Mindmasterclass dot Com: Health and Medical Blog

In this economy, many people have lost their jobs or are in fear of losing them. Retirement savings are down and no one seems to know when the economy will turn around. In times like these we must pay close attention to how every dollar is spent. If you’ve lost your health insurance or otherwise need to get health insurance, it’s more important than ever to get the coverage you need to protect your family’s finances without paying for coverage you don’t need.

PPO, HMO, HSA…with so many health insurance plans to choose from, how do you know which health plan is right for you? With hundreds of health plans available it can be difficult to decide which health plan is best for you and your family.

The following guidelines are provided by Jeff Breazile, owner of Benefit Studio Health Insurance Services (http://www.benefitstudio.com), a California based independent insurance agency.

To help narrow down the many choices available and find the right plan for you and your budget, it’s important to compare premium quotes from different health plans. But what benefits do you get for your monthly premium? Look beyond just the quoted premium of a health plan and consider what benefits in a health insurance plan are most important to you.

Focusing on the benefits you need most is the first step in finding a Califorrnia health insurance plan that not only offers the protection you need, but is affordable as well. The health plan with the lowest premium may not give you the financial protection you need if you get sick, have an accident or otherwise need to seek medical attention. A comprehensive health plan that covers a wide range of services and benefits may cost more in premium, but could actually save you money over a basic or “catastrophic” plan on the other end of the spectrum where you would pay a much larger share of the costs when you receive medical care.

Here are some tips to help you narrow down the list of health insurance plans when deciding which plan will be the best fit. Start by deciding which type of benefits are most important to you. What benefits have you used most in the past? How much of the medical expenses could you reasonably pay yourself if you have a major medical event? Use the following list to focus on the most important benefits. Then you can compare the plans with the benefits that best fit your needs.

PPO or HMO plan maternity benefits deductible amount copayment (copay) coinsurance amount out of pocket maximum prescription drug coverage (generic + brand name benefits or generic-only) preventive care services health savings account (HSA) compatible health plan

PPO – Is it important to you that your plan offer a large network of participating doctors and hospitals? Do you want to be able to see a specialist without having to obtain a referral from your primary doctor? Preferred Provider Plans (PPO) offer the largest networks of participating doctors and hospitals. With a PPO you also have the option of getting medical care outside of your PPO network, although you will usually pay more if you receive care from a provider that is not in your network.

HMO – Another option is a Health Maintenance Organization (HMO). Although not as popular as PPO health plans, many people prefer them due to their simplicity. You can obtain most services for a low copayment and usually no coinsurance requirement. The tradeoff with an HMO is you must stay in network to receive covered medical services. HMO networks are normally smaller than PPO networks and generally a referral is required from your primary care doctor to see a specialist.

Maternity Benefits – While the cost of health insurance plans vary widely, and it’s important to choose a health plan that has the benefits you need, you may be able to save money by choosing a plan without certain benefits. If maternity benefits are not important to you, look for a health plan without maternity benefits. This alone could save you hundreds of dollars annually on your health insurance plan.

Deductible Amount – Except for services where you are only responsible for a copayment, the deductible is the amount you pay before the insurance plan pays anything. If you’re willing to pay more of the upfront costs when you need medical care, choosing a higher deductible can help keep your insurance premiums lower.

Copayment (Copay) – The copay is a flat fee you pay at the time of service. After paying the copayment, the plan usually pays 100 percent of the balance of covered services. Some California health insurance plans allow you to visit the doctor’s office for a low copay without having to meet your annual insurance deductible.

Coinsurance – In addition to the deductible, when comparing health insurance plans, pay attention to what coinsurance amount you will be responsible for after your deductible is met. Coinsurance is the percentage of the charges you are responsible to pay for covered medical services apart from any copays or your deductible.

Out of Pocket Maximum – The out of pocket maximum is the maximum amount per year you’ll have to pay for covered medical services. After reaching your out of pocket maximum, your health insurance plan pays for any additional covered medical expenses up to the plan’s lifetime benefit amount.

Prescription Drug Coverage – When it comes to prescription drug coverage, some health insurance plans keep the premiums lower by covering only generic prescription drugs. Keep in mind that while there are many generic prescription drugs available, not every prescription drug is available in generic form.

Preventive Care Services – In order to encourage healthy lifestyle habits and thereby reduce future medical expenses, many California health insurance plans offer low or no copayments or other financial incentives for preventive care services such as physical exams, immunizations, annual gynecological exams, mammograms, prostate exams and cancer screenings.

Health Savings Account (HSA) – Are you interested in a health plan that will help you save money on your tax bill? Consider a Health Savings Account (HSA) compatible health plan. A Health Savings Account (HSA) combines high deductible health insurance with a tax-advantaged medical savings account. Withdrawals that are used to pay for qualified medical expenses, including your insurance deductible, coinsurance and co-payments are federally tax-free.

By focusing on these nine plan benefits when shopping for California health insurance, you’ll find a plan that fits your healthcare needs and your pocketbook.

A review of health seeking behavior: problems and prospects

Author: Sara MacKian Article reviewed by: Dr Nihar Ranjan Ray

INTRODUCTION:

Health seeking behavior refers to all those things humans do to prevent diseases and to detect diseases in asymptomatic stages. In contrast illness behavior refers to all those activities designed to recognize and explain symptoms after one feels ill, and sick role behavior refers to all those activities designed to cure diseases and restore health after a diagnosis has been made.

I agree to the author that there is growing recognition, in both developed and developing countries, that providing education and knowledge at the individual level is not sufficient in itself to promote a change in behavior. We need do something extra or focus to a different dimension to bring effective changes in health indicators. One more important thing that the author has insisted that factors promoting ‘good’ health seeking behaviors are not rooted solely in the individual, they also have a more dynamic, collective, interactive element. Understanding of the social capital and proper understanding of health seeking behavior could reduce delay to diagnosis, improve treatment compliance and improve health promotion strategies in a variety of contexts. Author has given utmost importance to make studies of health seeking behavior more useful from a health systems development perspective. In initial part of the article the author suggested the two approaches namely

(a) Health care seeking behaviors: utilization of the system

(b) Health seeking behaviors: the process of illness response

According to author variety of studies were conducted on the basis of macro analysis. Taking age, sex, geographical region etc.. But author aptly suggested that these determinants can be further broken to smaller fragments like Status of women, Elements of patriarchy, Social Age and sex, Socioeconomic Household resources Education level, Maternal occupation, Marital status, Economic status, ‘Cultural propriety’, Economic Costs of care Treatment, Travel time, Type and severity of illness Geographical Distance and physical access, Physical, Organizational Perceived quality and so many to identify the reality of the back ground problems. Despite the ongoing evidence from different studies that people do choose traditional and folk medicine or providers in a variety of contexts which have potentially profound impacts on health, few studies recommend ways to build bridges to enable individual preferences to be incorporated into a more responsive health care system. I find it most interesting that has been quoted by (Needham et al, 2001).  As they suggested “the need to improve integration of private sector providers with public care to tackle this problem in a better way” And with the Indian perspective at least I can’t agree with Ahemad et al that the training to these non formal providers are wrong. At least we can use their community motivation in a modern way so that the health seeking behavior of these people will change gradually.

Now it is time to focus upon to understand the psycho logical process of these people as discussed in the section  Health seeking behaviors: the process of illness response. The understanding of the ‘healthy choices’, in either their lifestyle behaviors or their use of medical care and treatment. Among the different models discussed here namely (a) social cognition models (b) Health belief model (c) health locus of control

•(a) social cognition models:

Predicting health behavior with social cognition models as per the figure illustrates I am completely agree with the author as she criticizes the model as “The downfall of these models is that most view the individual as a rational decision maker, systematically reviewing available information and forming behavior intentions from this. They do not allow any understanding of how people make decisions, or a description of the way in which people make decisions.”

•(b) Health belief Model:

The health belief model is a largely accepted theory and like any other theory it has its limitation also like the author writes “The health belief model has been criticized for portraying individuals as asocial economic decision makers, and its application to major contemporary health issues, such as sexual behavior, have failed to offer any insights” Any how I personally feel this can be a model of reference for contemporary diseases. and also what I feel this model is still holds good in describing the STIs though stigma, shame ness and sexual conservativeness comes into play.

It may be right that the way Mc Phill et all thinks “developed country research has a better track record of exploring this broader contextual picture, whilst work in developing countries tends not to acknowledge the poor relationship between knowledge and health seeking behavior.” Apart from the KABP model I find the description of the Reflexive communities are interesting .Reflexive communities reflect the particular ways of behaving, thinking and reaching decisions of individuals or groups, that in turn reflect the social construction of their position in wider society at a particular place and time. Information regarding health seeking has many facets and determinants like ‘moral, affective, aesthetic, narrative and meaning dimensions’. So more scientific way of approach will be ‘aesthetic reflexivity’ which “means making choices about and/or innovating background assumptions and shared practices upon whose bases cognitive and normative reflection is founded” In order to understand how people reach the decision  we need to know also how  the underlying, unspoken, unconscious feelings and assumptions which support that cognitive process. These concepts that are been discussed here  are seems to be more theoretical to practice . But still these issues are need to be addressed aptly for events like HIV/AIDS . I and I am completely agreed with Harvey that “the way people perceive risks and experience risk should be a matter for public policy”

Health seeking behavior and the probes: a review

Health seeking behavior differs for the same individuals or communities

when faced with different persons, times& illnesses. The article has described some of the examples here. They have  given a very nice example here regarding the health seeking practices of women when faced with abnormal vaginal discharge, as opposed to malaria. I think this is more a big problem in countries like India & Bangladesh than the developed worlds. Again the shortage of the female Health care staffs worsens the problem. And the most important thing that I feel is most of the sensitive illnesses or diseases or public health problems are having this problem. Or thinking in the reverse way that due to this embedded problem it is very difficult to address these problems or not getting quick results. Among the examples I try to touch them in short. Only the key issues are given as described the author. I think she has identified it very nicely from different studies.

Tuberculosis

(a) Late presentation and delayed diagnosis are  problems for TB, reflecting both

individual and social factor. Delay can be related to social stigma, gender, fear or multiple health seeking.

(b) Culturally sensitive and situated understanding of health seeking behavior may

Provide better  treatment compliance and shorten delay of diagnosis.

©Health education should be started  at family and community level to improve

awareness and to avoid stigma.

(d)The doctor-patient relationship may need particular attention in relation to TB due to the lengthy treatment period.

Maternal and child health

(a) The way in which women reach the decisions they can have a great influence

on child morbidity and mortality and is therefore worthy of continued study.

(b) There may be a better ways of exploring women’s involvement in health

system and social structures .

Diabetes Type 1

(a)Perhaps the lack of material suggests there is more work needed in this area?

(b)The doctor-patient dynamic can potentially be used to promote ‘good’ health

seeking behavior and compliance with treatment, and is an issue reflected across

the probes.

Social capital and Health & Development

Social resources norms and networks or processes and conditions within society that allow for the development of human and material capital. So  social capital is created and used through individual participation. Bonding social capital which links members of a particular group, and bridging  social capital which links across groups. So the first one when addresses the Horizontal Equity the later addresses the Vertical Equity. Social capital provides a means of shifting the focus from individuals to social groups, and the social involvement of the actions of individuals. Though it varies from community to community but social capital also has implications for the operation of health systems description of that in detail is beyond the scope of this literature.

Health seeking behavior in the context of health systems

Non formal practitioners  and birth attendants so embedded in the existing social

fabric and reflexive communities so that mostly the women deny delivery in favour of trained public service doctors. And in the Indian sub-continent  public doctors running private clinics alongside their public role, where they can charge patients they have referred from the public system, may have the effect of undermining trust in the wider system.

Conclusion

“To begin to picture the resources and constraints…the way the actor experiences them, is to take a crucial step towards understanding why and how people do what they do”

This statement by  Wallman and Baker I think we always need to remember be coz Health care is a system that is so much embedded into the society and individuality of the people that if you search for the influencing the factors than finally you will get all the branches of science on your table. So to be practical is more important than criticizing any issue theoretically and parallely we can’t ignore any issue how ever that may seem impractical. That is the beauty and problem of designing the policy for the Health care. What I feel like head of the family neglects himself in due course of taking care of other family members we should not land in a troubled water by focusing more on the peripheral issues of Health care delivery system than the center stage. We should not forget to address the problems of the internal clients to provide a better motivated care to the external clients. Which in my view very poorly addressed in international, national & regional level. And last but not the least is the financing system and its proper management is the key issue.

Dr Nihar Ranjan Ray

Indian Institute Of Public Health, Gandhinagar