Power to the Patient: Mount Sinai Puts Medical Records Snapshot on Smart Cards : "Today, Mount Sinai patients participating in the pilot test can choose to carry a 'personal health card.' This encrypted smart card with 64K of memory holds not only the patient's name, photo, and insurance information, but also a medical history snapshot, including notes on allergies, medications, recent treatment data, and even in some cases, a compressed EKG test result. The goal is to distribute 100,000 cards in the initial pilot project, Contino says. Mount Sinai's registration staffers can use the cards to check in patients quickly and accurately; emergency room triage nurses can use the cards for quick access to relevant patient data."
Wednesday, October 31, 2007
U.S. Needs to Push Harder for E-Health
U.S. Needs to Push Harder for E-Health: "The U.S. government needs to step up its push for electronic health records because they are not being adopted quickly enough, a group of health advocates said Friday. MORE ON CIO.COM Hurdles to an Electronic Medical Records System Big Hospital Puts Medical Records on Smart Cards Microsoft's HealthVault Health-care providers in the United States continue to make errors that hurt tens of thousands of patients each year, and e-health records could prevent many of those problems, said Dr. Alan Lotvin, senior vice president of oncology for Magellan Health Services. The U.S. health-care system is failing patients 'despite the fact we have the knowledge and the technology to really do a much, much better job.'"
Tuesday, October 30, 2007
Do your healthcare bills confuse you?
Do your healthcare bills confuse you? " Government and state laws require doctors, hospitals, ambulance services, therapists, and other caregivers to use different bill forms and sometimes-different terms for treatment. You may receive a lot of paper after a doctor or hospital visit, and may be confused by these bills and the words on them.
This booklet also includes a sample of a typical bill. Printed on the sample bill are notes explaining what different areas of the bill mean. We have also included some questions that patients often ask their doctors or hospitals about their bills, and answers to those questions. There is also a page that you can use to write notes or questions to ask your doctor or hospital about your bill."
Patient Friendly Billing
Patient Friendly Billing " The Patient Friendly Billing project is committed to helping the healthcare system create patient bills that are:
❍ Clear: All financial communications should be easy to understand and written in clear
language. Patients should be able to quickly determine what they need to do with the
communication.
❍ Correct: The bills or statements should not include estimates of liabilities, incomplete
information, or errors.
❍ Concise: The bills should contain just the right amount of detail necessary to communicate
the message.
❍ Patient Friendly: The needs of patients and family members should be paramount when
designing administrative processes and communications."
Hospitals can be very "creative" in the way they bill their patients - especially when it's a third party which is paying the bills. Here are some useful guidelines to follow.
Patient friendly billing
Patient friendly billing First, healthcare financial services will need to become more patient-centric in focus. This means coming up with new ways to identify and address patient needs, learning how to communicate with patients as partners, and incorporating such patient-friendly concepts as pricing transparency, point-of-service payment, and simplified charge structures. Providers will also need to provide meaningful information about quality of care.
Second, in order to be successful in the future, providers must be willing to make radical changes. Consumerism in health care poses a truly different way of doing business. Incremental change—nibbling around the edges—will not be enough to get us where we need to go.
Third, we cannot go it alone. The only way to make the system truly work for the consumer is to collaborate creatively with other providers, commercial and government insurers, employers, regulators, and— first and foremost—consumers themselves.
Innovative ideas in healthcare - how to generate them !
Innovative ideas in healthcare - how to generate them !
1. Patient Healthcare Advocate – “Health Buddy”.
Phone and on-site credentialed clinical advocacy services to patients and their family
members sold as a voluntary benefit through employers and to individuals. This helps
put patients more confidently in charge of their care because of access to an
educated advocate.
2. Global Research Network Use electronic medical records to identify potential subjects for clinical research. More rapid access to a broader and more diverse patient population by researchers should accelerate clinical trials, reduce costs, increase drug safety and medical practice innovation and population-wide surveillance.
3. Health Key Providers and other stewards of patient healthcare information use a secure “key” to identify an individual patient’s data. Making those “keyed” data available outside of firewalls gives patients web access to their records anywhere in the world when they need it.
HealthShopper : Vimo Newsletter
HealthShopper : Vimo Newsletter: "The 'Healthy Living' Credit Card Aetna and Bank of America have teamed up to develop the Aetna Healthy Living(TM) credit card for Aetna's medical, dental, pharmacy and behavioral health members. The innovative credit card, available later this year to qualifying Aetna members, is a rewards-based credit card that facilitates payment of out-of-pocket medical expenses as well as everyday purchases while promoting healthy living at the same time. The card offers a convenient way for consumers to manage their healthcare dollars. Members who apply for and are issued the Aetna Healthy Living credit card will have access to a base rewards program that offers one point for every qualifying retail dollar charged to the card and access to a wide variety of redemption options. Additionally, Aetna Healthy Living credit card members will be rewarded with the following unique features that provide incentives for healthy living. * Earn points for money spent on certain health-related purchases including hospital treatments, doctor and dentist charges, sporting goods stores, fitness and weight loss centers, vitamin stores and more. * Receive a discount on dozens of health-related items - gym equipment, spa set, bicycles, blood pressure monitors and more from the WorldPoints catalog."
This is a clever idea ! Now that insurance companies and banks are getting into the healthcare space, this is a logical extension of their offerings.
ConsumerReports.org - Medical ripoffs, overspending on overtreatment
ConsumerReports.org - Medical ripoffs, overspending on overtreatment: "Do more, make more . Paul DeLeeuw, M.D., whose whole-body CT scan led to many follow-up tests but no diagnosis of serious disease. Photo by Roark Johnson When it comes to health care, more is not necessarily better. But more is what patients tend to get. While America's health system has achieved important gains against major diseases, it has also encouraged the overuse of costly treatments. The system pays the vast majority of doctors and hospitals on a piecework basis called 'fee for service.' The more services they provide--a blood test, surgery, an MRI or CT scan--the more money they make. Experts estimate that the nation's $2 trillion annual health-care tab is one-third to one-half higher than need be, in part because of overuse of costly treatments and unnecessary care."
ConsumerReports.org - Medical ripoffs, 10 overused tests and treatments
ConsumerReports.org - Medical ripoffs, 10 overused tests and treatments: " 1 BACK SURGERY. Don't rush to surgery for a simple slipped disk. In 90 percent of cases, the pain goes away on its own within six weeks. In stubborn cases, surgery, which can cost $20,000 plus physician's fees, can relieve pain somewhat faster than physical therapy and medication, a recent study showed. But it also found that both groups of patients wound up with similar improvements after two years. 2 HEARTBURN SURGERY. Doctors surgically tighten a sphincter muscle that blocks stomach acid from backing up into the esophagus. But research shows the operation, which costs $14,600 or more, provides no better long-term relief than taking a proton-pump-inhibitor drug such as omeprazole (Prilosec OTC), which costs less than $1 a day. 3 PROSTATE TREATMENTS. Prostate cancer is often overtreated by surgery that costs $17,000, or by radiation therapy for $20,700 or more, plus physician's fees, without adequate discussion of the alternatives or the high risk of distressing side effects such as incontinence or impotence. Because prostate cancer can grow slowly, sometimes the best approach is 'watchful waiting.'
Check out the entire list !
JS Online: Do online reviews of doctors by patients hurt or help?
JS Online: Do online reviews of doctors by patients hurt or help?: "Hundreds of Wisconsin physicians are being rated on Internet sites such as RateMDs.com, Vimo.com and RevolutionHealth.com. From Rhinelander to Kenosha and Eau Claire to Appleton, patients are grading doctors from all specialties on their helpfulness, knowledge base, personal skills and punctuality. Advertisement Buy a link here According to a recent Forbes magazine article, this appears to be becoming a popular online activity, with some sites averaging 1,000 new reviews per day. Proponents of such sites argue that patients are customers who are paying for a service and should be able to openly express their level of satisfaction and that informed health consumers will make better choices about how to spend precious health care dollars. Critics complain the sites are defamatory and capricious. For example, customers are not qualified to judge a doctor's decision to order a particular test or procedure."
Sunday, October 28, 2007
MEDgle - search your symptoms
MEDgle - search your symptoms: "Search over 6000 symptoms and more than 2000 diagnoses. General Medicine Personalized medical search by doctors for everyone (for informational purposes only) All data have been entered by physicians. We are still in BETA and continuously updating the database."
This is a great tool - check this out. You'll have a pretty good idea of what your doctor will be considering once you check out this site !
Health Populi: The Future of Retail - Implications for Health
Health Populi: The Future of Retail - Implications for Health: "The new retail environment for consumer products has direct implications for consumers in health care. Control, co-creation, technology, globalization...these forces are, together, shaping some consumers' approach to health in the current market. By 2015, these forces will be part of the health landscape in which providers and marketers will compete, and where patients will behave more like...consumers."
Health Populi: Health 2.0 Conference -- Present at the Birth
Health Populi: Health 2.0 Conference -- Present at the Birth: "Paul Wallace, Medical Director of Kaiser Permanenete, offered that 'we talk about trust as a zero-sum game,' but that we should look at trust 'as an asset that you can grow.' Instead of thinking about the number of patients a doctor can see in a day in the office, Dr. Wallace thought it more relevant to think about 'how many patients you can touch in a day,' virtually, through e-consults, e-mail, and other technology-enabled tools. This could make each in-person visit richer, longer."
I already "talk" to more patients by email today than I do in real life !
Practice Fusion - Practice Fusion Officially Launches
Practice Fusion - Practice Fusion Officially Launches: "Practice Fusion, a leading force in healthcare IT, today announces the availability of its free, on-demand, no-risk Practice Management and EMR suite. With this launch, Practice Fusion is poised to change the dynamic in EMR adoption, significantly increasing independent practitioners’ ability to quickly select and begin using world class practice management and EMR. “Today marks the end of the era of big vendors taking advantage of independent physicians—we are empowering them to take control of their EMR decision,” enthuses Ryan Howard, CEO of Practice Fusion. “Our Practice Management and EMR Suite, which is free and on-demand, eliminates the risk of those traditional systems and expedites the purchase and implementation processes. Our EMR allows practitioners to stay competitive and thrive in a world of constant change and growing responsibilities and still increase their overall quality of care.”"
Tech Medicine
Tech Medicine: "Dr. Jay Parkinson (MD, MPH) runs an unusual type of medical practice in New York City. Like many 'concierge' physicians, he accepts no insurances -- the flat rate is $500 a year. He has no office -- he makes housecalls to your home or work. $500 gets you two visits and 'unlimited e-visits': email, phone calls, video chat, or instant messaging. In order for this system of primarily mobile medical care to work, Dr. Parkinson chooses his patients carefully. They must be accessible in Manhattan or Brooklyn, and they must be young (less than 40) and generally healthy. He runs his practice on a laptop, an electronic medical record system (Life Record), and an iPhone. Many of his patients don't have insurance and must pay 'out of pocket' for their medical care. To make his practice more appealing, Dr. Parkinson has contacted local laboratories, pharmacies, and radiologists to obtain the best prices on their services. Not only does he see patients, but he acts as their personal medical shopper for products. While there are many potential problems with this model of practice, the reality is that many younger people (who are generally healthy) don't have insurance, are very comfortable with instant messaging and electronic communication, and would prefer this type of online relationship with their doctors."
Enhanced Medical Decisions, Inc. - Announcing DoubleCheckMD.com (Beta) -- A Powerful, First-Ever, Online Medical Search Technology That Empowers Users
Enhanced Medical Decisions, Inc. - Announcing DoubleCheckMD.com (Beta) -- A Powerful, First-Ever, Online Medical Search Technology That Empowers Users To Quickly And Easily Find Accurate Information: "Enhanced Medical Decisions, Inc., a health information technology (IT) innovator dedicated to creating solutions for U.S. healthcare issues -- today announces DoubleCheckMD.com ( Beta) -- a powerful, first-ever, online medical search technology that empowers users to quickly and easily find accessible, accurate information on drug interactions and side affects. Consumers and medical professionals will save vast amounts of time and eliminate irrelevant searches while using DoubleCheckMD.com's groundbreaking 'natural language' search technology. This technology can determine whether any of the following may be causing adverse symptoms or reactions individually or together: prescription drugs, over-the-counter medications, vitamin supplements and herbal substances."
iGuard Drug Interactions, Risk Ratings and Safety Alerts
iGuard Drug Interactions, Risk Ratings and Safety Alerts: "iGuard is the fastest and easiest way to learn about the safety of your medicines. And, by keeping your iGuard profile up-to-date, you can help the FDA and other researchers identify problems faster than ever. iGuard is a powerful communication and research tool designed to: 1. Alert you and your doctor (if you choose) about important safety information for the drugs you are taking. 2. Distribute risk ratings that help you understand your risk today, and in the future as new safety information emerges. 3. Facilitate communication between you and your doctor about medication risks and monitoring. 4. Provide an easily accessible summary of your health to use in coordinating care across all your doctors. 5. Help researchers identify safety problems faster. 6. Support family members and caregivers who are responsible for monitoring the safety of others."
Pew Internet: E-patients With a Disability or Chronic Disease
Pew Internet: E-patients With a Disability or Chronic Disease: "About a fifth of American adults say that a disability, handicap, or chronic disease keeps them from participating fully in work, school, housework, or other activities. Half of those living with a disability or chronic disease go online, compared to 74% of those who report no chronic conditions. Fully 86% of internet users living with disability or chronic illness have looked online for information about at least one of 17 health topics, compared with 79% of internet users with no chronic conditions. Those with chronic conditions are more likely than other e-patients to report that their online searches affected treatment decisions, their interactions with their doctors, their ability to cope with their condition, and their dieting and fitness regimen."
Empowering the physician-patient relationship: The role of the librarian
Empowering the physician-patient relationship: The role of the librarian: "While searching the Internet is often personally empowering for patients, this sense of empowerment does not necessarily translate into self-efficacy in interactions with health care providers. Whether health information found on the Internet is empowering for patients in clinical consultations appears to depend on the power relations between patients and practitioners, how patients use the information they retrieve, as well as on physicians’ affective responses to these patients. Librarians have a role to play in educating health care consumers and mediating the exchange of information between practitioner and patient."
The librarian can play an important role as an infomediary in dispensing information therapy prescribed by the doctor !
Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery -- Rosen and Kwoh 120 (4): 701 -- Pediatrics
Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery -- Rosen and Kwoh 120 (4): 701 -- Pediatrics: "Patient-physician e-mail is a service that patients will use given the opportunity. The e-mail service enables physicians to answer medical questions with less time spent compared with telephone messaging. In our experience in an academic pediatric subspecialty practice, patients reported enhanced communication and access with the e-mail service."
The Partnership for Healthcare Excellence
The Partnership for Healthcare Excellence: "There are a lot of things you can do for your health. You can exercise and eat right — but one of the most powerful things you can do for your health is to be an active and engaged patient. That’s where The Partnership for Healthcare Excellence can help. The Partnership for Healthcare Excellence is dedicated to helping you — as a patient and as a consumer — get the high quality care you and your family deserve. Research shows that patients who are informed about their health, ask questions, and get involved in making decisions, actually get better care. That’s why we’re making it easier for you to get the information you need, by offering you tools, tips and resources that you can use to improve the quality of care that you and your family receive."
The second IVF cycle
For many patients, doing a second IVF cycle is much easier than their first one. There is much less apprehension and anxiety, because they have "been there, done that". They know exactly what is involved; and that there is no physical pain during the treatment. Their comfort levels are also much better, because they have developed a personal relationship with the clinic staff. However, for some patients, the second cycle is much harder. The first cycle is often done with the hope that " it has got to work !" The failure of the IVF cycle can be heart-wrenching and forces patients to confront the reality that there are no guarantees with IVF and that life is full of uncertainties. The fear of another failure can become a huge hurdle in some patient's minds - and many can never muster the courage to try another IVF attempt. This is especially true if their experience with the medical staff has been poor; and the clinic is seen to be impersonal and uncaring.
Fortunately, most patients have much more realistic expectations during their second IVF
cycle , which means that managing them is much easier. The index of a good IVF clinic in my mind is how many patients come back for their second attempt !
I especially enjoy treating patients who have failed an IVF cycle at another clinic. Not only are these patients more medically challenging;, it's much more fun to treat them, because we provide so much more personalised attention and care, which means they are more
appreciative . After all, unless patients have experienced poor quality care at another IVF clinic, how can they judge how much better we really are ?
Helping patients to make a decision
One of the most important roles a physician plays is helping patients to make the right decision. This is always very hard to do , because a good doctor should try to empower patients to make their own decision for themselves !
I see myself as being a Sounding Board, and I try to help my patients walk through their options. I do my best to not impose my answers or to tell them what to do , even though this can be hard . I often play the role of a Devil's Advocate, to make sure they have considered all the pros and cons before deciding. I will often give them a "cooling off" period, during which they have time to mull over their choices, so they can follow their heart.
I do have biases, and I share these with them, so they can factor these in when deciding. At the end of the day, they should have peace of mind they did their best !
From retired caregivers, a spoonful of compassion - The Boston Globe
From retired caregivers, a spoonful of compassion - The Boston Globe: "A prominent Boston physician is organizing retired colleagues to provide the personal attention that is often missing in modern medicine. The volunteers with Bedside Advocates will not practice medicine. Instead, they aim to provide comfort and compassion while helping fragile and elderly patients navigate the increasingly complex medical system by accompanying them to the doctor's office, the hospital, and the nursing home. They hope to help patients get better care by empowering them to ask questions, follow their medication regimes, and get prompt attention to problems. And most of all, they plan to be there when no one else is, providing relief for tired caregivers and support for patients without families, according to Dr. Jonathan Fine, who is leading the effort."
This is such a great idea ! Retired doctors can be excellent patient advocates; and their skills are very poorly used at present. They have a lifetime of wisdom to share - why can't we tap this properly ?
Incidentally, retired doctors are a great resource when you want a second opinion; or when you want a referral to a specialist.
Communication now part of the cure - USATODAY.com
Communication now part of the cure - USATODAY.com: "Retired Boston physician Jonathan Fine became a patient advocate in 2004 when he realized communication between doctor and patient is often the first casualty of a major illness. Miscommunication puts patients at greater risk of becoming victims of preventable medical errors, according to a report this year by the Joint Commission, a national hospital accreditation organization. And the Institute of Medicine reports that medical errors cause up to 98,000 deaths a year."
Two numbers every women should know !
Many women are now choosing to postpone childbearing because they want to pursue their career. However, sometimes it's hard to have your cake and eat it too, and some older women regret their decision when they find out that their eggs are too old for them to be able to have a baby .
So it is safe for you to do so ? At what age should you start worrying about your eggs ? 30 ? 35 ? What about all the celebs having kids at the age of 40 ? And can't IVF fix all problems ?
Unfortunately, there is no alarm on your biological clock, and every woman has a limited number of eggs which will run out as she grows older. So how do you know how old your eggs are and how much time you have left ? How can you assess what doctors call your "ovarian reserve" ?
There are 2 simple numbers which will help you to do so - your FSH level; and your antral follicle count. These are two basic numbers every woman who is more than 25 needs to know, so she can make well-informed decisions as to how long she can safely postpone childbearing.
Let's review some basic biology. Women are born with all of the eggs (oocytes) that they will ever have. A female fetus will have the greatest number of eggs around 16-20 weeks of pregnancy (5 million); at birth this number decreases to about 1 million; and by puberty it's down to about 300,000. This constant and dynamic process of decline continues until menopause and is not interrupted by birth control pills, pregnancy, or ovulation. From this reservoir of eggs, fewer than 500 eggs will ovulate during a woman’s reproductive life. Once a women runs out of eggs, she reaches her menopause. About 10 years prior to the menopause is a phase called the oopause, when the egg quality is good enough to produce hormones to generate a regular menstrual cycle ( and this sometimes lulls women into a false sense of security); but not enough to make a baby.
There is a continuous process occurring in the ovaries where eggs are constantly being prepared for the maturation process. It takes 3-6 months for eggs to develop and mature. As the eggs are developing, they transition from a primordial ( immature follicle) to a mature follicle, called an antral follicle. Antral follicles are visible by vaginal ultrasound. Antral follicles therefore represent the reserve of eggs in the ovaries ; and these are the follicles which can be stimulated by fertility stimulation medications (gonadotropins).
An antral follicle count ( AFC) is done during the 2nd-4th days of menstrual flow and is performed by doing a vaginal ultrasound scan. Studies show that the AFC is predictive of the expected ovarian response to gonadotropins. An AFC less than 6 total (between both ovaries), predicts a poor stimulation response. This means a low AFC can correlate with diminished ovarian reserve.
The other simple test for checking how young your ovaries are (the ovarian reserve) is by doing a blood test to measure the level of FSH ( follicle stimulating hormone) in the blood on Day 3 of your cycle . This is called the basal ( day 3) FSH level. Young women with lots of follicles produce a hormone called inhibin, which inhibits the production of FSH, which means they have low Day 3 FSH levels. A normal level is about 3-4 mIU/ml. A high level ( more than 8 mIU/ml) suggests poor ovarian reserve; and a very high level ( more than 20 mIU/ml) is diagnostic of ovarian failure.
These 2 basic tests should be a part of the annual checkup for all women. Unfortunately, most family physicians and gynecologists are clueless about the importance of this test. When a 28 year old asks them whether it's safe for her to postpone childbearing, most of them give her a reassuring pat on the head, and tell her not to worry !
While this advise may be fine for some women, it's a major disservice for others. I feel women need to take matters in their own hands, and ask their doctor to measure their FSH levels, so there is a sound scientific basis for their reassurance. If the FSH level is borderline high, which suggests poor ovarian reserve, further testing to check ovarian reserve is called for, including an ultrasound scan for antral follicle counts.
As Robert Ringer explains, remember that there is a price you pay for every decision you take in your life. There is a price you pay for pursuing a career; and there’s a price you pay for having a baby. No matter what you do in life, do it with your eyes wide open to the tradeoffs involved. And then deal with those tradeoffs with a mature confidence ... and don’t complain. If you find that you are not willing to live with the price of a decision you’ve made, cut your losses short and try to reverse the error as quickly as possible.
ConnectYourCare Consumer-Directed Healthcare Administration of HSA, HRA, and FSA plans
ConnectYourCare Consumer-Directed Healthcare Administration of HSA, HRA, and FSA plans: "ConnectYourCare's CDH Solution provides a complete Consumer-Directed Healthcare platform for employers and employees. Our unique CDH platform provides a pathway for employers to realize healthcare cost containment through CDH adoption. For employees, our solution puts the consumer at the center of the healthcare decision making process, with an enhanced user experience and state of the art tools. Products and Services * Healthcare Account Administration - ConnectYourCare administers all types of healthcare accounts, including HSAs, HRAs, and FSAs. We can administer any combination of accounts, giving employers ultimate flexibility. * Healthcare Payment (Debit) Card - Healthcare accounts can be easily accessed through the card to pay for healthcare expenses at the pharmacy and doctors’ office. * Online Account Access – Participants have online access to account balances, claims and reimbursement requests in real time. HSA participants can also access investment options online. * RapidRequest Claims Processing - State of the art claims process enables automated, paperless claims handling that reduces processing time for speedy turnaround of reimbursements. * Health Education Tools - ConnectYourCare provides a suite of online tools "
Medical Banking - Dr Stephen Parente
Medical Banking - Dr Stephen Parente " I’m very excited about the prospects of medical banking. What intrigues me most is the integration of medical banking and person health records (PHR). There are three elements of vision of medical banking:
- Personal health records (PHR) are a portable resource that patients and their families can use for the long term.
- Patients will use PHR technology as a critical resource for health improvement, prevention, and long term medical care affordability.
- PHR will give patients emergency access to critical information and allow the record to be customized to clearly define their preferences for treatment. For example, pregnant mothers can clearly identify their delivery preference. A delivering OB/GYN still can counter the patient’s preference for the safety of the mother, but there would be no ambiguity about the mother’s wishes. Likewise, patients who want their organs donated in the case of mortal injury could make their preferences known.
The technology platform that appears to be emerging for medical banking is the integrated health card solutions. Several insurers have been experimenting with this technology. Of the early adopters Exante Bank of United Health Groups appears to have made significant progress in developing a product as well as a client base for a early for of this platform know as an integrate health care (IHC) technology."
MedEncentive P4P EBM Ix P4Q
MedEncentive P4P EBM Ix P4Q: "The MedEncentive Program is designed to 'bolt-on' to existing health plans (such as Blue Cross, Medicare, commercial insurers, self-insured employers, etc.) to control healthcare costs by improving the standard of care and encouraging healthy behavior. MedEncentive accomplishes these objectives by financial rewarding both physicians and patients on a per-occurrence-of-care basis for incorporating evidence-based medicine (EBM) and information therapy (I x) through proprietary Internet Website applications, simple but profound checks and balances, and other innovative features. This method of financially rewarding accountability and empowerment falls into a national movement referred to as pay-for-performance or P4P."
McKinsey & Company - A Framework to Guide Health Care System Reform - January 2007
McKinsey & Company - A Framework to Guide Health Care System Reform - January 2007: "The main functions of health care systems – wherever they are in the world – is to promote health among the country's citizens. In designing and operating any system, health care leaders aim to satisfy three leading requirements: ensuring that all people have adequate access to the benefits of health care; making certain that the system delivers care of consistently high quality; and achieving all this at a sustainable level of cost. These three objectives raise a host of complex questions. What constitutes adequate access and quality care? What is sustainable cost? To what extent should market forces be allowed to play a role in managing health care costs, quality and service? Going back a step, shouldn't health care systems shift their current focus on caring for the sick to a more holistic effort to maintain citizen's health? The answers to all those questions vary widely, depending on the historical, political and social context of each national system. But sufficient commonality may exist to construct a universal analytical framework that can help leaders identify reform priorities then design and implement them effectively. By focusing on seven key principles that healthcare intermediaries can use to affect demand and supply of health care goods and services, MGI provides such"
Insurers refuse cover for infertility treatment-The Times of India
Insurers refuse cover for infertility treatment-The Times of India: " Early this year, Tata Consultancy Services, which has more than 90,000 employees, approached New India Assurance Company with a proposal. It wanted New India to devise an insurance package for its employees based out of India which would cover procedures like in vitro fertilisation and artificial insemination. The proposal was prompted by an internal survey's finding that about 15% of TCS employees, both men and women, had fertility problems. Sources say TCS wanted New India to cover each of its employees for Rs 1 lakh. This was meant to be over and above the regular health insurance benefits the company offered. On its part, the insurer examined the proposal and declined to prepare the package TCS wanted. New India argued that these procedures were expensive and did not require hospitalisation. More significantly, the argument went, infertility was not a disease as in such cases it could be a result of, among other things, stress. TCS is not the only company in India to approach insurers for customised packages to cover infertility treatment. Sources in the insurance business say companies such as outsourcing firm Evalueserve, Computer Sciences Corporation and GE have all approached insurers at some point in recent times to seek similar cover for their employees. And all of them have been turned away."
This is actually a big opportunity for a clever and innovative health insurance company in India ! Insurance has now become privatised in India, which means it is no longer just a seller's market. Huge IT companies such as TCS and Infosys employ a large number of young employees who are in the reproductive age group. Many of them get so caught up in the rat race that they tend to put off child-bearing in order to pursue a lucrative career - which means that by the time they are settled and want to start a family, many of them find that their biological clock has ticked on, leaving them infertile. Now these are smart young driven employees, who are used to being successful and getting their own way. They have become senior in the company and can exercise quite a bit of clout ! If they need IVF treatment ( which they feel is partly a result of the overtime and long hours they had to pay in order to advance in the company), they want the company to pay them back by covering for their fertility treatment. Companies are going to start feeling the heat - and they are going to pressurise insurance companies to provide this coverage !
The good news is that many studies done in the US have proven that providing this additional coverage does not increase the cost of insurance cover by a significant amount , so that this is a very cost-effective option insurance companies should be happy to provide. Not only will this be a valuable differentiator for them and a great USP, they can also project themselves as being pro-family and employee-friendly. It's my prediction that infertility coverage is an option insurance companies in India will soon provide to corporates, if they don't want to lose their business. Health insurance is a "hot area" in India right now - and infertile couples will benefit from this.
Of course, if the carrot approach does not work, I think infertile couples need to use the stick option. Many of them are smart and successful executives and entrepreneurs, and they can get together to lobby and advocate for making infertility coverage compulsory for all insurance companies. This is exactly what Resolve did in the US many years ago, as a result of which infertility coverage is compulsory in 13 states in the USA.
Hopefully a group of infertile couples or an infertility support group in India will file a PIL ( public interest litigation) in the High Court, based on the grounds that it's unfair for insurance companies to discriminate against infertile couples by refusing to cover their medical treatment. Infertility is a disease caused by medical problems ( such as blocked tubes); and modern treatment is very successful and cost-effective in providing a solution !
The right to have a baby is something most of us take for granted, and we often lose sight of the fact that 1 in 10 married couples will not be able to have the child they want. Infertility is a very common problem, and if you stop to think about it, you will realise that you know at least one person who is infertile amongst your own group of friends or relatives. However, it remains one of those taboo topics which no one wants to talk about, even though it interferes with one of the most fundamental and highly valued human activities – building a family.
Millions of infertile couples in Indian cities today face many obstacles in their attempts to build a much-wanted family, and one of the most frustrating is the lack of insurance coverage for medical treatment. What this means is that while infertility specialists in India can provide even the most advanced reproductive techniques to solve extremely complex infertility problems, at a level of sophistication which is comparable with that in the West (and at a fraction of the price), most couples cannot avail of these techniques because these are not covered by their insurance policy. So near – and yet so far, would sum up the situation for most couples!
The financial burden that some of the treatments may place on couples can be large, and adding this on to the emotional and physical consequences of experiencing infertility can literally be the last straw which breaks the camel’s back. The strong desire to build a family gives many the strength to face these obstacles, but infertile couples also need additional support from their employers and insurance companies.
While most diseases and medical conditions are covered by insurance, the disease of infertility is often singled out for exclusion, and such discrimination is unfair! Thus, to add further insult to injury, infertile couples not only face the emotional pain associated with not being able to have a child, but also face obstacles put in front of them by their health insurance and employers for reimbursement of the medical expenses they incur on their treatment.
Unfortunately, insurance companies in India still do not provide health insurance coverage for infertility. This is a very archaic attitude, but because the insurance industry in India is still a monopoly, this situation is unlikely to change, until the field gets privatised, or Indian companies fall in line with their Western counterparts.
Insurance companies have traditionally denied claims for infertility on one of the following flimsy pretexts.
- Infertility is not an illness;
- Treatment of infertility is not medically necessary;
- Treatment of infertility is experimental.
- Infertility treatment is too costly for a country like India to offer
Medically necessary is usually defined by insurance policies as medically appropriate for treatment of an illness under professionally recognized standards of health care – and treatments such as IVF are now universally acknowledged to be standard medical treatments, which are no longer experimental.
While certain infertility treatments can be costly, most are quite inexpensive, and only about 5% of all infertile couples will need expensive treatments like IVF. Moreover, if expensive medical procedures like bypass surgery can be covered, then why should treatment for an abnormally functioning reproductive system be excluded?
Why this discrimination against infertile couples in India? Ironically, this is because of the high premium Indians have always placed on the family unit! The major role of the woman in Indian society was seen to be to have children to propagate the family name. Therefore, if a woman could not have children, she was singled out, ridiculed, ostracised and stigmatised.
In fact, given the value Indians have placed on having children, infertile couples should actually receive even more tender loving care from others – and be helped in their quest to complete their family!
However, because of centuries of misconceptions and myths regarding infertility (for example, "a barren woman has been cursed by God, and being punished for the sins of a prior life"), it will take a long time for social attitudes in India to change. Infertile couples are an easy and soft target for everyone –
Ranging from:
- friends ("life is incomplete without a baby!");
- in-laws ("when will I become a grandmother?");
- relatives ("what do they want to earn money for – they do not have any children to leave it to!"),
- neighbours ("they may have a lot of money, but what’s the use, they don’t have any children");
- acquaintances (" no good news yet? Go see this doctor my sister-in-law’s cousin went to – he’s the best!") ;
- co-workers ("you don’t have any kids, so can you stay on a little longer to finish this job – I need to go back to take care of my children!");
- right to servants (" the reason she shouts so much is because she doesn’t have any children – serves her right!)
Many otherwise enlightened people take the attitude that infertility treatment is elective – and even compare it to cosmetic surgery. However, infertility is a serious medical condition – it is both a disease and a life crisis.
Others pontificate that these couples should just adopt a baby, rather than take treatment. While adoption is an excellent method of building a family for some couples, it is not acceptable to everyone– and forcing couples to do so when they don’t want to is very unfair.
A major problem is that infertile couples in India are too ashamed to stand up for their own rights – with the result that they often suffer in silence. However, infertility exacts a high toll! Not only do many marriages break up, many women are abused for being infertile as well. Also, infertile employees, because of the emotional stress they are under, are often not as productive in the workplace as they could have been if their problem was successfully resolved.
Fortunately, this discriminatory attitude is now being challenged by advocates for infertile couples – at least in the US. The pathbreaking Americans with Disabilities Act (ADA), provides protection against discrimination for Americans with a disability – a disability being defined as" a physical or mental impairment that substantially limits one or more major life activities."
The US Supreme Court has clearly ruled that reproduction is a major life activity. Since infertility is a physical impairment that substantially limits the ability to reproduce, this means that if an individual experiences discrimination because of his or her infertility, a claim can be made that this is illegal under the ADA. Thus, a police woman employed by the city of Chicago sued the city recently because it did not provide infertility insurance coverage. The Court ruled that infertility is a disability under the ADA, and today the city of Chicago covers the cost of infertility treatment incurred by all its employees.
Many employers in India are not still aware of the issues and concerns facing those with infertility. Employers need to be more understanding of the special needs of those of their employees who are infertile, and be willing to make workplace accommodations for those undergoing infertility treatments – for example, allowing the employee to change her work schedule or to take some time off. Employers, insurance companies, and legislators in India also need to take steps to recognize that reproduction is a major life activity – and that infertile couples need all the