By the nature of their business model, a Health Maintenance Organization’s (HMOs) desire for medical and cost efficiency jeopardizes the process and treatment goals for clients seeking mental health services. Often, mental health experts, operating under HMO guidelines and reimbursements, find themselves backed into ethical corners with near impossible solutions and lose-lose situations.

In order to address the harmful effects HMOs have on the delivery of mental health services, one has to know the two basic principles that explain the philosophy of managed care: 1) containing costs and 2) ensuring quality of care. In order to keep costs down, HMOs limit the amount and type of services provided, monitor services administered, change the nature of services offered, use cost efficient but questionably effective treatment guidelines, and financial incentives and penalties to influence providers, payers, and financial intermediaries.

The cost containment philosophy requires mental health counselors to immediately assess the client’s problem, establish a diagnosis, and set treatment goals – which under normal conditions, takes many sessions to discover core problems. However, HMOs want determinations and diagnoses made in the first one or two sessions.

The treatment for the too rapidly diagnosed issue is often delivered as a brief, short-term, highly focused intervention that follows treatment guidelines and protocols that favor the HMO, but not necessarily the client. Although such standardized treatment can be effective for certain mental health issues, it fails to take in consideration the unique nature of the diverse clientele that seek mental health services. The use of brief, solution-focused therapy also raises the concern of a counselor’s competency. The American Counseling Association Code of Ethics requires that counselors practice within their range of qualifications and competency. Although many counselor educational programs currently teach brief-therapy (also called solution focused therapy) principles and techniques, not all counselors practicing for HMOs have the necessary training, experience, or credentials to use brief therapy.

The dignity and client’s welfare is the first and foremost responsibility of any counselor and it is respected through researched backed, effective treatment plans that are consistent to the client’s needs, abilities and situations, while respecting the client’s freedom of choice in treatment. However, this responsibility is jeopardized when the counselor lacks the freedom to plan and implement the needed treatment and he or she has to choose between implementing the proper treatment and losing the HMO’s reimbursement -or- implementing the less suitable treatment plans favored by HMOs and getting paid. These HMO guidelines also compromise the counselor’s autonomy in determining what form(s) of intervention are appropriate according to the client’s problem, and it usurps the counselor’s clinical judgment and professionalism. Moreover, the counselor is forced to spend less time providing psychological services to their clients in order to complete increased paperwork demands on behalf of the HMO.

The client’s welfare is also jeopardized through the rationed treatment (HMO set time limitations) which compromises the quality of services received. Time-limited treatment means that only partial treatment is provided and this might result in premature termination of the counseling process (despite the client not resolving the problem they requested help for). Unfortunately, such clinical restriction not only affects the quality of services provided, but represents an ethical and legal concern and the counselor can be held accountable if the case is taken to court, even though it followed HMO guidelines.

Another troubling issue introduced by HMOs is the inability to assure the confidentiality of the counseling process. Confidentiality is one of the major elements that facilitate the counselor-client relationship, and allows the client to feel safe and share the most private and intimate aspects of their life. In addition to the confidentiality limits imposed the ACA Code of Ethics (breach of confidentiality only allowed in situations where the client can harm themselves or others), HMO regulations ask for extensive, personal information on clients and detailed reports on their treatment. The risk of providing such private information is that once it is shared with HMO, the counselor has little to no control over what happens to it.

HMOs support the medical model in understanding mental health – the client’s problem has to be a medical term (e.g. depression, anxiety) similar with a diagnosis made by a physician, in order to authorize mental health services. Issues addressed in marital or career counseling that represent a normal component in one’s life are not eligible for reimbursement. Therefore, the process of setting an accurate diagnosis is also influenced by the HMOs who will not reimburse for certain issues. The counselor is faced with the uncomfortable and unethical situation of upcoding or downcoding a diagnosis (setting a higher or lower diagnosis than the accurate issue) in order to authorize more counseling sessions or to make sure the client actually receives the needed treatment for the true issue.

The minority but growing opinion is that cutting out the middle man (the HMO) benefits both the client and the practitioner. The direct payment option should be carefully considered by both parties with practitioners reducing their rates to incentivize the appeal of direct payment and allow the client to negotiate the cost of services for the most effective treatment outcome. Through direct payment options, the client can receive more treatment and directly negotiate the conditions that make him or her feel most comfortable. Third-parties should not dictate treatment protocol when it is not in the best interest of the client, and eliminates the freedom a mental health practitioner needs to benefit their client.

One of the most common diseases found in children and teens is diabetes. 90 to 95% of children with diabetes have type 1 diabetes.the other 5 to 10% have type 2. Most of the time when a child is diagnosed with diabetes it is assumed to be type 1 but in the last 20 years type 2 diabetes has been on the rise with children and teens. More than a thousand children a year are diagnosed with diabetes and health care providers keep finding that more and more of these children have type 2 diabetes.

Type 2 diabetes is a metabolic disorder unlike type 1 which is an autoimmune disease. Instead of the body attacking itself and destroying the beta cells it develops a resistance to insulin and starts using it improperly. As a result glucose builds up in the blood causing eventual damage to the kidneys and other organs leading to more complications. Without the glucose being absorbed the body cannot produce energy leaving you feeling tired and exhausted all the time. Health care providers are finding more and more children with type 2 diabetes, a disease usually diagnosed in adults aged 40 years or older.

Research from the American Diabetes Association shows that the increasing rate of obesity and low physical activity may be the cause of this increase of the prevalence of type 2 diabetes among children and teens. Most of the children and teens diagnosed with type 2 diabetes are between 9 and 19 years old, have a family history if diabetes, obese,? have insulin resistance, and poor glycemic control. Type 1 diabetes prevalence of U.S. residents aged 0-19 years is 1.7 per 1000.

Because Diabetes in children can go undiagnosed for quite a while it is hard to detect its prevalence. Children can have few or no symptoms and blood tests are needed for an accurate diagnosis.It is difficult to diagnose type 2 or type 1 diabetes in children. The criteria to find the difference between the two is very complicated because children with type 2 can develop ketoacidosis as well as type 1 and type 1 diabetic children can be overweight too and the prevalence of this disease overall is still low.

Signs and symptoms of the onset of Diabetes are extreme thirst, weight loss, increased urination, tiredness, fatigue, increased appetite, headaches, and stomach pains. Look for these warning signs so that the disease can be diagnosed ahead of time and treated more effectively. To help prevent complications from this disease ask your doctor about diabetic vitamins and supplements. Also some lifestyle changes are needed such as a balanced diet and daily physical activity.

Finding low cost health insurance in New York is difficult enough if you are not employed, so it should not be too difficult task if you are employed, right? Wrong. Many employees of small businesses in New York are not offered low cost health insurance through their employers. This is not beneficial to the employers or the employees, since many people choose their jobs based somewhat on the benefits they will receive.

If you live in New York and work for a business whose owner thinks it is “too small” to offer health insurance, you may be in luck. In 2000, the governor of New York proposed to a comprehensive insurance coverage plan to be made available to New York employees and their families if they do not have health insurance. The New York Legislature ratified the proposal, and the program became known as Healthy NY.

According to Healthy NY, a “small business” is one that has 50 or fewer employees. When a small business has this number of employees, the business feels as if it can not afford to offer low cost health insurance to its employees; however, thanks to Healthy NY, all small businesses can take advantage of offering low cost health insurance to its employees.

The even better news is that you do not have to be an employee of a small business to purchase low cost health insurance through Healthy NY. Sole proprietors may also purchase low cost health insurance through Healthy NY.

If you work for a small business in New York that does not offer health insurance because it feels as if it can not afford to, talk to your employer about Healthy NY. Not only with Healthy NY benefit the employees of the business, but being able to offer low cost health insurance to employees will also help your employer because he or she will be able to attract and retain quality employees.

Everyone knows that prevention is better than cure and most people try to take preventive actions so that they do not face any health related issues in the future. Basically, there are two different reasons for them to undertake such preventions. Primarily, they can have a peace of mind, armed with the knowledge that they are least likely to fall sick as compared with those who do not take preventive actions for their health. The second and the most important reason are escalating medical treatment costs.

Over the years, the costs of medical treatment have gone up so much that it pinches most people. Add to that the global economic crisis which is making people spend more money to cope up with their day to day expenses. They can hardly manage to purchase essential items and the costs of footing health care premiums are the last thing on their mind. However, if they were offered an option of a cheap, yet effective and useful health care plan, they would no doubt opt in for it. Thankfully for such people, there are organizations like Premier Health Care, which is reaching out and providing affordable health care services to the masses.

Most people might be wondering that there might be a trade off somewhere or the other, especially when Premium Health Services is charging such low premiums compared to other health care organizations. This is a wrong notion. In fact Premier provides a far better quality of service than other medicare organizations and is very transparent about their terms and conditions. With them by your side, you need not worry about your inpatient or outpatient costs, since they cover both of them. If you are new to medical insurance, and do not know which plan is best suits you, just check out their website and you will find all relevant details over there.

When starting a business, entering the health industry is a very good idea. Starting a business from home is an even better idea. What then is the best home health business one should start? Several ideas come to mind, but one of the best is a health care home business.

A health care venture is primarily intended to provide assistance to the elderly. In the United States, the elderly population is rising and health care for them is in great demand. Target demographics for this kind of business include individuals who are aged 60 and above and have certain disorders and health care problems that curtail their mobility. These people may need regular medical attention. A health care business can also provide services to those seniors recuperating from surgery or illness.

A senior health care business is one of the best home health businesses because it is one aspect of the health industry that is experiencing a continuous rise of consumers. This business will involve the provision of assistance and services like meal planning, meal preparation, and proper managing of the patient’s health. It may also involve light chores like running a few errands and light house cleaning.

One of the reasons why a senior health care business can be the best home health business is that it does not require a large amount capital. Start-up costs are minimal and since it is a home business you need not even spend money to rent business space! Although this type of business is considered the best health home business, it does not mean you will not have to exert some effort. A background in the health care department would really be advantageous for you.

However, you need not have formal training. As long as you are willing to expand your knowledge through manuals, books, and courses, you are good to go! If you prefer to attend programs that provide intensive training, go ahead and do so. Doing so will considerably increase your chances of success. A senior health care home business is not hard to put up and it can truly be the best health home business.

National health care might be a disaster, due to the cost and the complexity. A government-controlled system also creates agonizing moral dilemmas (read about the eye treatment ruling covered further down). Still, despite my opposition to it, I can see it’s a real possibility, and soon. Keeping that in mind, here is what we can do to solve some of the inherent problems and make the system work better.

What’s Your QUALYs Score?

Who gets what health care? That would be a tricky decision for any of us, but some might argue that the bureaucrats in the National Institute for Clinical Excellence (NICE) are pretty good at it. They are evaluate and approve treatments for the National Health Services administration in Britain (their national health care bureaucracy). After all, the life expectancy in Britain is about the same as in the United States, and the government spends less on health care while covering ALL citizens.

Making such decisions, of course, does lead to some interesting problems. One example: In 2002 NICE recommended that a certain treatment for macular degeneration be used only in one eye – the one less affected by the disease. What about the other eye? It is presumably allowed to go blind. They arrived at this decision by using “QUALYs,” or Quality-Adjusted Life Years.

How does this methodology for measuring the value of treatments work? Let’s look at a couple examples. A surgery that gives you an average of ten years of life is better than one that gives you five, and so scores higher on the QUALYs scale. Years added to life matter, but so does quality of those years. Suppose you could be saved by a treatment but be in a coma for six years, while another person could be saved and healthy for six years by some other treatment. If funds are limited (aren’t they always?), the latter would be approved.

Now let’s look again at the case of the eye treatment. The score for QUALYs is high for the first eye, since seeing presumably greatly increases the quality of life over blindness. But seeing with the second eye doesn’t boost the quality of life nearly as much, right?

We don’t need to get into the complexities of the system to understand the logic. Life matters, but quality of life also matters, an idea most of us can agree to. But it leads to some uncomfortable conclusions, doesn’t it?. For example a person with a debilitating disease or handicap presumably scores lower in QUALYs when considered for a life-prolonging heart operation. We might pass her over in favor of a healthier person who would benefit more according to the QUALYs score.

The real truth, normally ignored, is that there a financial limit to any national health care plan. As a result, we have to make decisions that can certainly be uncomfortable, and sometimes downright disturbing. What if a million dollars could prevent ten thousand people from getting a deadly disease, or that same million could be used to treat and possibly cure twenty people who already have the disease. Should we allow the twenty to die in order to prevent the deaths of ten thousand?

Of course, it’s easy to say we should cure the twenty AND run the prevention program. This may even be possible, and we certainly could pay for both eyes to be treated in the case of macular degeneration. On the other hand, we really can’t do everything. Honesty compels us to admit that perhaps going blind in one eye isn’t nearly so tragic as losing sight in both, and if treating just one eye for one patient saves enough money to treat another patient’s heart problem with a new procedure that saves his life, maybe we need to make that kind of decision.

Whatever utopian theorizing we do, tough choices will have to be made at some point if we decide on national health care. We’ll need to put a value on life, or on various qualities of life at least. Yes, we may even have to put a value on one eye versus two, or on eyesight versus saved limbs that might be amputated otherwise. In a market system medical providers compete to provide better treatments for your diabetes, but this will be, in part, a system where your diabetes competes with somebody’s migraine headaches or broken nose.

National Health Care – Some Suggestions

If we allow a market system of health care to exist alongside a government system, we could at least pay to have the other eye fixed. The rich will obviously get better care, but I don’t think we are such a petty envious people that we would vote against such a dual-system just because of this. The healthiness of the wealthy doesn’t hurt the rest of us. Also, we all would at least have the hope of raising money for whatever additional health care we desire. So let the market still exists.

There will also be the problem of demand. Free means higher demand, of course. At the moment I have a few teeth that I might have a dentist look at this week if the examination and treatment was free, but since it isn’t I’ll wait a bit. People often delay treatment because of the expense, but they also look for and find cheaper alternatives. That would change if we had free national health care.

There will be a big increase in demand. Naturally, cuts that might be bandaged will be more often be stitched if the service is without cost. A headache or sore throat that would normally be endured might mean a trip to the free hospital or clinic. Sadly, this would use government health care money that might otherwise pay for research or treatment for life-threatening illnesses, meaning more tough decisions.

How do we alleviate this problem of excessive demand? Design a system that isn’t free. After all, the problem isn’t that we have to pay for health care, since we find a way to pay for groceries, clothing and cable television without government handouts. The problem is the high price and unpredictability of health care expenses. An occasional surprise is one thing if it’s a few hundred dollars, but a few weeks in a hospital can eat up a lifetime of savings.

Address THIS issue, instead of encouraging people’s unwillingness to budget for unexpected, but affordable surprises? How? One way is to have national health insurance for all, but with a $500 annual deductible. When a person can’t afford this (it amounts to $42 per month) it usually suggests a budgeting problem, not a problem of over-priced care.

Have each person pay 20% of all costs beyond that deductible as well, up to $1,000 ($5,000 in costs). This would keep people from running to the doctor or hospital for every little thing. This also encourages them to look for cheaper effective treatments, so the system doesn’t destroy the usual incentive (money) for this creative process of health care improvement.

Prescription drugs shouldn’t be covered until the cost goes beyond that $500 annual deductible, and even then the patient should pay his or her 20%. People (even poor people in this country) find a way to pay for bigger expenses in life, and this would keep the system from being abused. What if some people really are too poor to afford even this? Address that problem through general welfare programs, rather than paying for prescriptions for tens of millions who can easily afford them.

I am not thrilled with the idea of a national health care system. On the other hand, if it is going to happen in any case, we at least make it sustainable and leave open more options for all of us. That’s what the system outlined above would hopefully accomplish.

PR: n/a I: 728 L: 0 LD: 32 I: 1 Rank: n/a Age: February 6, 2010 I: 0 whois source Robo: yes Sitemap: yes Rank: n/a Price: n/a

PR: n/a I: 728 L: 0 LD: 32 I: 1 Rank: n/a Age: February 6, 2010 I: 0 whois source Robo: yes Sitemap: yes Rank: n/a Price: n/a

PR: n/a I: 728 L: 0 LD: 32 I: 1 Rank: n/a Age: February 6, 2010 I: 0 whois source Robo: yes Sitemap: yes Rank: n/a Price: n/a

PR: n/a I: 728 L: 0 LD: 32 I: 1 Rank: n/a Age: February 6, 2010 I: 0 whois source Robo: yes Sitemap: yes Rank: n/a Price: n/a

PR: n/a I: 728 L: 0 LD: 32 I: 1 Rank: n/a Age: February 6, 2010 I: 0 whois source Robo: yes Sitemap: yes Rank: n/a Price: n/a

Info PR: n/a I: 728 L: 0 LD: 32 I: 1 Rank: n/a Age: February 6, 2010 I: 0 whois source Robo: yes Sitemap: yes Rank: n/a Price: n/a Links: 79|9 Density

 

 

Finding Health Insurance that’s Right for You

If you are an individual looking for health insurance, the best individual health insurance will be the plan that is customized to meet your needs. The best option would be a plan that is purchased as part of a group plan through an employer. These can be very cost efficient with numerous options, but not everyone is in the position where that is an alternative. For those who not, there are choices that are available through private insurance plan.

Many people toss around the idea that it is okay to go without health insurance.

After all, they are healthy and a little while won’t hurt. You should rethink that belief. Your life can change in the blink of an eye and that blink can cost you thousands of dollars. You never know when you will have an accident or are afflicted with an unexpected illness. You may not need health insurance to cover your doctor’ visits or annual exams, but most of us would not be financial prepared for a five figure medical bill. This is the reason that medical insurance is so important.

There is such a large variety of health insurance plans for individuals and families that it is not difficult to find a plan that fit your needs. It is as simple as going online and getting a quote for your needs. You enter a few pieces of information and there will be several search results returned. They will give you a basic overview of what coverage the health insurance plan includes, the deductible and the monthly payment. You are able to compare these quotes and apply for a health insurance plan right from the same page.

If you expect to move forward, financially, health insurance is a must-have. It is essential to protect your assets.

Get a quote for your individual health insurance plan today.