As you move forward on your journey toward caring for patients, you’ll find that your ability to build on this initial guidebook and make your own ethical decisions during times of moral crises will sharpen exponentially.

image source: dlsii.com

men's height

Men’s height up 11 cm on average since the industrial age

men's height

A new study that surveyed through records of hundreds of thousands of men from 15 European countries found that the average height has risen by 11 centimeters since then 1870s. This remarkable surge in men’s height over the span of just four generations has been attributed to the advances in health care since, most notably antibiotics and a massive drop in infant mortality. Improved nutrition is factor that also played a determining role, according to the researchers involved in the study.

“Increases in human stature are a key indicator of improvements in the average health of populations,” said Timothy Hatton, a professor economics at Britain’s University of Essex who led the study.

Only men were surveyed since data on women were more limited. In the XIXth century and early XXth century, public records of men’s health and physical characteristics were far more abundant than those of women because of military service.

On average, men’s height had grown by 11 centimetres (cm) – from 167 cm to 178 cm –  in just over a century, the researchers found, but there were differences from country to country. Most surprising was that during the two great wars, as well as the following Great Depression, there was a significant surge in average height for a select couple of countries like  including Britain and Ireland, the Scandinavian countries, Netherlands, Austria, Belgium and Germany – times of notoriously great turmoil.

This was most surprising to learn because major advances in both medical science and medical reforms came after this period.  Long-term improvements in sanitation, hygiene and nutrition were being seen at the time and this most likely is the cause of the upsurge, the researchers report. Reduced infant mortality, which is linked with basic child health in general, also means that children were healthier at the time, than they were before. The most important period that goes on to determine much of a human’s health later on in life are the first 2.5 years according to health experts. A downward trend in fertility during this period also played an important role, as fewer children per family meant there were more resources to spare, and thus an improved nutrition.

Dr John Middleton of the UK’s Faculty of Public Health said: “Does how tall we are really tell us how healthy we are? This interesting research suggests that it’s certainly a factor.

“Increasing height is a reflection of how the availability of food and nutrition had broadly improved until the recent excesses of fat and sugar.

“However, we can’t conclude that shorter men are somehow unhealthier. Like a lot of research, this paper prompts more questions than it set out to answer.

“While our average height is a useful barometer to bear in mind, what we really need is to tackle the many reasons for poor health that we can address.

“Employment is one of the best ways to do that, which is why we need to focus on more than just diet and exercise when it comes to improving the nation’s health.”

The findings were reported in the journal  Oxford Economics Papers.

California fire

Climate-change disasters cost $14 billion in casualties and health care

California fire In the first study of its kind, a group of researchers have quantified the financial impact of climate-change infused natural disasters on health care in the U.S., during the past decade. Floods, famines, fires and other natural disasters are reported to have cost the US government $14 billion in lost lives and and heath care costs.

“When extreme weather hits, we hear about the property damage and insurance costs,” said Kim Knowlton, a senior scientist at Natural Resources Defense Council and a co-author of the study. “The healthcare costs never end up on the tab.”

If you think these numbers are high, consider the researchers only chose a highly conservative margin, by only picking six significant climate-change related natural disasters between 2000-2009.

  • U.S. ozone air pollution, 2000-2002, $6.5 billion;
  • West Nile virus outbreak in Louisiana, 2002, $207 million;
  • Southern California wildfires, 2003, $578 million;
  • Florida hurricane season, 2004, $1.4 billion;
  • California heat wave, 2006, $5.3 billion;
  • Red River flooding in North Dakota, 2009, $20 million.

Interestingly enough, researchers estimated that the 1,689 premature deaths from all six catastrophes cost $7.9 million each—meaning casualties contributed the bulk of the climate change costs. It’s odd to put a fix price on human life, but for the sake of the study, the authors pinpointed the total cost of casualties for these six natural catastrophes alone at $13.3 billion.  Health care costs from hospitalizations, emergency room visits and consulting doctors summed up the remainder of $740 million.

To put things into perspective, 14 weather disasters in the United States so far this year have cost at least $14 billion, according to Jeff Masters of the Weather Underground website. However, the study, while very interesting, manages to raise more questions than it answers. For instance, more than 287 million Americans live in areas where ground-level ozone levels climb above 80 parts-per-billion for extended periods, which probably would also amount in time to hundreds of millions in heath care as well, although it doesn’t necessarily relate to a one-time climate disaster. I believe if someone would try to factor in all the climate change factors, induced by human consumption, one would certainly come up with astronomical figures.

For Mark Conley of Raymond, Maine, whose 11-year-old son Jake suffers from asthma that gets worse with the rise in ozone air pollution, the calculation is more than dollars and cents, however.

“On those days that are really bad out there, he doesn’t have the lung capacity,” Conley said of the son who plays soccer, basketball and baseball. “A lot of times we have to pull him out of the game.”

The study was published in the latest edition of the journal Health Affairs.

reuters 

Obesity responsible for $147 billion in US health care costs

Obesity

A recent study conducted by the U.S. Centers for Disease Control and Prevention shows that obesity related disorders account for ~10% of the total medical spending in the U.S. or, money-wise, approximately a whooping $147 billion. The study continues on stipulating that obese individuals spend 40% more on medical treatment than those of normal weight, or $1,429 more per year.

“It is critical that we take effective steps to contain and reduce the enormous burden of obesity on our nation,” Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, told a news conference at a CDC obesity meeting where the study was presented.

“Reversing obesity is not going to be done successfully with individual effort,” Frieden said. “It will be done successfully as a society.”

Willing not only to sight out an ever pressing issue, the CDC outlined 24 new recommendations on how communities can combat obesity in their neighborhoods and schools by encouraging healthier eating and more exercise. However, like Dr. Frieden very well put it, the fight against obesity will require a national effort as the numbers of obese people grow as each day passes. Actually, it seems 26% of the American populace is obese.

When is it fair for a person to be declared obese, you ask? A person is obese if his body mass index, or BMI, is of 30 or higher. BMI is equal to weight in kilograms divided by height in meters squared. I used this tool to calculate my BMI as well as my ideal weight.

“Report after report shows that if we fail to take meaningful steps now on prevention of chronic disease like obesity, healthcare costs will continue to spiral out of control,” said Democratic Senator Tom Harkin, a member of the Senate Health, Education, Labor and Pensions committee and chairman of the Senate Committee on Agriculture, Nutrition and Foresty in a recent statement.

Between 1998 and 2006 the obesity rate has risen by 37%, which translated in a 89% increase on speading for  treatments for obesity-related diseases such as diabetes, heart disease and arthritis. [via Reuters]

No health care revolution in sight

health

Health care seems on the floor right now

Though we have to admit there are some small steps toward an improving in general health care, we’ve expressed our opinion about how bad things are on numerous occasions. Only the fact that major pharmaceutical companies spend more on advertising than research is a huge problem, that (along with others) leads to a domino-like effect with a result that’s not good for anybody. Almost anybody, at least.

A study conducted in 21 countries analyzing the health care systems and the prospects of improvement in this area led to dire conclusions. I’m not really sure what these 21 countries are (just a few of them, for example the U.S.), but I’d bet they didn’t go deep into Africa for this study. The findings were published in the Journal of Health and Social Behavior.

“Our findings explain, to the dismay of many who would like to see more radical change in the U.S., why President-elect Obama’s campaign proposal regarding health care reform was pretty much a center proposal, compared to Sen. McCain’s to the right,” said Indiana University sociologist Bernice Pescosolido. “Why didn’t Obama’s go farther toward considering a state model? In normal times, societies can only tolerate systems that match their understanding of what a health care system should look like. It showed an understanding of the tolerance for change.”
“People are socialized into a contract that is essentially established between the state and the citizens of this country, and they come to believe that this is the best way to do it,” Pescosolido said. “Even though there are similar pressures on health care systems around the world, politicians really have to deal with public pressure, which is local, and this is going to produce different pathways to health care reform in other countries.”

Here are just a few findings:

Across the board respondents supported the idea that the government should “definitely be responsible for health care,” with some countries showing more support than others. Respondents from the U.S. were least likely to agree that the government should be responsible for health care, with 38.1 percent indicating support. Eighty percent or more of respondents in Slovenia, U.K., Spain, Italy, Russia, Latvia and Norway reported that the government should be responsible for health care.
Levels of support for the government “definitely spending much more on health care,” appeared in clusters, with U.S. respondents again being toward the bottom, with only 17.5 percent of respondents supporting this notion. Support from Canadian and French respondents ranged from 14.2 percent to 17 percent, with 19.9 percent of Germans supporting this idea. These countries tended to have insurance models of health care. On the other end of the spectrum, countries with centralized models of health care, such as Russia and Latvia, showed 64.2 percent and 53.2 percent support for the idea of increased spending, respectively.

Big Pharma Spends More On Advertising Than Research

drug company
A drug company is a commercial business whose focus is to research, develop, market and/or distribute drugs, most commonly in the context of healthcare; from wikipedia. But according to a study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim.

But how could this be you might ask yourself. Well the answer is fairly easy; regardless of its purpose of helping people it is a bussiness and thus it has to make money and the way of making money is by advertising more and researching less. The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion.

In case you are wondering who made this study well the research is co-authored by PhD candidate Marc-André Gagnon, who led the study and Joel Lexchin, a long-time researcher of pharmaceutical promotion, Toronto physician, and Associate Chair of York’s School of Health Policy & Management in the Faculty of Health.

“In our paper, we make the case for the need for a new estimate of promotional expenditures by the U.S. pharmaceutical industry,” says Gagnon. “We then explain how we used proprietary databases to construct a revised estimate and finally, we compare our results with those from other data sources to argue in favor of changing the priorities of the industry.”

[digg-me]This study is very important as it shows the most accurate image yet of the promotional workings of the pharmaceutical industry, says Lexchin. But even this could be wrong a bit because there are other advertising campaigns which could not be taken into consideration such as ghost-writing and off-label promotion so in fact these companies are probably spending more than twice advertising rather then researching. As well, note the authors, the number of meetings for promotional purposes has dramatically increased in the U.S. pharmaceutical industry, jumping from 120,000 in 1998 to 371,000 in 2004, further supporting their findings that the U.S. pharmaceutical industry is marketing-driven.