Monthly Archives: September 2017

Healthcare And Capitalist Evangelism

The success of any society is ultimately determined by how well its population lives and dies. Within this paradigm of “successful population” are two fundamental elements – individual and collective wellness. A successful society therefore embodies the notion that both individuals and the overall population are well, and these two measures are reasonable assessments of the wellness, and hence the success of any given society.

In other words, the success of a society can be assessed, characterized, and understood through these two main measures. To break it down, individual wellness consists of answering the question: does the society reasonably allow and encourage individuals to be well? Secondly, does the society allow and encourage wellness for the entire population from birth to death? To the latter question, the most important component of population wellness and hence, societal success, is the degree to which the sum of individual wellness creates collective wellness. The single-most important component of population wellness is a high level of population health, measured by the numbers of individuals who are well or have reasonable access to being well.

The four scenarios below represent a summary snapshot of healthcare systems currently in existence in the Western Hemisphere. The scenarios are predicated on the reality that the cost of healthcare is (next to purchasing a home) the most expensive cost one will experience during his or her lifetime and that these costs are expected to continue to escalate over time as new technology, treatments, and pharmaceuticals continue to drive costs. These four main approaches to healthcare are:

1. No healthcare programs (other than free market)

2. Universally funded programs

3. Insurance company funded programs

4. Combinations of the above

These four healthcare approaches are summarized below with respect to how well they represent the ability to create a successful society. Remember, a successful society is one that encourages, promotes, and allows for both individual and collective wellness, as measured by population health.

1. No Healthcare Programs: Countries which have no healthcare programs generally have lower than average population health. While some members of the population in these societies (namely the very rich) who are able to afford healthcare may be healthy indeed, the overall population health is often quite low. It is important to note that socioeconomic status is generally a good predictor of population health. In countries where no healthcare programs exist, and the reason for these lack of programs is lack of finances, then population health is usually comparatively low. Using our definitions of societal success, the success of these societies would be low, or unsuccessful.

2. Government Sponsored Programs: Countries with government sponsored and funded universal healthcare programs generally have a collectively higher level of healthcare than other countries. Again, if the one applies the definition of success of the entire population as the sum total of the wellness of all individuals within that system, then countries which offer healthcare programs that collectively confer benefits on the highest number of individuals are, by definition, successful. Since one cannot be more than well, there is no incentive for individuals to access more services than are required in order to be well. Leaving aside preventative programs and social marketing costs as key aspects of overall population health, health and wellness can be accessed within government sponsored programs up to a certain level depending on the aggregate overall need of the population. Therefore, by definition, and in spite of incentives and disincentives within the system, the societies that employ these systems are successful.

3. Insurance Company: Healthcare programs sponsored by insurance corporations can work well, provided that the insurance coverage provides all members of society with at least basic coverage and coverage through catastrophic illness. Nobody plans on getting leukemia, or ALS, or meningitis, or lupus, for instance. If you are well-educated and have a position with health benefits with a corporation or you have been successful in your career or business, then it is likely you will be able to afford the costs of healthcare. However, since healthcare and profit-motive are mixed within the same crucible, there is a strong incentive to cheat or to create environments where profit supersedes care if the two vie for supremacy – much as suggested in Michael Moore’s movie, Sicko. The active removal or denial of healthcare is a logical and inevitable outcome of a for-profit, insurance corporation controlled system of care delivery – particularly where the population is aging. Also, there is no compelling motive for insurance corporations to cover individuals susceptible to high healthcare costs (i.e., those with catastrophic physical illness; mental illness; the frail elderly; new mothers and infants), period. The outcome of such a system would be to spiral into category 1 – No healthcare programs – (mediated by a very few insurance companies) wherein the richest segments of society would be able to access services. The irony is, the richest citizenry often require much less healthcare than others. The upshot is this: there is an increasing disparity in the number of people who are able to access healthcare in the face of age and cost escalations. One needs to question the current and future success of these social systems.

4. Combinations of Above: Combinations of the above become extremely complex and difficult to assess. There are certainly advantages and disadvantages, as well as incentives and disincentives for a hybrid of the above systems. Each of these advantages and incentives (or lack of) are inextricably connected to the socioeconomic class you and your family belong to or are transitioning into as well as a host of external and internal factors. A government funded universal system provides healthcare to everyone, including those who are disadvantaged and could not possibly access care without subsidization. It also provides care to those who are charged by some who would abuse care (though unclear who this group might be as people do not consume unlimited healthcare once they are well). Alternatively, the system dominated by large insurance companies provides very high quality, responsive care to individuals who can pay or who are insured by corporations who in turn can pay. This system works well where individuals insured are reasonably healthy and young. A problem occurs when the population of employees becomes older and insurance premiums are either hiked to cover extraordinarily high costs (insurers will only cover healthcare costs where the profits of covering healthcare costs actuarially calculated costs) or removed entirely. Countries in which no healthcare programs exist (presuming healthcare is available) results in costly but accessible services for the very few. There is no need to get into the obvious personal suffering and strife in this latter healthcare system.

How Would Obama and McCain’s Healthcare Proposals Impact Medical Travel?

American Healthcare & Medical Travel

Today, more than 48 million Americans are uninsured, while millions more learn they are underinsured when they become sick. America spends more than $2.3 trillion, or 16% of GDP, annually on healthcare costs. By the year 2016, U.S. Department of Health and Human Services forecasts that health spending will be $4.3 trillion or 20% of GDP.

Though America spends more than any other country on healthcare, it is ranked 37th in overall quality among the world’s healthcare systems by the World Health Organization. According to the Organization for Economic Cooperation and Development, healthcare spending accounted for 10.9% of the GDP in Switzerland, 9.7% in Canada and 9.5% in France, all countries ranked higher than the U.S.

A recent Wall Street Journal-NBC Survey reported that the cost of healthcare is Americans’ number one economic concern. Growing numbers of underserved patients are turning to healthcare delivery alternatives such as traveling to foreign hospitals for necessary treatment. While the medical travel phenomenon started with cosmetic surgery, successes have emboldened patients who need joint replacements, cardiac surgery, spinal fusions and bariatric surgery to reach beyond America’s borders for alternatives. At the same time, health insurers and employers are noticing the opportunities for cost savings by outsourcing and the ability to reach new markets with tailored healthcare products.

Republicans and Democrats agree that current trends in healthcare are not sustainable. Not surprisingly, both presidential candidates, Senators Barack Obama and John McCain, have proposed equally radical remedies for America’s broken healthcare system. Though neither candidate addresses medical travel specifically, their healthcare plans suggest the likely impact on the medical travel market.

McCain’s Healthcare Plan

Sen. McCain would ask Americans to take on greater personal responsibility for their healthcare choices and rely on market forces to meet today’s healthcare challenges. According to Sen. McCain, increased competition and less government involvement will improve the quality of health insurance with greater diversity among plans, lower prices and portability.

Specifically, Sen. McCain would seek to make insurance more available by increasing variety and affordability of private plans. The Senator’s revolutionary idea is to eliminate the tax break that workers receive from employer-sponsored health plans, treating the benefit as taxable income, offset by a new tax credit of $2,500 for individuals and $5,000 for families. If the tax credit is more than the amount a person spends on healthcare premiums, the excess can be placed in a health savings account.

Sen. McCain believes that people who are covered by employer health benefits consume more healthcare services than is necessary. Presumably at least some of those excess services that can be redirected to the uninsured population. Putting patients in control their health spending will encourage competition among providers and insurers, reduce costs and improve the quality and portability of coverage.

Sen. McCain has proposed several policy initiatives to lower healthcare costs. These include: (1) greater competition in the pharmaceutical market; (2) improved systems for chronic disease prevention and management; (3) coordinated care among providers to render better outcomes at lower cost; (4) improved access through walk-in clinics in retail outlets; (5) use of information technology; (6) reforming the Medicaid and Medicare payment systems to pay for diagnosis and prevention but not treatment made necessary by preventable medical errors or mismanagement; (7) anti-smoking programs; (8) state spending flexibility; (9) tort reform to reduce frivolous lawsuits; and (10) improved transparency with better public information on treatment options, doctor records, outcomes, quality of care, costs and prices.

Can Government Healthcare Work in America?

Much has been written on this site and others, about the fallacy of a successfully run government healthcare delivery system in the United States.

Whether it is labeled single-payer, socialized medicine, national healthcare, etc., it is all the same and it will never work in America. In virtually every nation where the government runs the healthcare system, costs have risen well beyond expectations; long waits for treatment are commonplace; care is rationed and some treatments are denied; and taxes have increased to pay for the unexpected cost increases. There are no truly successful nationalized healthcare systems, when quality of care is compared to the gold standard: The U.S. healthcare system. By most measures however, the U.S. lags behind many other industrialized nations.

According to the World Health Organization, the U.S. ranks 24th in the world in life expectancy. This statistic alone should be cause for alarm, but upon further examination, we learn that the reasons have little to do with our healthcare system and more to do with the way we drive, what we eat, our violent behavior, our tobacco use, and our substance abuse.

The U.S. spends more on healthcare, per capita, than virtually every other industrialized country. But again, if we examine why, we find that this has much more to do with factors other than the actual cost of healthcare, like legal awards and fees, defensive medicine, malpractice insurance, the high cost of advanced technology, and certainly not least; the high cost that we all incur for the government mandates placed on health insurance companies.

We pay more for prescription drugs than any other country. However, the cost of drugs still remains only about 10% of our total cost of healthcare. Upon further examination, we can thank our own government for this. More on this later.

There is no arguing against significant reform of our healthcare system, but the prescription for the cure cannot be written by our current government. The Democrats in control of the U.S. government have only one fix; more government. They know no other way, it is in their DNA. But even putting aside politics, there is no way for a single payer system to work in America. Here is why…

Our Legal System: The American Bar Association would have us believe that litigation accounts for only 1% of total healthcare costs. This may be true for jury awards, but they are leaving out the biggest drivers of legal costs within the healthcare system. Things like legal fees for the defense, defensive medical practices, and malpractice insurance premiums are not factored in to the ABA figure.

Countries that rank above us in healthcare, according to the W.H.O., all limit plaintiff awards and have nowhere near the medical litigation we have in the U.S. In fact, if we were to just copy the medical-legal reforms of France, we could bring down healthcare costs in a significant way. Healthcare reform without true tort reform is only a haphazard attempt.

Immigration Law Enforcement: Virtually none of the illegal immigrants in the U.S. have healthcare insurance, since one needs a valid Social Security number in order to obtain coverage. Knowing that emergency rooms cannot turn away patients, the illegals have turned so many emergency rooms across the country into their primary care providers and pay nothing. These costs must be paid, so they are shifted to paying customers, driving the cost of an emergency room visit up for everyone except of course, for those who do not pay.

Illegal immigrants get sick, they get pregnant, they get into auto accidents and work-related accidents, they are involved in violent crimes, etc. If one multiplies the likelihood of these events by the millions of illegal immigrants, the result is enormously costly to us all.

IAQ in Healthcare Environments

As the economy heads further down the slippery slope of what promises to be a deep recession, and our healthcare infrastructure continues to grow and age, it is a natural progression to see more and more IAQ professionals turn to what some believe is a recession resistant market. From ambulatory facilities to long term care, the buildings that make up our healthcare infrastructure are constantly in need of renovations and repair. This new and promising opportunity for IAQ pros offers many long term rewards but is not without new and complex challenges that must be addressed.

Every IEP realizes the importance of appropriate use of antimicrobials, containment barriers and personal protection. Though often times IEPs find the regulations and guidelines they encounter in healthcare facilities to be daunting to say the least. In traditional remediation environments the focus is to ultimately provide an environment free of dangerous pathogens or contaminants. While attention is give to the methodology, often times the end results dwarf the means of acquiring those results. With a host of accepted methods to address indoor air quality in businesses, homes and public spaces the contractor finds themselves able to select from a variety of methods to deal with each issue. In the end it is the air clearance that counts, not so much which method was used to obtain it.

While the end results are just as, if not more important in healthcare environments; far more attention must be paid to the processes used. As many occupants of a healthcare facility cannot be moved and are highly susceptible to infection, there are very specific guidelines in place that govern all maintenance, repair and renovation work in a healthcare facility. Organizations like CDC, APIC and JCAHO have placed standards that apply to all activities that may have an impact on a healthcare environment. This is done with good reason considering the number HAIs (Hospital Acquired Infections) reported annually due to airborne pathogens like Aspergillus, which is disturbed during common daily maintenance. Nosocomial infections caused from routine maintenance reach into the hundreds of thousands each year. These guidelines and regulations are enforced in a facility by ICPs or infection control professionals.

Hospitals continually adapt to new, more stringent CMS guidelines limiting what medical treatments are reimbursable through Medicare or Medicaid, this has caused hospital administration to look more closely at every aspect of infection control in their facility. Beginning in October of 2008, Medicare and Medicaid began limiting payments made to facilities for the treatment of preventable nosocomial infections or conditions. These new CMS guidelines are driven by Section 5001(c) of the Deficit Reduction Act, which could mean that as deficits climb the list of non-reimbursable conditions are likely to grow. Infections like Aspergillosis, which is caused by airborne A.Fumigatus, are common in healthcare facilities. Aspergillus is one airborne pathogen that is commonly disturbed and distributed throughout a facility after maintenance work or renovations. The argument could be made that Aspergillosis is a preventable condition by ensuring appropriate containment and disinfection of disturbed areas.

Infection control professionals in healthcare environments have become increasingly diligent in monitoring the actions of contractors that work in their facilities. It is ICP’s responsibility to ensure all components of the infection control risk assessment are adhered to. While these key people can complicate the lives of the contractors working in healthcare facilities they are also actively saving lives by doing so. ICP’s will monitor and log details about each project to ensure that all compliance issues are being addressed. Two primary issues that impact infection control and prevention in healthcare settings are disinfection of contaminated surfaces with broad spectrum EPA registered disinfectants and appropriate containment of airborne particulate and pathogens.

Choosing the best disinfectant is one way to ensure the best possible level of microbial control during any abatement project in a facility. Healthcare facilities present the IEP with a unique set of challenges in regards to pathogens beyond the standard fungal and bacterial flora. Many of these pathogens can be highly infectious as well as drug resistant making them far more dangerous to the many immunocompromised patients housed in a healthcare facility. When selecting a hospital grade disinfecting it is imperative to keep several things in mind.

Does your disinfectant have sufficient kill claims to address the microbes you might encounter?
While no disinfectant can list every possible organism, it is important to find a disinfectant with the most possible EPA registered kill claims. Look for efficacy data. Disinfectants that do not show efficacy & testing data often have few or irrelevant kill claims and are not sufficient for the challenges found in healthcare facilities. It is also a positive if your disinfectant has EPA approved efficacy in the presence of 98% soil load as opposed to 5% which is required by the EPA. This higher soil load represents real world conditions. Beyond fungicidal kill claims, other claims that you might require involve infectious pathogens like MRSA, E-coli, HIV, Salmonella and Avian Influenza. You may also want to look for a product that can be used on both porous and non-porous surfaces and has disinfectant and sanitizing claims.

Understand what the active ingredients are in your disinfectant
It is essential to know what type of disinfectant is appropriate. Most common disinfectants are formulated using Alcohol, Phenol, Chlorine or a Quaternary Amine Base. There are arguments for each type of disinfectant and it is important to know the facts about the products you are working with. Each has advantages, but some have dramatic disadvantages that might make you think twice about using them.