Thursday, June 28, 2007

Tourists gain better insurance protection - from 2009

Millions of holidaymakers will enjoy greater protection when they buy insurance from travel agents and tour operators after the government yesterday announced a tougher regulation regime.

Ed Balls, the economic secretary to the Treasury, said some of the 20 million people who buy travel insurance each year were putting themselves and their families at risk by taking out cover that may not meet their needs.

Consumer groups welcomed as long overdue the news that the Financial Services Authority would police travel insurance sold with a holiday. Travel firms will have to meet statutory requirements on treating customers fairly, and customers will have access to the Financial Ombudsman Service if things go wrong.
But the move will not benefit the millions preparing to pack their bags for this summer's break or next year's holidaymakers; it will take effect from January 2009 after a further period of consultation.

The announcement follows research by Which? and others that has indicated that not only are travel agents' policies generally more expensive, but these firms often do not follow basic procedures when selling insurance. The FSA already regulates travel cover sold directly to people by insurers and brokers.

In November the Treasury expressed concern that half of all policies fail to provide guaranteed cover for medical expenses after a terrorist attack.

Yesterday Mr Balls said there was evidence that firms regulated by the FSA had more success in getting consumers to make an informed choice because they were better at guiding people through the sales process and explaining the key features and policy exclusions.

"Consumers in the future buying travel insurance sold alongside their holiday will get the same core regulatory protection and rights as consumers buying stand-alone travel insurance do now."

The announcement is a belated u-turn after the government in 2003 rejected demands for regulation, prompting much anger among consumer bodies. Which? said: "This finally offers consumers the protection they deserve."

Which? carried out research last year that found that two-thirds of travel agents failed to ask about people's medical histories and most did not explain what their policies covered.

Travel firms that decide not to seek FSA authorisation will be able to sell insurance on behalf of a regulated company.

The Office of Fair Trading yesterday announced it was embarking on a six-month "programme of work" with the credit card industry and consumer bodies to make the cost of credit cards easier for people to understand.

The OFT will look at how pricing information can be improved. This follows a super-complaint from Which? that highlighted how consumers were choosing cards without understanding all the issues that affect the cost.
by:Rupert Jones

OC jury awards $11 million to man in medical malpractice case

SANTA ANA – A 45-year-old man who suffered a stroke because doctors failed to treat an infection that spread to his brain was awarded $11.7 million in damages by a jury.

The jury on Friday awarded the judgment to Joey Crumes, who at the time he was treated in 2004 was working as a health technician at the San Onofre nuclear power plant.
Five days after Crumes went to a Mission Viejo hospital emergency room with a severe headache, he suffered a massive stroke that paralyzed him on the left side of his body, confining him to a wheelchair and bed.

The lawsuit was filed against radiologist Charles Aucreman and emergency room physician Andrew Lawson.

The jury found that both were negligent but that Lawson bore the responsibility for Crumes' injuries, said his attorney, Daniel Spradlin.

When Crumes went to the emergency room at Mission Hospital, he told doctors that in 1993 he was operated on for cancer in the right sinus area. During that operation, doctors removed a tumor, as well as his right eye and a portion of his sinus cavity.

Spradlin said Lawson ordered a CT scan, but Crumes ultimately was sent home with a painkiller and orders to seek further treatment if his condition worsened.

Five days later, Crumes lapsed into a coma, and doctors discovered an infection that had spread to his brain.

In the suit against the two doctors, Spradlin argued that had Crumes been treated properly when he went to the emergency room, he would not have suffered the stroke and become debilitated.

“A treating physician (of the coma) said Joey was sent home with a time bomb in his head,” Spradlin said.

Crumes spent 11 months in the hospital after the stroke.

Surprising number in medical malpractice claims

As a personal injury lawyer at a law firm which handles plaintiff's side, medical malpractice cases, I find the following reported numbers startling:

1. The majority of medical malpractice claims close without payment to the injured person.
2. Only 2% of medical malpractice victims make a claim.
3. 80% of the time the doctor or the hospital wins in cases that go to jury verdict

How to reconcile these statistics:
First, most Americans are not litigious and find the idea of making a claim against a doctor or hospital is distasteful. So, even though over 80,000 Americans are killed by medical negligence each year and many more are hurt, 98% of them never make a claim. They want to trust that their doctors are looking out for them and are forgiving errors because after all, doctors are human. so, it means that the vast majority of people who are killed or severely injured by medical malpractice never even contact an attorney.

The same study that showed that most claims never result in any compensation to the victim also showed that clients did not file medical malpractice claims immediately after injuries. Typically, according to the report, medical malpractice claims are not filed with insurance companies until about 15 to 18 months after the injury. Even though the statute of limitations for medical malpractice is two years in Virginia (VA), the injured patients are giving the doctors and hospitals time to correct their errors and waiting to see if the harm is permanent and catastrophic, before even bringing it to the attention of an attorney.

The batting average for Plaintiff's lawyers against the insurance defense lawyers in medical malpractice is hardest for me to understand. Part must be that some of the meritorious cases are resolved during the litigation process prior to jury verdict by way of settlement. Perhaps, the quality of the Plaintiff's bar handling these cases is not as good as it should be, given the complexity and specialized knowledge involved in trying medical malpractice cases. The ability of the doctor defendant to get his colleagues to circle the wagons and support him must account for some of the bad trial results for the injured patients. Even an experienced personal injury lawyer with a background in medical malpractice would typically only be able to find and afford one or two good quality experts to testify against the doctor on the standard of care, showing that the doctor committed negligent error. For every one good expert we have, the Defense is typically able to find 3 or 4 extremely well credentialed colleagues who will come to aid the doctor standing trial for his negligence. However, some doctor groups go a step further and deliberately try to put pressure on the few doctors who are independent enough to be willing to help Plaintiff's lawyers in these cases. Some medical organizations have threatened to revoke the membership of the physicians who dare to speak out about violations of standard of care. This conduct I think is extremely unethical. Plaintiff's medical malpractice lawyers and the doctors who are brave enough to come forward and tell the truth in court about other doctors errors really are heroes. They are the ones who are forcing the medical profession to take a hard look at itself and get rid of bad apples. Not only are we helping to get compensation for deserving people with terrible injuries, we are also holding up a mirror to the health care system to show where things are not being done as they should be.

Lawyers battle over state malpractice proposal

A hot issue among California lawyers -- whether tens of thousands of them should be required to tell prospective clients that they carry no malpractice insurance -- isn't just a legal abstraction to San Francisco attorney Paul Frassetto or the destitute businessman who recently approached him.

As Frassetto described it, the man had spent years refurbishing a low-rent San Francisco hotel to qualify it for a city-funded temporary housing program, and ran out of money as he finished the repairs. When he tried to file for bankruptcy, a local attorney mishandled the filing, the lender foreclosed on the building and the client lost his life's savings, more than $1 million in equity, Frassetto said.

It was only then that the client, whom Frassetto declined to identify, learned that his lawyer had no malpractice insurance or other assets that would cover his losses, he said.

Frassetto, who has spent the last 20 years suing fellow lawyers, said he has agreed to handle the man's malpractice case. But that's unusual, he said -- for the most part, he and his colleagues won't sign onto lawsuits against uninsured lawyers because their fees depend on winning an award for damages, and there's little prospect of collecting damages from an attorney without coverage. The clients, he said, are generally out of luck.

Such horror stories would be less common, Frassetto said, if the State Bar adopted a proposal before it to require lawyers who have no malpractice insurance to notify prospective clients of that fact, as well as the bar. The bar would post that information on its Web site.

"It's unfair to a client for a lawyer to represent them without having insurance," Frassetto said. Requiring lawyers to disclose that they don't have coverage "at least would let the client make an informed decision."

But opponents say such a rule would actually hurt more consumers than it helps.

Los Angeles attorney Diane Karpman, who writes a legal ethics column for the State Bar Journal, said the proposal would hit hardest at the lawyers least likely to be insured, those who represent lower-income clients and middle-income clients in small or one-person firms. Some would lose business; others would buy coverage to avoid public stigma, adding $4,000 to $7,000 a year to their operating costs, she said.

"Who's going to end up paying this? The poor and the middle class," Karpman said.

Her views are widely shared among lawyers. Nearly 80 percent of the more than 100 attorneys who have commented on the proposal to the bar oppose it. A resolution denouncing the plan was approved overwhelmingly by delegates of local bar associations at last year's State Bar convention.

"It sets up a two-tiered bar, those with insurance and those without," said Los Angeles attorney J. Anthony Vittal, co-author of the resolution with Karpman.

Another critic, attorney John Dutton of Auburn (Placer County), is a member of the State Bar Board of Governors, which is scheduled to take up the issue this fall. He said the proposal would unfairly brand uninsured lawyers with a "scarlet letter."

Malpractice insurance protects clients who lose money because of a lawyer's negligence -- missing a filing deadline, for example, or providing incompetent representation that affects the outcome of a case.

A lawyer's insurance status is "a highly relevant piece of information that a new client deserves to know," said San Jose attorney James Towery, a former State Bar president and head of a task force that drafted the proposal.

The proposed California requirement would be the most stringent of its kind in the nation.

Only one state, Oregon, requires lawyers to carry malpractice insurance. Twenty other states have insurance disclosure rules, but none requires that lawyers notify both the bar and their clients, officials say.

Most of California's 142,000 private lawyers are insured through their firms, but State Bar officials say about 1 in 5 is uninsured. Nearly all of those are in one-person or small firms, said bar official Starr Babcock.

The proposal before the bar's governing board would require that uninsured lawyers notify new clients and the bar, which could suspend lawyers who failed to comply.

The bar's Web site now lists lawyers' educational backgrounds and fields of specialty, and states whether they have been disciplined for misconduct. No public agency keeps records showing whether a lawyer has been successfully sued for malpractice.

Towery, who was appointed by the State Bar's then-President John Van de Kamp in 2005 to lead the organization's task force on malpractice insurance, acknowledged that mandatory disclosure would chiefly affect lawyers who practice by themselves or in small firms. But he said those lawyers' clients are among the ones most in need of protection against legal blunders.

Towery, a partner in a corporate firm, said small-firm lawyers typically handle cases involving issues such as consumer law, personal injuries, immigration, bankruptcy and family law. "When those lawyers make mistakes and don't have insurance, it really creates the potential to cause harm," he said.

But co-author Vittal, who handles business litigation as the sole lawyer in his Los Angeles firm, said compulsory disclosure would cause more harm than good. Prospective clients who learn that a lawyer is uninsured will probably be misled into thinking the lawyer is incompetent and go elsewhere, he said. Clients who get no such notice may be reassured, but they won't know whether their lawyers' insurance is enough to cover their cases.

The result, he said, will be that some lawyers serving needy clients will lose their practices, others will face discipline for conduct that "has nothing to do with ethics," and the bar will have done nothing to make insurance more available or affordable.

Babcock, who oversees the bar's low-cost insurance program for new lawyers, agreed that the organization "ought to have some kind of carrier of last resort." But he said such a program might require legislative action.

He said the disclosure proposal, now in its final round of public comment, would go before the Board of Governors for a vote in November and, if approved, would be submitted to the state Supreme Court for final review. Implementation is probably at least a year away, Babcock said.

Online resources

Information about the State Bar's proposal to require lawyers to reveal that they don't carry malpractice insurance can be found at:
by:bob egelko, chronicle staff writer

Vitamins a good insurance policy

It's estimated that half of all American adults take a daily vitamin supplement. Yet, in spite of the popularity of the pills, many wonder whether they're good for our health.

CNN learned more about vitamins from Dr. George Blackburn, director of the Center for Study of Nutrition and Medicine at Beth Israel Deaconess Medical Center in Boston, Massachusetts.

CNN: What do you say when asked by patients whether they should take vitamins?

Blackburn: I say take a simple, once daily vitamin or mineral that costs about 7 or 8 cents as insurance, not to help their health or treat a disease but to ensure that they don't have a vitamin/mineral deficiency. (Health Minute: Watch to learn more about the benefits of vitamins and supplements Video )

CNN: Is that general advice for a healthy person?

Blackburn: I think it's important to realize that most people taking vitamins and minerals are healthy. Very few Americans are sick other than for a short time and therefore they should be concentrating on a healthy diet: fruits, vegetables and whole grains. Unfortunately, only 25 percent of Americans do that, so it's for them that we want the once daily vitamin/mineral.

CNN: What about taking calcium and folic acid supplements?

Blackburn: We've built some of it into the food supply. Now the flour we get has folic acid in it that takes care of most of the folic acid problem. We're now facing a shortage of calcium and vitamin D. We prefer three servings [daily] of low-fat dairy, yogurt, and cheese. We're learning that we may need more vitamin D. If we see a person isn't getting a good supply of dairy and dark green vegetables we definitely are urging that they take a calcium supplement and a vitamin D supplement.

CNN: Are we at risk of getting too many vitamins because of fortified foods?

Blackburn: I don't think the fortification, the intake of vitamin and mineral fortification of food, has been other than good so far. It's not likely that a person is going to overdose in a food fortification. You would have to be taking a high dose, single supplement to worry about overdose.

CNN: Are natural vitamins better than synthetic?

Blackburn: They are the same. It doesn't matter when they are absorbed into the body whether they were synthetic or natural sources; most supplements are synthetic.

CNN: Is there any scientific proof that vitamin supplements are a magic bullet?

Blackburn: Any claim to preventing disease or extending life with vitamin/mineral supplements is unproved.

CNN: So what's your advice to patients who can't decide whether to take a vitamin supplement?

Blackburn: Concentrate on eating a healthy diet with dark green vegetables, whole grains and fruits. Start your day with a healthy breakfast and watch your portion control. If you're physically fit and eating a healthy diet you'll get things that are not in any supplement. The good news for people looking at supplements, if they just stay with one multivitamin a day they'll be safe.

by:Judy Fortin is a correspondent with CNN Medical News. Accent Health reporter Linda Ciampa contributed to this report.

Health plan protects China's poor

Chinese hospital administrator Yang Xizhong is more than willing to talk about a new medical insurance scheme for farmers that has been extended to his county.

Waving his arms around enthusiastically, he explains how 90% of people in Chiping County, in Shandong province, now benefit from the government-backed scheme.

"Using this system, ordinary people really benefit," he says of the plan, in which the state pays part of the cost of the treatment.

"It solves the problem of going to see a doctor," he adds.

On a tour of the new wing of the Chiping County People's Hospital, Mr Yang introduces several bed-ridden patients who also give the new system their approval.

Farmers like these, Mr Yang says, would not have been able to afford hospital treatment before the introduction of the New Rural Co-operative Medical Scheme.

Success story

Even when you go outside the hospital - and away from Mr Yang's influence - people tell a similar story.

Twenty minutes drive away, in the village of Donglu, home to around 500 people, 75-year-old Huang Beiyou is recovering from treatment for an inflamed prostate.

A few months ago Mr Huang, who tends a herd of goats, spent more than 20 days in Mr Yang's hospital at a cost of around 10,000 yuan ($1,300). The government paid half.

"Before, when we became ill, we had to pay for it ourselves. Sometimes we couldn't afford the treatment so we didn't have it," he says.

Chiping County People's Hospital
Local communes used to pay for medical treatments

"But now the government reimburses part of the cost, so we can afford it more easily. This system is a lot better. The government is really looking after us."

The scheme that is receiving so much praise was first introduced in 2003 to a select few counties in China, but is now being rolled out to rural areas across the country.

In a keynote speech given in March this year at the National People's Congress, China's parliament, Premier Wen Jiabao said he wanted 80% of rural people covered by the end of December.

With the central government spending close to 10bn yuan ($1.3bn) on rural healthcare this year, the Chinese health ministry was able to announce that it had met that target just one month later.

The scheme itself is relatively simple.

Each farmer pays as little as 10 yuan ($1.3) a year to join the insurance plan. The government then adds a similar amount.

Each county can have slightly different rules, but in Chiping the local government will repay 30% of medical fees for treatment costing up to 2,000 yuan ($263), according to Mr Yang.

If the cost is between 2,000 and 5,000 yuan, the government pays 45%. Above that, it guarantees to pay half the cost.

New system

A new insurance scheme for the countryside became necessary after China introduced radical economic reforms in the 1980s.

Under the old system, farmers' medical costs were paid by local communes, but when these were disbanded, rural people were left to fend for themselves.

That left many people in the countryside unable to buy even basic medical treatment without seriously affecting their household finances.

Chinese medical insurance papers
The scheme has extended medical treatment to the poor

According to a popular countryside saying, a trip in an ambulance means a pig has to be sold at market, once a hospital bed has been slept in a year's farm earnings go down the drain and a serious illness requires 10 years of savings.

While experts both inside and outside China praise the new scheme for extending medical coverage to China's poorest people, there have also been some criticisms of the plan, not least over whether local governments have enough money to pay their share of the costs.

James Murray, of the humanitarian organisation Plan International, which runs medical programmes in Shanxi province, says rural areas have always received less health spending than China's towns and cities.

Rural areas have traditionally been allocated just 20% of total health spending, despite the fact that 70% of China's population live in the countryside, he says.

And he adds that if rural people are to enjoy all-round good health, there needs to be more emphasis on basic health education instead of just promising to reimburse farmers when they become ill.

"It's not only infrastructure, it's not only machines that are needed to achieve better health. The population needs to be aware of what causes diseases and how to prevent them," Mr Murray says.

He might be right, but that is not going to dampen the enthusiasm of health workers like Mr Yang about what has already been achieved.

ABI: Popularity of personal private medical insurance grows

For the first time in recent years, the number of subscribers to personal Private Medical Insurance (PMI) policies has grown year-on-year. Latest figures from the ABI show that in 2006, 1,030,000 people subscribed to personal PMI policies, an increase of 1.8% from 1,012,000 in 2005. Personal and corporate PMI plans now cover 5.9 million UK adults and children.

Commenting on the data, Nick Starling, the ABI’s Director of General Insurance and Health, said:

“Private Medical Insurance offers people greater choice of treatment and other services for a wide range of medical conditions and injuries. It also takes pressure off the NHS, so by buying PMI, people are effectively reducing the burden on Britain’s hard-pressed health service.

“It is encouraging that more individuals are choosing to buy PMI for themselves and their families. PMI bought by companies on behalf of their employees has continued to increase in popularity too, helping to ensure that people can get back to work sooner after illness or injury.”

- ENDS -

Notes for Editors

1. The ABI has revised its data for corporate PMI in order to separate out all healthcare trust business. Previously, some companies had included healthcare trust business (schemes administered, but not underwritten, by insurers) in their PMI returns to the ABI. From now on we will publish data separately for 1) the total number of people covered by personal and corporate PMI schemes and 2) those covered specifically by corporate trust schemes.

2. In 2006, there were a total of 3,375,000 subscribers to PMI policies, up by 3.3% from 3,266,000 in 2005. This comprised 1,030,000 personal and 2,345,000 corporate subscribers, up from 1,012,000 personal (up 1.8%) and 2,254,000 corporate (up 4.1%) respectively in 2005.

3. Gross earned premiums in 2006 totalled £3.071bn, up by 4.4% from £2.942bn in 2005. Individual premiums rose by 4.2% from £1.449bn in 2005 to £1.509bn in 2006, while corporate premiums rose by 4.6% from £1.493bn in 2005 to £1.561bn in 2006.

4. A table giving full details of PMI sales, subscribers and people covered is available on the ABI web site,

5. The ABI is the trade association for Britain’s insurance industry. Its nearly 400 member companies provide over 91% of the insurance business in the UK. It represents insurance companies to the Government, and to the regulatory and other agencies, and is an influential voice on public policy and financial services issues. ABI member companies hold up to a sixth of all investments traded on the London Stock Exchange, on behalf of millions of pensioners and savers.

State budget has more for education, medical insurance for poor

HARTFORD -- The General Assembly is expected tonight and over the weekend to approve overwhelmingly a new biennial budget that orders huge spending increases for education and health care while avoiding major tax hikes.

The plan also includes modest increases both for nursing homes and for private, nonprofit social service agencies, two components that received little new money under earlier proposals.
The budget won't include any income tax changes. Both the $500 tax break for middle-income families and the tax rate hike for households earning above $272,000 -- both Democratic proposals -- have been scrapped.

"When folks take a look back at this," Senate President Pro Tem Donald E. Williams Jr., D-Brooklyn, said late Thursday, "this will truly be viewed as the historic budget year it was."

House Minority Leader Lawrence F. Cafero, R-Norwalk, who led the push this spring to reject major tax hikes proposed by both Democrats and Republican Gov. M. Jodi Rell, predicted "overwhelming" Republican support for the final package.

"It's a compromise document," Cafero said, adding that while Republican lawmakers are wary of the spending growth, they are pleased to see major investments in health care and education.

The House of Representatives was scheduled to convene at 6 p.m. and begin the budget approval process by adopting the main appropriations and revenue bill.

Besides that measure, lawmakers also need to approve three technical policy bills to implement new and revised programs within the budget, as well as three or four bonding bills that will outline state government's capital program for the next two fiscal years.

House and Senate leaders say they hope to have all measures approved by both chambers by the end of Saturday.

Full details on the budget's bottom line were not available early today. Legislative leaders said general fund spending -- which covers the bulk, but not all, of government operations -- should grow by just under 9 percent in the coming fiscal year.

State government is operating this year with a $16.1 billion total budget, with a general fund of more than $14.8 billion.

Rell, who initially called for $660 million in new taxes and then reversed herself in May after state revenue forecasts improved, will score her biggest victory in terms of education.

The governor, who asked for more than $600 million in additional Education Cost Sharing grants to towns over the coming two years, will see a healthy share of that request in the final budget.

ECS grants will top this year's $1.6 billion level by $181 million in 2007-08, and will reach $261 million over current spending by 2008-09. That $442 million in additional ECS outlays is the largest increase in any budget since state government launched a major education grant system in response to the 1979 Connecticut Supreme Court's decision in the Horton vs. Meskill lawsuit.

Democrats, who control two-thirds of both the House and Senate, campaigned largely on a plan to bolster the state's faltering health care safety net.

And the budget reflects that priority, pouring more than $215 million total over the next two years into boosting state reimbursements to doctors, dentists, hospitals, community health clinics, and other care providers who treat poor patients on state assistance.

The budget also:

-- Expands the Husky health insurance program's eligibility rules for pregnant women.

-- Allocates $39 million to give nursing homes a 2.9 percent funding increase next fiscal year. Both Rell and the Democrat-controlled Appropriations Committee hadn't recommended any hike in their plans.

-- Provides for a 3 percent increase for private, nonprofit groups, with whom the state contracts to provide the bulk of social services in Connecticut. It was unclear late Thursday whether that increase would begin with the start of the fiscal year on July 1, or on Oct. 1 -- a date when several past nonprofit rate hikes had taken effect.

Rep. Denise W. Merrill, D-Mansfield, said she and many other Democrats are disappointed that Rell wouldn't allow an income-tax hike on wealthier households so that middle-income families could receive a tax break. But she added that the health care and education increases will make a huge difference.

"We are talking about large increases in very important programs," Merrill said, adding many of the health care rates had been neglected for a decade.

Rep. Henry Genga, D-East Hartford, said "I'm disappointed that the property tax relief we wanted isn't there," referring to a Democratic proposal to boost the property tax credit within the income tax system from $500 to $1,000. "I think the Republicans did what they wanted to do: protect the rich," he added.
by:Keith Phaneuf, Journal Inquirer

Private Medical Insurance gaining popularity

Despite Tony Blair’s claims this week at King’s Fund event to launch four reports into the health service, that there have been “real and transformative reductions” in NHS waiting lists since 1997, more people are turning to the private sector, according to research by the Association of British Insurers (ABI).

ABI figures show, that for the first time in many years, the number of subscribers to Private Medical Insurance has grown year on year.

In 2006, 1,030,000 people has private medical insurance polices, and increase of 1.8% from 2005’s figure of 1,012,000.

“Private Medical Insurance offers people greater choice of treatment and other services for a wide range of medical conditions and injuries,” said Nick Starling, Director of General Insurance and Health at ABI.

“It also takes pressure off the NHS, so by buying PMI, people are effectively reducing the burden on Britain’s hard-pressed health service.

“It is encouraging that more individuals are choosing to buy Private Medical Insurance for themselves and their families.

Private Medical Insurance bought by companies on behalf of their employees has continued to increase in popularity too, helping to ensure that people can get back to work sooner after illness or injury.”

Popularity of medical insurance increases

More people from the UK are opting for private medical insurance, a new study has found.

According to the Association of British Insurers (ABI), 2006 was the first year in recent times when the number of people opting for private medical insurance (PMI) increased.

ABI figures show that 1,030,000 people subscribed to PMI policies during 2006 - compared to 1,012,000 the year before.

This represents a 1.8 per cent increase and now personal and corporate PMI plans cover around 5.9 million UK adults and children.

"Private medical insurance offers people greater choice of treatment and other services for a wide range of medical conditions and injuries," explained Nick Starling, the ABI's director of general insurance and health.

"It also takes pressure off the NHS, so by buying PMI, people are effectively reducing the burden on Britain's hard-pressed health service.

"It is encouraging that more individuals are choosing to buy PMI for themselves and their families."

Mr Starling also pointed out that more companies seemed to be buying medical insurance for their workers.

Recently, another spokesperson for the ABI said that people who were obese were likely to find their medical and life insurance premiums increase.

"Lifestyle factors could have a bearing on the premium that you pay - and it's likely that different insurers will use different measures to determine lifestyle factors," Jonathan French, press officer for the ABI, explained.

Good counsel: Medical care on vacation

Even under the best of circumstances, illness and troubles can find you on vacation.

Fortunately, many vacation and resort areas have doctors or other health care providers available for consultation. They may work in an urgent care facility or clinic, or be on call to come to your location.

These services are generally charged at a premium. Many will not accept out-of-town insurances, so payment at the time of service will be expected. Reimbursement may be possible once back home, but plans vary widely. (See "Check your insurance," below.)

If the need for antibiotics or another medication arises while you're traveling, you'll probably need to have a local evaluation. There are very few circumstances when phone consultation alone can safely result in ordering antibiotics. An on-site evaluation and decision is almost always better for care and safety of the patient.

Primary care office staff may, however, have helpful suggestions for how to manage a problem while away from home and can be consulted before seeking out care on the road. The staff also may be able to help with over-the-counter solutions.

A little forethought can go a long way in easing the pain of unexpected illness or injury on your trip.

Check your insurance: Before you leave, it's important to learn what your insurance policy says about coverage out of the home area. Emergencies are almost always covered, but other situations requiring medical care may not be. Find out whether you need to notify the company of medical expenses within a certain period of time and how to do that correctly.

Fill your prescriptions: Most places will have a pharmacy for basic needs. Should you or your child take medication for a chronic condition, however, have plenty on hand for the trip. In fact, plan ahead so you'll have enough to last you after getting home, to lessen the urgency of getting your prescription filled.

When flying, pack chronic medications in your carry-on bag to lessen the risk of loss or any delay in getting them. Your primary care provider at home may be able to phone in refills and out-of-town pharmacists often will accept them, but this is less than ideal.

Pack a first-aid kit: You can cover most anticipated needs by packing pain and fever reducers, an antihistamine (such as Benadryl or Loratidine) and first-aid supplies. This is especially important if your journey will take you off the beaten track.

by:Dr. Catherine A. Goodfellow is a pediatrician with Genesis Pediatrics in Gates.

7 Tips for Selecting Long-Term Care Insurance

by Newswise — As the massive Baby Boomer generation braces for retirement, many are turning to long-term care insurance to prepare for potential age-related care.

Long-term care insurance helps cover the costs of assisted-living facilities, nursing homes and at-home care. To receive coverage for a specific period of time, policyholders pay a premium based on age, health and the type of plan. According to trade group America’s Health Insurance Plans, a typical long-term care policy bought in 2002 with inflation protection added would cost a 50-year-old $1,134, while a 65-year-old would pay $2,346 and a 79-year-old would fork out $7,572.

In addition to covering the cost of their own health care, many of the nation’s approximately 78 million Baby Boomers are also pitching in to help pay for the medical needs of an elder parent.

"More than a quarter of those responding to the NAELA Elder Issues National Survey made long-term care arrangements for themselves or a family member," said G. Mark Shalloway, CELA, president elect of NAELA. Of that group, the majority chose nursing homes – which typically cost more than $75,000 a year – over assisted living or home-based care. The NAELA national survey of elder issues polled 1,001 Americans aged 35 and older about aging issues such as concerns about growing older, long term care, elder debt, healthcare insurance costs, Medicare Part D, living wills, retirement, and elder abuse.

About 8 million Americans now own long-term care insurance protection, a number that has risen in recent years. Elder law attorneys nationwide, however, have seen a subsequent escalation in the number of grievances and lawsuits filed against the insurers. The majority of those complaints allegedly stem from unnecessary delays and unfair regulations related to the claims process.

To avoid the complications and possible surprises, NAELA offers several tips on choosing long-term care insurance:

1. SELECT THE RIGHT KIND OF COVERAGE. Home Health Care Coverage, for example, means you receive insurance benefits covering in-home care services provided by a licensed or registered practice nurse or therapist. Respite Care guarantees a facility will offer some help – about one to two weeks each year – to those caring for a homebound person. Adult Day Care can also help, ensuring assistance is provided during the day for recreational, therapeutic and personal care.

2. REQUIRE ADMITTANCE TO ALL LEVELS OF CARE. You should be able to use any skilled, intermediate or custodial care facility without having to start at the highest level of care. Skilled care, for example, is the highest level an individual can receive outside of hospital confinement and requires constant medical attention from licensed medical professionals under a physician’s supervision. Intermediate care, which is handled by a licensed practical nurse, involves occasional nursing and rehabilitative care.

3. AVOID POLICIES WITH A PRIOR-HOSPITALIZATION REQUIREMENT. "Make sure your policy does not require hospitalization before benefits are paid," said Shalloway. Typically, certain conditions must first be met – usually by measuring a person’s ability to do one or more "activities of daily living" such as bathing, eating or dressing – before benefits are activated for nursing home care or assisted living. Preferred policies will require the insured to be unable to do two of the "activities of daily living" rather than rely on a "medically necessary" standard.

4. SELECT HIGHLY-RATED POLICIES. Financial strength is important, helping determine the insurer’s long-term survival and whether they can pay future claims. "Look for a company that has an "A+" rating from A.M. Best Co. and a triple "A" rating from at least one other service,’ says Shalloway. Policies from the same insurer vary from state to state, so verify the information is appropriate for your particular region.

5. SECURE FRONT END UNDERWRITING TO HELP IMPROVE YOUR INSURANCE PLAN. Front end underwriting requires an attending physician’s statement at the time of application and can help protect against claim denial due to underwriter mistakes. Expect the procedure to take up to a month and a half.

6. KNOW THE DIFFERENCE BETWEEN "GUARANTEED RENEWABLE" AND "NON-CANCELABLE." Non-cancelable means the policy stays in force as long as the premium is paid and the insurance company is unable to raise the premium. Guaranteed renewable means the insurance company can’t drop the policy unless you skip payment, but premiums can be raised for all policyholders within a particular group.

7. OBTAIN INFLATION ADJUSTMENT. Since medical costs increase with inflation, you should consider obtaining an inflation adjustment factor. The three most common types of inflation protection are indexed, simple percentage and compounded percentage. Indexed is initially the cheapest, but might not protect you down the road. Simple Inflation Protection sets a fixed annual percentage increase. Compounded Protection is best, but typically the most expensive.

These are just some options to consider when evaluating long-term care insurance plans. Long-term care insurance is more complicated than life insurance or health insurance, so it’s best to consult with a financial planner, Elder law attorney or insurance professional prior to any decision-making.

``No Worry'' from Humana Makes Health Care Costs Predictable for Small Businesses in Michigan

New, three-year health insurance packages cap annual premium increases at 6-percent or lower
Addressing the particular challenges faced by small businesses, Humana Inc. (NYSE: HUM) is introducing a series of new health insurance packages designed to alleviate the financial stresses of increasing health insurance costs. Dubbed No Worry, these packages offer predictable health care expenses over a three-year period and plans that gradually transition passive health care users into informed and active health care consumers.

Available for businesses in Michigan with 51-99 employees, employers may select one of 35 three-year No Worry packages. Each package presents a unique combination of predetermined health insurance plans for years one, two and three that provide actionable information and tools leading employees toward increased consumer engagement. For example, a No Worry package might include a traditional PPO plan in year one, Humana’s consumer-engaging CoverageFirst plan in year two, and a high-deductible health plan compatible with a Health Savings Account (HSA) in year three.

With No Worry, Humana guarantees the annual premium rate increase for medical insurance will not exceed 6 percent, well below industry cost trends, for the two subsequent years. Employers can qualify for an even lower 4.5 percent medical premium rate cap in the second and third years by adding dental coverage and meeting other requirements like having 90-percent of their employees complete a Humana Health Assessment.

No Worry was developed in response to feedback from small businesses and independent insurance agents and brokers.

“We asked small business owners what their key concerns were with respect to health benefits for their employees, and the same concepts resurfaced again and again,” said Denise Christy, president of Humana’s Michigan market. “They want predictability, a long-term solution to rising costs and a hassle-free process. We listened, and the result is No Worry.”

“Three-year contracts eliminate the need for benefit selection each year, saving small employers valuable time and energy. The rate increase cap ensures predictable health benefits costs, enabling more accurate budgeting and long-term financial planning for small businesses. We’re confident that Humana’s consumer-driven tools and programs encourage behavior changes that result in wiser health-care consumers and healthier, more productive employees, and our rate guarantee demonstrates that,” added Christy.

In addition, employers can add dental and/or life insurance to their No Worry package, and Humana will guarantee that the annual rate increase for dental will not exceed 2.9 percent in years two and three, and that there will be no annual rate increase for basic life insurance in the second and third years.

“Managing a small business is fraught with difficult decisions. Forgoing health benefits because they’re unaffordable is not an option any business wants to consider,” said John Crusse, director of small business sales for Humana’s Michigan market. “Humana’s No Worry program offers a long-term solution to this dilemma by holding down cost while still offering employees meaningful benefits and choice.”

Humana will quote No Worry beginning July 1, 2007, for Michigan employers whose health plans take effect on September 1, 2007 or beyond.

About Humana

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health benefits companies, with more than 11 million medical members, including more than 170,000 in Michigan. Humana offers a diversified portfolio of health insurance products and related services – through traditional and consumer-choice plans – to employer groups, government-sponsored plans, and individuals.

Over its 45-year history, Humana has consistently seized opportunities to meet changing customer needs. Today, the company is a leader in consumer engagement, providing guidance that leads to lower costs and a better health plan experience throughout its diversified customer portfolio.

More information regarding Humana is available to investors via the Investor Relations page of the company’s web site at, including copies of:

* Annual report to stockholders;
* Securities and Exchange Commission filings;
* Most recent investor conference presentation;
* Quarterly earnings news releases;
* Replays of most recent earnings release conference call;
* Calendar of events (includes upcoming earnings conference call dates, times, and access number, as well as planned interaction with research analysts and institutional investors);
* Corporate Governance Information.

Property taxes reduced in final North Allegheny budget

By David Guo, Pittsburgh Post-Gazette

The North Allegheny school board's best guess concerning next year's budget has turned out to be wrong, not that many taxpayers are expected to mind.

The board unanimously approved a $110.2 million spending plan June 20 that calls for a 0.38-mill reduction in the property tax rate, or $38 on a home assessed at $100,000. The new rate will be 19.34 mills.

The new figures were $1.3 million lower than those in the preliminary package approved in January, a savings that finance director Mike Hopkins primarily attributed to his getting a better handle on payroll costs such as medical insurance, salaries and retirement.

Fifty-six employees wound up retiring this year, a total that was higher than Mr. Hopkins had anticipated in January. Thirty-four were teachers. The district will work over the summer to determine how many positions can be filled based on fall enrollment, retirement costs and the lower salaries paid to new hires.

The other major factors were utility bills and general insurance premiums that should be lower in 2007-08, as well as a less expensive photocopying lease and revised costs for sending students to the A.W. Beattie Career Center in McCandless.

Mr. Hopkins identified four areas of major cost increases totaling about $3.07 million, including salaries, retirement benefits, medical insurance and charter school payments.

He also cautioned the board that certain factors could affect the bottom line that were largely beyond North Allegheny's control -- the ongoing county tax reassessment case and the politically volatile 2008 state budget.

About $700,000 in North Allegheny refunds prompted by property owner appeals of the 2002 base-year assessment have been accounted for, but there's still $900,000 worth unresolved. Based on prior experience, he suggested that the district could expect to win half.

In Harrisburg, meanwhile, the GOP-controlled state Senate has approved a $27 billion budget that is $300,000 less than the version backed by Gov. Rendell and the Democrat-controlled House. The budget battle is far from over, since the House is set to push for restored funding for mass transit and, perhaps, education.

Left unsettled is what the district's state subsidy will be, an amount that should cover 18.3 percent of the district's budget next year -- about half of what the statewide average is, but nonetheless a vital revenue source.

"Funding could be altered dramatically by the Harrisburg showdown that comes in the next few weeks," Mr. Hopkins said.

The largest slice of the North Allegheny budget remains for instructional items including teacher salaries, benefits, supplies and services. More than $44 million goes for salaries, primarily for the district's 580 classroom teachers whose average salary is $69,138.

About $15.1 million goes for instructional-budget benefits, an amount less than had been anticipated because of higher employee contributions for health insurance.

The support services part of the budget includes annual salaries for 37 administrators averaging $96,542, with benefit-cost increases proportionately the same as for teachers.

Board members universally praised Mr. Hopkins and financial analyst Sherri Ludwig for being able to craft such a detailed plan despite an accelerated budgeting process prompted by state Act 1 mandates and property tax reform.

Still, at least three board members were concerned that a larger tax cut might have been possible, given a budget surplus of about 8 percent. The 8-percent cap is often referenced in school tax debates since it is the most a district can hold in reserve if it wants to get state approval for a millage increase.

"I think this body needs to keep an eye on this fund balance," said Alan Shuckrow. "If we have another surplus next year, I think we have to look at ourselves and say we need to be returning some of this surplus to the taxpayers," he said.

Ralph Pagone was disappointed the tax break was so meager, while Scott Cunningham later said that he would have preferred a tax cut tied to a smaller fund balance of about 7 percent, which would still allow the district to cover a year's worth of bond payments.

The three had opposed last year's tax increase.

Medical Bills Costly With And Without Insurance

A new University of Florida study shows three millions Floridians under the age of 65 are living without health insurance.

But whether or not you have insurance, you could still be racking up those medical bills.

On Sunday, Scott Rosenbluth attended a fundraiser for his friend Aaron Nichols. Nichols is currently in a coma after being in a car crash on Memorial Day.

Rosenbluth knows all too well how costly medical bills can be. He is currently in remission from cancer.

"Even with medical insurance, the costs are still a little bit significant,” Rosenbluth said. “There's a deductible. His family with be paying for the rest of their lives."

The weekend benefit for Nichols raised over $5,000.

Rosenbluth says personally, he doesn't have health insurance. It's not a choice. Insurance companies have labeled him as a high risk case.

He isn't eligible for coverage for another six months.

Insurance firms destroying health care

A letter to the editor regarding the health care system in Arizona missed the point of the real problems ("Medical liability is threatening Arizona's health care," Saturday).

There is a rapidly growing consensus that the primary problem with the practice of medicine today is clearly not the feigned "malpractice crisis" but rather the manner in which health insurers dictate and, in fact, intimidate physicians into accepting way too little reimbursement for the competent and beneficial care provided to their patients.

Insurance companies place physicians in completely untenable positions, namely, "Either go along with our pricing for your services or we will exclude you as a member of our physician panel." Studies over the past years have demonstrated that at the same time insurance companies are refusing reasonable reimbursements for physicians and medical groups, the insurance companies are reaping record profits.

Litigation is presently ongoing in other states involving doctors challenging the practices of health insurers in this regard but, to date, I know of no such endeavor within the state of Arizona.

If Arizonans want our physicians to be available for us and our hospitals to remain open and financially solvent, the relationship between insurance companies and physicians needs to be dealt with, either through legislation or by way of judicial action. In that regard, perhaps the legal community could serve the medical community very well.

Wouldn't such an alliance be helpful to all of us? - Steve Ryan, Scottsdale

A $962,120 medical bill error

he patient didn't have to pay, but it's still a useful lesson for others, an economist says.
Helen Dorroh White thought she was doing the right thing when she called a health insurance company to question a nearly $1-million medical bill. Instead, she said, no one seemed to care.

White, a Glendale lawyer, was closing the financial affairs for a deceased client when she came across the insurance statement. It showed a $962,120 bill for her client, Dusanka Mlinarevich, who spent four days at Glendale Adventist Medical Center after suffering minor injuries in a fall at her Burbank home last year.

That struck White as odd, she said, because the hospital had told her the bill was $48,106.

Concerned about the discrepancy, White called the health insurance company, Long Beach-based SCAN Health Plan.

"My first question was, 'Is this some kind of typo or some mistake?' " said White, 73. A customer service representative paid little heed, White said, and insisted that the amount was correct.

"She didn't even bat an eye," White said.

Fearing fraud, White wrote a letter to the U.S. attorney's office and contacted The Times.

After inquiries from a reporter, SCAN's vice president of marketing, Sherry Stanislaw, said the company found a computer glitch that was producing erroneous claim reports for customers.

Actual billings and payments were not affected, Stanislaw said. She confirmed that Glendale Adventist's bill was for $48,106 and said that SCAN paid a negotiated rate of $4,350 and that Mlinarevich, who died in August at age 78, was assessed a $150 co-payment.

Because patients are responsible only for co-payments and deductibles, few consumers ever take a close look at their medical bills, said Devon Herrick, a healthcare economist and senior fellow at the National Center for Policy Analysis.

To help keep rising healthcare costs in check, more consumers should do what White did, Herrick said. "Most insurance companies will agree that they'd want their enrollees to scrutinize their bills."

SCAN said the computer glitch was being investigated. Stanislaw conceded that her customer representative should have heeded White's concerns and contacted a supervisor. The company is sending White a new claim statement, she said.

White wasn't completely pleased.

"It is easy to blame the computer. Well, who programs the computers?" she asked. "The last I checked, computers didn't program themselves."
By Daniel Yi, Times Staff Writer

Clarian Health Making Changes to Insurance Plans

Clarian Health is announcing changes to employee medical insurance plans in order to promote healthier lifestyles. Beginning in 2008, all employees wishing to enroll in Clarian-sponsored plans will have to report all potential health risks, including whether they use tobacco. A health risk charge of $5 per paycheck will be assessed to employees who have used tobacco within six months of their health risk assessment completion date. Beginning in 2009, employees will also have to participate in a complete health screening.
saw the introduction of Clarian Health’s mission strategy: A Call to Change. Through billboards, television and radio commercials, as well as community events and health fairs, Clarian has issued a call to all citizens of Indiana to take control and improve their health. Not only did Clarian issue a call, but the organization and its employees are acting on it.

There is no shortage of news stories or political speeches about the rising costs of health care, how much money and productivity companies lose due to employees who are sick and cannot work, or how unhealthy lifestyle habits such as smoking are affecting Hoosiers and resulting in higher hospital utilization.

Year after year, headlines remind us that Indiana has had the dubious distinction of being one of the most unhealthy states in America. However, there has been no significant improvement in this status and a comprehensive solution is nowhere in sight.

As Indiana’s health care leader, Clarian has been a leader in exploring ways to better manage and reduce the cost of health care. Like other organizations, Clarian is looking for ways to help improve the health status of its employees. Focusing on health prevention and wellness, Clarian is actively working to improve its employees’ health by incenting and empowering them to lead healthier lifestyles.

Beginning in 2009, all Clarian Health employees who elect to participate in the organization’s medical insurance plans must complete a health screening (body mass index, LDL cholesterol, glucose, blood pressure) and Health Risk Appraisal (HRA).

In 2008, the HRA is necessary for enrollment in company-sponsored plans with employees self-reporting their health risk results. One self-reported health risk will be a statement of tobacco use or non-use status.

Also new in 2008 will be a health risk charge of $5 per paycheck for medical plan participants who have used tobacco within six months of their HRA completion date. This is an effort within our health plan changes to provide an incentive for employees to adopt healthier lifestyle habits.

“Any employee currently enrolled in medical coverage or electing coverage during open enrollment will need to complete the HRA to obtain coverage under the medical plan as of January 1, 2008,” said Steve Wantz, senior vice president of Administration and Human Resources. “Clarian has carefully weighed the pros and cons as well as conducted research surrounding this approach, including a timed series of focus groups with Clarian employees,” added Wantz.

“Clarian Human Resources and associates from Clarian’s Wellness staff have structured this program based on measurements and guidelines from the National Institutes of Health and the National Heart, Lung and Blood Institute,” stated Brian O’Connor, director of Benefits for Clarian.

Clarian is notifying employees of the medical plan well in advance to ensure they “know their numbers” and allow employees time to address any personal areas of risk with their doctors before the screening and before the 2009 benefit changes go into effect.

Clarian will offer free screenings for blood pressure and BMI during the summer and fall of 2007 for employees interested in obtaining these health measurements. The organization will offer a variety of resources and support, as well as education about health risks, to employees who “know their numbers,” and who want to make positive change toward improving their health and lessening their health insurance premium costs.

“The information provided in the HRA will not be used to exclude anyone from our medical insurance plans,” said O’Connor. “We hope that employees learn about one or more health risks they may not have been aware of, they will take steps to protect their health and, by addressing those risks, no longer fall into a high-risk category for some or even all of the risks identified by the time the 2009 plan changes take effect.”

Wantz added, “This is really part of our Call to Change mission communications strategy. This time, we are asking employees to make a personal call to change.”

Employees who have a health risk they would like to address or want help quitting tobacco can find help through a variety of resources at Clarian.

A reasonable alternative will be in place for those employees for whom it is unreasonably difficult or medically inadvisable to satisfy the standard for any particular health risk due to a medical condition.

“We are as committed to the health and well-being of our employees as we are to that of our patients,” stated Wantz. “As both a premier health care provider and employer, Clarian is in a unique position to provide the necessary resources and support to our employees seeking to improve their own health and make that personal change.”

Source: Clarian Health

Over USD 6Mn paid to insured retirees in Morocco in 2007

The hospitalization expenses paid off by the national fund of insurance "Caisse Nationale des Organismes de Prévoyance Sociale" (French acronym CNOPS) to insured retirees and their claimants, reached some USD 6Mn for the year 2007, revealed, here Wednesday, Moroccan Employment Minister, Mustapha Mansouri.

Speaking at the House of Representatives' (lower house) question time, the minister noted that the Mandatory Health Insurance (AMO) enabled some 74,929 new insured to benefit from health coverage.

The minister said services concern preventive and medical care.

The AMO guarantees risk insurance and fees of medical services following sickness, accident, delivery or physical rehabilitation to the insured and his family members, with the exception of cosmetic surgery.

With the AMO and the Medical Assistance Regime (RAMED), which is destined to the economically destitute population, the overall number of the population benefiting from medical insurance in Morocco will reach 50%.

Two Models of Health Care Rationing

Sick and Sicker

Everyone knows that Canadians live longer and have lower infant mortality rates than Americans. In Sicko, Michael Moore suggests that a Canadian-style medical system would solve this problem. Surprisingly, the evidence indicates that it would not.

A cross-border team of 17 researchers (including high-profile supporters of the Canadian system) examined a variety of medical problems, including cancer, coronary artery disease, chronic illness and surgical procedures. With the single exception of end-stage kidney disease, where Canadian patients fared better, they found no consistent difference in patient outcomes between the two nations.1 As I have argued elsewhere, the United States has the worst health statistics in the industrialized world because it is the most unequal society in the industrialized world.2

Although Canada's medical system does not produce generally better patient outcomes, it is more equitable and far more economical. In 2003, the average American spent almost twice as much for medical care as the average Canadian. Exorbitant medical bills are a constant worry and a major cause of personal bankruptcy. Profit-taking is responsible for the high cost of American medicine. However, the Canadian system is also subject to market forces.

Contrary to popular belief, Canada does not have a single-payer medical system. Government pays about 70 percent of medical costs, including most hospital and physician care. Individuals and private insurance companies pay the remaining 30 percent for prescription drugs, dental and vision care, ambulance, medical devices, home care and other services.

To contain costs, both the United States and Canada ration medical care, but they do this in different ways. In the U.S., more than 47 million people have no medical insurance at all. The Institute of Medicine estimates that 18,000 people die every year as a result. In Canada, lack of access is more equitably spread across the population in the form of long waits for assessment and treatment. We don't know how many Canadians die while waiting for treatment, because no one is counting the bodies.3 The Canadian model of rationing is sick, and the American model is sicker because it unfairly discriminates against those who cannot pay. Neither is good enough. Medical care is a human right and should not be rationed at all.

Disgust with the American medical system has built support for HR 676--The United States National Health Insurance Act--a single-payer system where medical care would be publicly financed and privately delivered. Winning HR 676 would be a tremendous victory. However, the Canadian experience shows that private delivery of medical care opens the door to parasitical profit-taking.

The Canadian experience

Until the 1960's the American and Canadian medical systems were nearly identical. Those with the highest incomes obtained the lion's share of medical services even though those with the lowest incomes experienced the most illness. The logical solution was a government-run system to provide medical care for all, but doctors and private insurers rejected what they called "state medicine and socialism."

During the upturn of the 1960s, the pressure grew for universal health care. To contain demand, the federal government launched a Royal Commission to "study" the problem. The Canadian Labour Congress (CLC) made its preference clear.

"We favor a system of public health care that will be universal in application and comprehensive in coverage. We favor a system that will present no economic barrier between the service and those who need it. We are opposed to any provision which will require some people to submit themselves to a means test in order to obtain service. We look to a system of health care that will be regarded as a public service and not as an insurance mechanism."4

The public-service model, where government is both payer and provider, was rejected. Instead, the Medical Care Insurance Act of 1966 established a publicly-financed system that would be administered and delivered by the private sector, "free of government control or domination."

The province of Quebec took a different route. Pressured by workers' demands that culminated in the 1972 General Strike, Quebec incorporated medical services into a broad social benefits system, paid for and provided by the provincial government. The Quebec working class is rarely credited for producing the most comprehensive medical system in North America.

The assault on Canadian medicare

The ink was barely dry on the Medical Care Insurance Act before the federal government began cutting funds for health and social services. The 1974 recession and the recessions of the early 1980s and the early 1990s were followed by deeper cuts. As the cost of medicare was downloaded from the federal government to the provinces, the principle of equal access was eroded.

Private corporations rushed into the breach created by under-funding. The more medical services were removed from the public realm, the more individuals had to pay out of pocket, purchase insurance to cover the gap or go without.

To reassure nervous Canadians that medicare was safe, the Canada Health Act of 1984 guaranteed universal and equal access to medical services, but provided no funds to make this possible. Behind the scenes, government was committed to "growing" the private medical industry.

In 1994, the Ontario government concluded, "To have the effective launching pad it needs, the health industries sector must expand its share of its own home market. Steps must be taken to ensure that, as in other countries, the domestic market supports the development of globally competitive companies." One of these steps was to eliminate regulations mandating a minimum level of daily care for Ontario nursing-home residents.

In 1997, the federal government declared "Promoting Canadian companies as global health-keepers is the main objective driving the strategies and plans of the government for the medical devices, pharmaceutical and health-services sector."5 And in 2004, Canada's Supreme Court ruled that, "The Canada Health Act [does] not promise that any Canadian will receive funding for all medically required treatment."

Behind the mask of "health-care reform" and "restructuring," the Canadian medical system has been handed, piece-by-piece, to private industry in a manner similar to the dismantling of Britain's National Health Service6 --publicly-provided health care is under-funded to the point of crisis, then denigrated for its inadequacies. The private sector is proclaimed the only possible savior, and opponents are ridiculed as old-fashioned and sentimental. When the market fails to deliver, we are told we must adapt to "the new reality." The strongest opposition to this process has come from organized health-care workers.

Canadian hospitals, which by law must be non-profit institutions, became a battleground as unionized workers resisted wage cuts and contracting-out of housekeeping, information systems, food preparation, laboratory and other services to private, non-union companies. In 1981, Ontario hospital workers launched a province-wide strike, defying back-to-work legislation and the jailing of union leaders. Unwilling to broaden its challenge to neoliberal social policy, the union caved and the strike was defeated. Most small, local hospitals were closed. Those that remained open were merged into giant conglomerates managed by business consultants.

Privatization has decimated services. Families stagger under the burden of sick, injured and frail relatives who were previously cared for in hospital, rehabilitation and chronic-care facilities. In-home nursing care is scarce or pricey.

Tens of thousands of hospital nursing jobs have been eliminated at the same time that average hospital stays have been cut, so that fewer nurses care for much sicker patients. Hospital food lacks nutrition and infectious diseases plague hospitals that are no longer clean.7

As hospital out-patient clinics closed, patients were sent to family doctors (GPs) for follow-up. The downloading of medical services has created a crisis at the primary-care level. By 1998, 62 percent of Canadian physicians reported that their workload was too heavy, and more than half said that their family and personal life were suffering. By 2000, only 39 percent of Ontario GPs were accepting new patients. By 2006, fewer than 10 percent were accepting new patients. People typically wait months to see a specialist and more months for treatment. Patients grow sicker and die while they wait.

Quebec's model health-care system has been damaged severely by funding cuts. In 2005, Canada's Supreme Court ruled that lack of timely access to treatment in Quebec was serious enough that the province could no longer prohibit private funding for medically necessary services. Similar legal challenges are expected in the other provinces.

Unless the public system is resuscitated with a major transfusion of funds, it's only a matter of time before private hospitals begin servicing those who can pay to go to the front of the line. Ironically, while Americans long for a Canadian-style medical system, that system is disintegrating under the pressure of market forces.

Why ration medicine?

The capitalist class will pay anything to defend and extend its power. No ceiling has been set on spending to win the war for Middle-East oil. In contrast, there is fierce resistance to funding any services for workers beyond the minimum required to keep them productive. As the competition for capital increases, most governments are reducing their investment in health, education and social services --robbing the public sector to boost the profitability of the private sector. No nation and no medical system are immune to the relentless drive for profit.

The American medical system will be reformed. Ordinary people want medical services. Business complains that the cost of medical benefits is hurting their profits and global competitiveness; they want to transfer these costs to the public sector. Because Americans pay almost 90 percent more per-capita on medical care than Canadians do, rationalizing the medical system would offer fantastic cost savings. The real question is how it will be reformed.

The key demand is for affordable medical care. With almost 60 percent of the American workforce making less than $15 an hour, affordable care would have to be free. That shouldn't be a problem. A nation that can find the money to pay for war can find the money to pay for universal health care --in theory.

In practice, capitalism prioritizes cost-efficiency over human need by "industrializing" social services. The work of medicine is dissected into components that are individually priced and parceled out. The profitable parts are handed to the private sector and the unprofitable portions remain in the public realm or are abandoned altogether. While applying industrial methods to medicine is cost-effective from a business point of view, it fragments health care. Planning health services to meet population needs and integrating prevention and treatment, hospital and community care become impossible.

Winning HR 676 would be a definite step in the right direction. However, we need to go further. Eliminating profit from the medical system requires public financing and public delivery of services (socialized medicine). More than that, all health and social services must be provided as a human right --fully funded, fully integrated and with no rationing. If capitalism cannot meet these basic needs, then we need to construct a socialist society that can.

Dr. Susan Rosenthal has been practicing medicine for more than 30 years and has written many articles on the relationship between health and human relationships. She is also the author of Striking Flint: Genora (Johnson) Dollinger Remembers the 1936-1937 General Motors Sit-Down Strike (1996) and Market Madness and Mental Illness: The Crisis in Mental Health Care (1999) and Power and Powerlessness. She is a member of the National Writers Union, UAW Local 1981. She can be reached through her website:


UniCare Life & Health Insurance Company Launches SecurePack for Small Businesses

Many small business owners want to offer life and disability insurance as part of a comprehensive benefits plan, but believe they cannot afford it. UniCare Life & Health Insurance Company's SecurePack, specifically designed for small businesses, offers life insurance, disability insurance and employee assistance program (EAP) in an affordable and convenient benefit package.

SecurePack is available to small businesses with 2-99 employees. Five packages are available. Each includes a different level of:

- Group Term Life Insurance, delivering a timely benefit payment for the family if an employee passes away. - Accidental Death and Dismemberment, paying an additional benefit if an employee dies or faces a covered loss - like the loss of a limb - in an accident. - Dependent Life Insurance, paying a benefit to the employee if a spouse or child passes away. - Disability Insurance, providing temporary income to employees if they cannot work because of an illness or injury. This protection includes pregnancy.

"SecurePack offers solutions that can help small employers attract and retain great employees. There are no medical questionnaires and no mid-year rate changes," said Nicholas L. Brecker, president of UniCare's Life and Disability business. "SecurePack makes it easier for small businesses to provide these valued benefits to their employees."

Many small businesses owners also recognize that EAP can be helpful to their employees. SecurePack includes the InTouch, an EAP that offers:

- Ongoing support including toll-free, 24/7 telephone counseling, and referrals to financial and legal resources. - Convenient resources including access to child care and elder care databases, as well as additional Web site resources including on-line will preparation. - Face-to-face counseling including three sessions per year for employees with a disability and six sessions per year for beneficiaries dealing with the loss of a loved one - at no cost to them. - Human resources support is also available to help small groups through difficult situations, like alcoholism in the workplace. Employees don't have to fill out medical questionnaires as long as they sign up during the enrollment period.
"We are committed to providing small businesses with affordable, integrated and comprehensive benefits," said Jimmy Lee, vice-president for individual and small group business at UniCare. "When combined with medical insurance, SecurePack is one way small business owners can help deliver greater financial and health security for their employees."

Life and disability products are underwritten by UniCare Life & Health Insurance Company. For more information on UniCare Life & Health Insurance Company's SecurePack visit

UniCare benefits products are offered in Illinois and Indiana by UniCare Health Insurance Company of the Midwest, in Texas by UniCare Health Insurance Company of Texas and in all 50 states and the District of Columbia by UniCare Life & Health Insurance Company. UniCare Life & Health Insurance Company, an Indiana corporation, UniCare Health Insurance Company of Texas, a Texas corporation, and UniCare Health Insurance Company of the Midwest, an Illinois corporation, are separately formed and capitalized subsidiaries of WellPoint, Inc., an Indiana corporation. For self-funded plans UniCare acts as a claim processor and does not insure benefits under the plan.

Media Contact: Jerry Slowey Tony Felts (805) 557-6754 317-287-6036


When Minority Patients Have Insurance And A Medical Home, Their Health Care Improves

Providing minority patients a "medical home" in which they have a regular doctor or health professional who oversees and coordinates their care would help eliminate racial and ethnic health disparities and promote more health care equity, says a new report from The Commonwealth Fund. The report, based on a 2006 survey of more than 2,830 adults, shows that linking minority patients with a health care setting that offers timely, well-organized care where they can routinely seek physicians and medical advice can help them better manage chronic conditions and obtain critical preventive care services.
According to the report, Closing the Divide: How Medical Homes Promote Equity in Health Care, in 2006 nearly one-half of Hispanics and more than one of four African Americans were uninsured at some point during the year. In contrast, 21 percent of whites and 18 percent of Asian Americans lacked coverage. In addition to being the groups most likely to go without health insurance, African Americans and Hispanics are least likely to have a regular doctor or source of care. While health insurance coverage is an important determinant of whether people can obtain essential care, the authors say insurance alone cannot eliminate racial and ethnic disparities in health.

"Insurance coverage helps people gain access to health care, but the next thing you have to ask is 'access to what?'" says lead co-author Anne Beal, M.D., senior program officer at the Commonwealth Fund. "We found many disparities in care; however, disparities are not immutable. This survey shows if you can provide both insurance and access to a true medical home, racial and ethnic differences in getting needed medical care are often eliminated," she adds.

According to the report, patients have a medical home when they:

* Have a regular provider or place of care
* Report no difficulty contacting a provider by phone
* Report no difficulty getting advice or medical care when needed on weekends or evenings
* Always or often find office visits well-organized and efficiently run

Although there are many places that are already functioning as models of such care, what most limited a health setting from being designated a medical home in this survey was the ability to dispense medical advice or care after hours or on weekends, according to the report. Only two-thirds of adults who have a regular provider or source of care report that it is easy to get care or medical advice after hours. Among all groups surveyed, Hispanics have the hardest time seeking care or advice after hours, and they are least likely to have a medical home.

The survey shows that, when they have a medical home, the vast majority of adults of all races say they can always get the care they need when they need it. Nearly three-quarters of adults with a medical home report getting the care they need compared with only 52 percent of those with a regular provider that is not a medical home and 38 percent of adults without any regular source of provider.

Key survey findings on the role of a medical home in eliminating health care disparities:

* Racial/Ethnic Disparities Are Still Common.
* African Americans and Hispanics are less likely to be insured, and less likely to have a regular doctor or source of care.
* Hispanics are least likely to have a medical home; only 15 percent of Hispanics report having a medical home compared with 28 percent of whites, 34 percent of African Americans and 26 percent of Asian Americans.

Preventive Care Is More Routine.

* Minority adults with a medical home experienced no disparities in receiving preventive care reminders, which significantly improve rates of routine screening for conditions such as heart disease and cancer. For example, eight of 10 adults who received a preventive reminder had their cholesterol checked in the past five years compared with half of adults who did not get a reminder.
* Two-thirds (65%) of adults who have a medical home receive preventive reminders, according to the survey.

Chronic Care is Better Managed.

* Adults with a medical home are better prepared to manage chronic conditions such as diabetes or hypertension. Only 23 percent of adults with a medical home report their doctor or doctor's office did not give them a plan to manage their care at home compared with 65 percent who have no regular source of care.
* Forty-two percent of hypertensive adults with a medical home report that they check their blood pressure and it is well controlled compared with 25 percent of those without a medical home.

Having Health Insurance Matters.

* More than half of insured adults received a reminder from a doctor's office to schedule preventive visits compared with only 36 percent of uninsured adults; when African American and Hispanic patients are insured, they are just as likely as white adults to receive reminders to schedule needed preventive care.

Community Health Centers and Other Public Clinics Are Important Providers of Care to Vulnerable Patients.

* Although they care for a large proportion of uninsured, low-income, and minority adults, patients report that community health centers (CHCs) or other public clinics are less likely to have all four characteristics that comprise what the survey defined as a "medical home." Twenty-one percent of CHCs or public clinics have all four indicators of a medical home, compared with 32 percent of private doctors' offices.
* The main reason CHCs and other public clinics do not function as medical homes is because patients say they have more difficulty getting medical advice or care in the evenings or weekends. Since these safety net providers play a critical role in the care of vulnerable patients, the authors say it is important to find ways to support CHCs and public clinics becoming medical homes.

Promoting standards for the medical home through public reporting of performance and rewarding providers that meet these performance benchmarks would go a long way toward improving the way care is delivered and eliminating disparities, say Commonwealth Fund authors.

"We know the medical home is a promising model of care for narrowing health care disparities and providing patients with much higher quality care in terms of prevention and chronic disease management," says Fund Executive Vice President Stephen C. Schoenbaum, M.D. "Adopting policies to encourage practitioners to embrace this model would improve care for everyone, particularly those in safety net settings," he adds.


The survey was conducted by Princeton Survey Research Associates International from May 30 through October 19, 2006. The survey consisted of 25-minute telephone interviews in English or Spanish among a random, nationally representative sample of 3,535 adults at least 18 years of age living in the continental United States. The report restricts the analysis to the 2,837 respondents ages 18-64. The sample was designed to target African American, Hispanic, and Asian households and it classifies adults by insurance status and annual income. The survey has an overall margin of sampling error of +/- 2.9 percentage points at the 95 percent confidence level.

The Commonwealth Fund is a private foundation working toward a high performance health system.

Note: This story has been adapted from a news release issued by Commonwealth Fund.

Finding Credible Mini-Medical Insurance Plans

Download this press release as an Adobe PDF document.

Limited medical insurance plans are not created equal. Many plans in the market are priced cheaply but offer few real benefits which can cause frustration for both employees and providers. But, with a few helpful tips, employers can find credible plans at reasonable costs.

Orlando, FL (PRWEB) June 28, 2007 -- Its no secret that double-digit healthcare premium increases over the last several years have forced many employers to reduce or cancel healthcare benefits altogether. A number of insurance carriers have responded by offering limited medical plans for groups, sometimes referred to as mini-med plans or limited benefits insurance. In order to attract greater employee participation, some plans are designed based on how much the employer is willing to contribute and are offered for as little as $20 per month. But at the same time, such low cost plans provide very little real coverage and can create more confusion and frustration for providers and consumers than the benefits are worth.

But, there are credible limited medical plans available in the market place, and savvy employers can learn the differences and pick plans that provide valuable benefits at reasonable costs. So, how can employers who can't afford major medical group plans find reasonably priced limited medical insurance plans?

First, review the benefit plan summary to check for minimum coverage amounts for:

  • Hospitalizations: According to Christopher Lang, President & CEO of AgelessCare, $500 per day is the lowest credible daily rate. If possible, employers should purchase a plan with a rate that mirrors average negotiated hospital per diem rates of between $900 and $1,100. "If the daily benefit level is lower than $500, don't bother buying a plan that includes inpatient hospital coverage since it won't be worth the extra premium cost or hassle for providers and employees," says Lang.
  • Doctor Visits: Primary care office visit fees normally range between $65 and $120 per visit. Look for at least $40 per visit since this will often fund a good share of the cost of basic follow up visits, particularly if the provider offers a self-pay rate when the appointment is booked.
  • Accident Medical Expenses: Many high cost medical bills result from accidents. "Be careful to find a plan that is not limited to one-fixed amount per year, but instead, pays at least $1,000 per accident with a low deductible," cautions Lang.
  • ER Visits: Many limited medical plans include very small benefits for ER, such as $100 or less per visit. But, an average bill can range between $500 and $750 per visit. Lang says the per-visit ER benefit should be at least $250 to cover a meaningful portion of a typical bill.
Once the employer finds an insurance agency offering a credible mini-med plan, they should ask whether the agency has experience working in the healthcare provider community. Knowledgeable agencies should also understand why employees seek healthcare and how to help them maximize the limited medical insurance benefits provided.

About AgelessCare:
AgelessCare, LLC is a licensed general insurance agency serving more than 40 states. Product offerings include health and life insurance, healthcare discount programs, and nurse hotline services for groups. For more information, visit