Jelf: PMI changes in Qatar

Employers must comply with new visa rules by the first quarter of 2015

Changes to the private medical insurance (PMI)-associated visa rules in Qatar mean that some firms operating in the region could be short staffed during 2015 if they do not comply with the new reforms, Jelf Employee Benefits has warned.

Under the new legislation employers with expatriates in Qatar are legally obliged to pay premiums on behalf of their employees.

Employers will not be issued with residence permits for their staff unless they have subscribed to the new National Health Insurance Service and have suitable coverage in place.

Insurance companies, including international insurers, must have their place of business in Qatar and be registered with the Supreme Council of Health and other Government Authorities in Qatar.

The new laws will come into force in the first quarter of 2015 for white collar workers. Blue collar non-national workers will be included in the final phase of the scheme by the end of 2015. 

James Spencer, international development manager for Jelf International, said employers looking to renew visas for their staff will find they are left without sufficient employee capacity unless they have complied with the new rules.

“It will be the responsibility of the employer to ensure that they comply with new legislation; and some insurers who do not have a solution may not be immediately able to cover employees in Qatar,” he added.

According to Jelf, while the medical facilities in Qatar are highly regarded the medical insurance market is less developed.

Not all international insurers will be registered in Qatar or have a local insurance partner.

“In a country expanding so rapidly it is not surprising to see this directive being put in place, and employers who plan ahead shouldn’t experience many difficulties. It is encouraging to understand that the new National Health Insurance Service will work with private health insurers in order to transition their member schemes to compliant plans to avoid double coverage. However, international employee benefits is such

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Jelf: PMI changes in Qatar

GW nixes health insurance option, avoids $1 million tax burden

Media Credit: Anna McGarrigle | Hatchet Designer

GW traded in a more expensive employee health care plan to avoid paying nearly $1 million in additional taxes, and will now offer a cheaper plan to ease faculty concerns about rising costs.

That new plan is the first “high-deductible” plan the University has offered in recent history, and will likely help employees and families with typically lower health care costs cut down on how much they pay out-of-pocket, officials say.

The Affordable Care Act will start taxing organizations with more high-end plans by 2018, which is known as the “Cadillac tax.” That would have resulted in an almost $1 million tax burden, Vice President for Human Resources Sabrina Ellis said at a Faculty Senate meeting Friday.

“The goal is to take steps now, in anticipation of the excise tax, to use our benefit dollars wisely in keeping the plans affordable,” Ellis said.

The cheaper option comes after a year of faculty lobbying for less expensive health insurance payments. Between 2012 and 2014, employee out-of-pocket costs grew by 30.5 percentage points. Out-of-pocket costs for employees rose about 3 percent this year.

Families on the new high-deductible health plan will pay about $1,400 this year to get on the plan, which is a few hundred dollars cheaper than the other two options from which GW employees can choose. GW nixed its premium plan, which cost families more than $2,100 last year plus out-of-pocket payments.

The new option will provide faculty and staff with a larger deductible than GW’s other two options, giving employees and their families more flexibility, Ellis said.

After employees reach their deductible limit, insurance kicks in. A smaller deductible gives families with higher medical bills a better chance of having insurance cover more of their bills.

A larger deductible comes with a lower annual charge, but forces employees to pay out-of-pocket until they reach a higher limit. For younger employees in good health, that may be a bet they are willing to take.

“This is something that responds to requests that have come through to have a plan that offers greater flexibility,” Ellis said.

Many universities have started introducing high-deductible plans, which allow employees to set up a health spending account and contribute to the account directly from their paycheck each month, Ellis said.

Just 132 faculty members were enrolled on the premium plan and will be able to switch to other GW plans.

Still, faculty members said they are frustrated that the University didn’t do more to offset out-of-pocket costs.

Benjamin Hopkins, a history and international affairs professor and the secretary of the Faculty Association, said he doubted the new plan would lower costs for employees because they would have to pay high out-of-pocket costs to use it.

“The insurance doesn’t kick in until you’ve spent $1,500 on the deductible, all out of pocket. For the people who are least able to afford it, if you don’t use it, it’s fine,” Hopkins said. “It’s going to be very difficult on these people.”

The new plan doesn’t stop GW’s trend of shifting costs onto employees, he said, adding that administrators failed to respond to faculty requests to increase their contribution to health insurance costs.

Media Credit: File Photo by Nicole Radivilov

Robert Harrington, chair of the Faculty Senate’s Appointment, Salary and Promotion Policies Committee, discussed the University’s faculty health care policies with Vice President of Human Resources Sabrina Ellis several times over the summer.

Hopkins was one of the faculty members to help create the Faculty Association last spring. The group, which claimed the Faculty Senate was not doing enough to raise concerns about health care costs, came together after more than 160 faculty members signed a petition asking GW to increase its contributions to insurance plans.

Hopkins said faculty do not believe GW is keeping up with how much peer institutions are putting toward their plans.

A document Ellis shared with members of the Benefits Advisory Committee showed that GW contributed fewer cents to fringe benefits for every dollar paid for an employee’s salary than nearly all of its competitor schools. GW contributed 25 cents per every dollar of a salary to benefits packages, while neighboring Georgetown University contributed 35 cents per dollar and American University offered 26.5 cents per dollar of their respective employees’ salaries.

Jon Gruber, a Massachusetts Institute of Technology professor of economics who focuses on health care, said slowing increases to health insurance costs puts the University back in line with the national trends, after a few years of being an outlier. Costs nationwide have grown at a slower rate since the recession, he added.

A report released this week by the Kaiser Family Foundation showed that premiums for employer-sponsored family health plans increased about 3 percent nationally, roughly the same as GW’s increase.

Still, that slower growth has translated into higher deductibles for plans covered by their employers. The report found the average deductible has risen 47 percent since 2009.

“The deductibles for workers have crept higher over time, topping $1,200 on average this year,” said Gary Claxton, the study’s lead author and a vice president at the Kaiser Foundation.

Robert Harrington, chair of the Appointment, Salary and Promotion Policies Committee of the Faculty Senate, said the committees that help decide benefits packages had met with Ellis to discuss the policies before the meeting.

Although the price for some plans increased more than 3 percent, he said faculty who use their plans likely will not see a significant change.

“The issue really is that a number of other costs have not been increased at all, in terms of prices of deductibles of various plans. And so overall, therefore, if you use the plan enough, you probably could say that the overall increase is about 3 percent,” he said.

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GW nixes health insurance option, avoids $1 million tax burden

NHIS sanctions 39 HMOs over insufficient funds….Sick <b>health</b> <b>…</b>

The National Health Insurance Scheme has sanctioned 39 Health Maintenance Organisations for failing to raise the N400m minimum capital base required of them to be in business.

The NHIS Executive Secretary, Dr. Femi Thomas, who announced the sanction at the meeting of the NHIS HMOs Standing Committee in Abuja, said the decision was part of its measures to strengthen the scheme.

An assessment report, Thomas said, found the affected HMOs “unhealthy.”

The NHIS had given 77 HMOs in the country till August 31, 2014 to raise the funds or be delisted from its transactions.

HMOs are organisations that provide group and self-funded health insurance package to subscribers. They act as intermediaries for the NHIS, hospital owners and the subscribers.

Only five million of over 160 million Nigerians have access to the health insurance policy inaugurated 15 years ago in the country.

Thomas said, “We have announced the results and the HMOs that didn’t meet up have been sanctioned so they will have to make up whatever deficiency they have before we register them. This decision is part of quality assurance that will ensure that only healthy HMOs will help us to drive our programmes. So it is going to add value to whatever we are doing and that is the way forward.”

The PUNCH, on September 1 and 2, had published a two-part investigative story, which revealed how some HMOS were short-changing the scheme by offering services not commensurate with premiums paid by enrollees.

The story highlighted unethical practices of some HMOs and complaints from disgruntled Nigerians who enrolled for the scheme.

Meanwhile, patients who subscribed to the affected HMOs have expressed fears that their hospitals may deny them treatment.

Efforts to reach the NHIS management to speak on how this would be resolved were not successful. But a source said the NHIS may take over the assets and liabilities of the affected HMOs and reassign their patients to functional HMOs if they fail to come up with the N400m minimum capital base by the end of September.

He said, “When a bank goes underground, it does not mean that the depositors’ fund in its custody is completely gone. The Nigerian Deposit Insurance Corporation comes to absorb the responsibilities of the bank, including its management, assets and liabilities and pay all the depositors.

“In this situation, the NHIS will absorb those assets and liabilities and take responsibilities for the payment of the depositors and later set up an interim management.”

Among firms that passed the HMOs re-accreditation exercise are InvestCorp Medical Limited, Total Health Trust, Healthcare International, United Healthcare International, Hygeia HMO Limited, Managed Health Care Services, Premium Health, Maayoit Healthcare and Defence Health Maintenance.

Others are Royal Health Prepaid Medicare, Prepaid Medicare, Health Partners, Oceanic Health, Princeton, Royal Exchange Healthcare and Salus Trust.

The HMOs, which received provisional accreditation, include Doma Healthcare, Avon, HMO, Reginix Healthcare, Redcare Health, Well Health Network, Bupar Healthcare and the Police HMO.

Thomas added that the NHIS was sensitising stakeholders on the enrollment of pupils in public primary schools nationwide as well as the repackaged tertiary institutions health insurance programme.

“All these are things we would begin to see later in the year”, he added.

Already, the NHIS said it had contracted Price waterhouseCoopers to audit the functional HMOs with a view to ascertaining their preparedness to drive the NHIS initiatives.


PUNCH

SEPTEMBER 1, 2014 BY NIKE POPOOLA

The crave for profitability by operators of the National Health Insurance Scheme is breeding bad ethics and eroding quality health care delivery for subscribers, NIKE POPOOLA writes

DISGRUNTLED ENROLEES

Mrs. Aderonke Korede works in a telecommunications firm that registered its employees with a Health Maintenance Organisation under the National Health Insurance Scheme.

She expected her health plan with the HMO to allow her to deliver her baby through Caesarean section. However, when the delivery time came, the HMO refused to bear the responsibility, claiming that her health plan did not cover such a procedure.

After unsuccessfully persuading the HMO to live up to its responsibility, her husband agreed to pay the hospital bill when his wife’s health showed signs of deterioration. The Koredes felt the HMO’s refusal to pick the bill had defeated the essence of having a health insurance in place.

Aderonke’s husband, Babatunde, says, “The experience was really traumatic. I could not stand the attitude of the HMO and risk the lives of my wife and our unborn baby; so, I had to go back to the money we were saving to roof the small house we are building in Ikorodu to fund the operation.

“Almost a year after, we’ve not been able to raise enough money to roof the house because of other contending issues. The development has left us at the mercy of our troublesome landlord and my wife is even sceptical of going to the hospital even for services covered by her health insurance package with the HMO.”

Different complaints emerge daily from both the enrolees, who are registered with the HMOs, and the hospitals, which are designated as health care providers under the NHIS.

On the other hand, the HMOs are also complaining about the treatment that the hospitals are meting out to them, especially when it comes to money matters. The relationship between the HMOs and the hospitals can best be described as that between a cat and a mouse, because they are always suspicious of each other.

The strained relationship between the HMOs and the hospitals has left the enrolees at the receiving end of terrible services.

Yet, amid the challenges militating against the ability of the scheme to provide quality health care services, little is being done to address the issues by the regulator of the scheme.

Unlike the financial services sector, where the regulators take strict and decisive actions, players in the health insurance sector in the country have continued to do things their own way.

The NHIS ensures the pooling of funds from different sectors of the economy, with many people contributing money but only a few of them expected to fall ill at a particular time. The essence is to guarantee free health care for the contributors whenever the need arises.

While the importance of a virile health insurance scheme cannot be over emphasized, experts are of the view that majority of those on the NHIS enjoy cover only for minor ailments.

When there is a need for surgery or an expensive treatment, the HMOs always require the hospitals to take permission from them. If not, they end up not paying for the enrolee’s treatment.

In most cases, enrolees have to pay from their pockets for such treatment. In times of emergencies, the hospitals may either have the challenge of reaching the HMO; or the HMO simply refuses to pay.

An enrolee, who works in an oil company, Mr. Tunde Atolagbe, will rather pay for his treatment than to depend solely on his health insurance plan because he lacks confidence in the cheap services being rendered by the hospitals in their bid to make profits.

“I use a particular hospital alongside my colleagues in the office through our HMO, but you find that the types of drugs that they are giving you may be different from when you are paying from your pocket,” he says.

Mr. Adeolu Oyeniran works in an oil company. He says he stopped getting free treatment in his hospital last November.

“Whenever I go to the hospital, they say they cannot treat me because the HMO has stopped service to my organisation. I am sure my employer has not been paying the HMO and this money is removed from my salary,” he laments.

HMOs VERSUS HOSPITALS

Common complaints by the hospitals against the HMOs include default in paying capitation (the amount payable per head irrespective of whether the person draws from pool of funds or not for a certain period of time); paying ridiculously low capitation; and delay in payment, even when the HMOs have collected their premium from the enrolees.

The hospitals are in a dilemma because they stand to be disengaged if they make official reports of HMOs indebtedness to them.

This hostile condition of doing business is forcing the hospitals to render very cheap services that may leave the patients worse off.

According to the result of a health insurance survey conducted by the Lagos Chamber of Commerce and Industry, majority of the enrolees are absolutely displeased with not receiving commensurate treatment for the premiums paid compared to when they visit their family or personal hospitals where they pay on the go.

The Director, Research and Advocacy, LCCI, Mr. Vincent Nwani, says the survey found out that many enrolees were actually opting out of being treated by HMO-registered hospitals, preferring to patronise their personal doctors for better treatment.

The average enrolee, according to the survey, thinks that he is fully covered by the scheme irrespective of the nature of the ailment.

Nwani says the hospitals are complaining that the capitation fees being paid to them are very small; adding that the present monthly capitation that the HMOs pay per person to the hospitals is between N500 and N750, but adds that some enrolees make regular visits to the hospitals even for minor complaints.

Those with serious diseases and infections want perfect treatment with the N500 or N750 paid by their HMOs monthly, he says.

The LCCI investigation shows that complaints are not limited to the hospitals. The HMOs too are not happy, because they say that sometimes when their corporate clients go to the hospitals for inspection, they get bad reception.

Some hospitals, Nwani says, accumulate bills for up to three months before sending them, and at the end of the day, they complain of delayed payment.

He also observes that the HMOs do not really explain in details to their clients the plans they registered for. This, he says, makes patients with the most basic plan to go to the hospital demanding major surgeries to be performed on them, or comparing their level of treatment to others with more comprehensive plans.

Recently, one of the hospitals being owed a large sum, in a mail to one of the HMOs, narrated how several attempts made to recover the money had proved abortive, and how the employees of the HMO had been lackadaisical to its plight despite sending monthly bills.

In response, the HMO made it clear that it was doing the health care provider a favour by having it on its register, and expressed frustration that its gesture was not appreciated!

Presently, about 5.5 million Nigerians are registered under the NHIS. Seventy-five per cent of these are Federal Government employees who are mandatorily insured, while the remaining are private sector employees.

The health insurance scheme, whose implementation began about 16 years ago with the signing into law of the NHIS Act, 1999, has continued to grow at a very slow pace.

Under the scheme, 77 HMOs are licensed and they are working with about 7,000 health care providers. The health care providers are hospitals that should be well equipped, but because most of them render services on credit, it has been extremely difficult for them to meet set standards.

At the commencement of the scheme, the minimum required capital base for each HMO was N30m. It was later reviewed to N100m, and it is now N400m.

RISING FRAUDULENT ACTIVITIES

Instead of prioritising quality health care delivery, fraudulent activities are prevalent among professionals in the health insurance scheme. For instance, Nwani says the results of investigations carried out by the LCCI WERE really displeasing.

He says, “One of the HMOs we visited during the fieldwork informed us that it had been receiving unrealistic bills from the hospitals. A mystery shopping was carried out by the HMO by sending one of its members of staff as a patient to one of the suspected hospitals that normally sent exorbitant bills. The disguised patient was treated for a very minor ailment and was given drugs.

“The staff kept the drugs, waiting for the hospital to send the bill. When the bill was received, it was discovered that the hospital had inflated it and added some drugs that were not given to him. The HMO took the drugs and the bill to the hospital as a proof that it had been sending unrealistic bills,” he notes.

Narrating another case, Nwani says, “One of the registered hospitals sent a bill to a HMO that a client was treated for dog bite. When the HMO called the parents of the boy to sympathise with them, it was discovered that the boy was never bitten by a dog. The hospital cooked up the case in order to extort the HMO.”

BETWEEN HMOS AND ENROLEES

The Managing Director, Healthcare International, Mr. Tosin Awosika, says HMOs actually have structures in place to ensure quality health care delivery to the enrolees.

“Before we accredit hospitals, we would have inspected them to ascertain what they can do and what they cannot do. On a regular basis, we do quality assurance visits to check what they are doing and how they are treating the clients. We have a feedback system; if there is an issue, we expect the clients to get back to us,” he says.

According to him, HMOs have the right to delist hospitals that are not doing well and transfer the patients to other hospitals for better care. With these measures in place, Awosika says the hospitals will ensure efficiency because they will not want to be delisted.

Many enrolees also erroneously believe that once they pay a certain premium, they will enjoy full treatment for any ailment throughout the year, but are shocked that their health plans sometimes operate like the mobile phone that goes off ones its credit has been exhausted.

The President, Actors Guild of Nigeria, Ibinabo Fiberesima, says, “Some of my members, after the first and second visits to the hospital, do receive text messages from the hospital that they have exhausted their plan.”

The Managing Director, MetroHealth, HMO Limited, Mr. Kola Awokoya, stresses the need to build the health insurance scheme on trust. “The responsibility of enlightening the enrolee on the coverage of his health plan lies with the HMO and the employers,” he explains.

It has been found out that the quality structures put in place by the HMOs are not working perfectly. A survey conducted by The PUNCH, using questionnaires to collect information from enrolees of different HMOs, showed that most of them subscribed to the cheapest plans, which do not provide treatment for the illnesses killing majority of Nigerians presently.

It was discovered that none of the enrolees had ever been called by their HMOs to either enquire about their welfare or ask if they were satisfied with their health plans.

Despite the fact that their employers subscribed to health insurance on their behalf, 30 per cent of respondents preferred to go to their family doctors than visit the hospitals recommended by their HMOs.

Mr. Gbenga Ilemobayo enrolled his family of five with a HMO and paid a premium price for choosing a band ‘B’ hospital and subscribing to the ‘Gold’ plan, but when one of his sons required an urgent surgery for a medical condition called hernia, the hospital could not obtain authorisation from the HMO to carry on with the procedure for more than 16 hours. The HMO’s customer care lines rang for hours without anybody picking up the calls.

Ilemobayo explains, “Due to the severity of the boy’s condition, the senior doctor at the hospital told me that the operation had to be done immediately and I had to approach my brother to lend me some money, which I could deposit.

“It was a difficult period for my family because I had just paid the school fees of my three children, who are all in private schools. Their mother has been out of job for about three years and my income leaves no room for any serious savings.”

MULTIPLE COMPLAINTS

The immediate President, Nigerian Medical Association, Dr. Osahon Enabulele, accuses some of the HMOs of not paying their capitation to the health providers, adding that the issue was raised during the Presidential Summit on Universal Health Coverage held in Abuja in March this year.

“At the last presidential summit on universal health coverage, the same allegation was made. It is very criminal for any HMO to withhold the capitation of the provider because that invariably will not motivate the provider to provide the needed quality services,” he says.

As a result of default, he says that the HMOs are short changing the insurance scheme and the health care system, which will invariably impact on the patients, who may get poor services resulting from lack of motivation.

Enabulele says a lot of disgruntled doctors have reported their HMOs to the NHIS, adding that the NHIS leadership has asked the doctors to provide information to establish that some of the HMOs are actually owing the providers their due capitation.

“It is criminal for any HMO to withhold capitation to the provider and the NMA frowns seriously on that, and we charge the leadership of the NHIS scheme to fish out such HMOs and appropriately discipline them so that the scheme does not die a natural death as a result of the poor assimilation of the providers of care due to the antics and acts of some of the HMOs,” he says.

The NMA boss notes that if a HMO is having grievances against an employer who refuses to pay his premium, such complaints should be tendered before the governing board of the NHIS.

Enabulele explains that it is not in the power of the HMOs to deny anyone of the services that they have promised to provide if the customer has paid the agreed premium.

“The HMOs have to pay their own capitation to the subscribers; once a portal has been allocated to a provider for health care facility, it is under obligation. For anybody to be allocated to a provider, it is assumed that the person has paid up his premium and subscribed to the care,” he says.

The Healthcare Providers Association of Nigeria is the umbrella body of the hospitals registered under the NHIS.

The National President, HCPAN, Dr. Adenike Olaniba, says the major frictions between the HMOs and the providers are low capitation, abysmally low tariff, indebtedness to the providers by the HMOs, slashing of hospitals’ bills and non-payment of capitation, among others.

Olaniba, who is also a consultant public health physician, observes that many private providers’ clinics are closing down as they cannot cope with the financial burden imposed on them by health insurance.

She explains that in February 2012, a joint consultative meeting was held in the premises of Healthcare International HMO between the Health and Managed Care Association of Nigeria (the umbrella body of the HMOs) and HCPAN.

Some of the items on the agenda of the meeting, she says, were the implementation of the new NHIS capitation, HMOs’ indebtedness to the providers, slashing of bills, care of the chronically ill and standardised contractual agreement between the HMOs and care providers.

“In order to fast track the review of capitation and tariff, the HCPAN forwarded the report of its tariff and pricing committee to the forum for consideration. No feedback has been received from the HMCAN on this document,” she adds.

If the issues are positively addressed, Olaniba says the relationship between the two stakeholders will improve tremendously.


SEPTEMBER 2, 2014 BY AGENCY REPORTER

In the concluding part of the story on the sorry state of the health insurance scheme in the country, NIKE POOPOLA writes on how it can be saved

OPERATORS CONCERNS AND SUGGESTIONS

A Consultant Radiologist, Lagos State University Teaching Hospital, Dr. Olukayode Adegboyega, points out that the health care providers need funds to be able to acquire up-to-date infrastructure to treat their patients.

He says the delay in payment or outright denial of capitation to the health providers has enormous effect on the services being rendered because the motivation may just not be there to render the best services.

Adegboyega says the health care providers’ inability to get their money from the HMOs will definitely affect their ability to purchase relevant equipment.

Citing the diagnostic aspect of health care service, he says without funds, hospitals will resort to treating patients without proper investigations.

He says, “For instance, if the HMOs are paying N1,000 or N500 on an individual to the hospital for an ailment like malaria, the doctor may not advice the patient to do malaria parasite test when drugs alone can take up to N200 or N300. How does he pay his nurses, maintain the infrastructure and cover other expenses?

“So, it boils down to the fact that all stakeholders in health insurance management should agree on an appropriate billing system.”

Another effect of poor capitation payment on the health providers, according to him, is that it hinders the development of the health insurance scheme, because more people will continue to travel to countries like China and India for better treatment, thereby worsening the capital flight problem in the country.

Adegboyega stresses the need for stiffer regulation of the health insurance system in which the HMO will be sanctioned if it fails to remit due capitation to the health provider out of the insurance pool that has been built.

He also counsels the government to motivate and support artisans and low income earners in the country by paying a part of the premium on their behalf from the taxes paid by the citizens in order to enable them to have access to free health care.

According to him, if more of the artisans, middle class and high income earners in the community can be introduced to the health insurance scheme; there will be huge premium that will help to develop the health sector.

Adegboyega observes that Nigeria has huge population, majority of who are not presently in the scheme but may as well join and increase the premium accruing to it.

The Managing Director, Capex Expartcare Limited, one of the HMOs in the country, Mr. Bimbo Banjoko, highlights some of the frictions between the HMOs and the hospitals, and suggests way out of the quagmire.

Firstly, he says most HMOs are being managed by doctors and it will be unreasonable to think that they will run down their colleagues managing the hospitals.

He says some employers actually default in premium payment but that the HMOs need to encourage them to stay in the scheme and not to opt out, especially the private sector employers.

“If you have been in a relationship with an organisation that has been paying premium for four years, and because it is having some financial challenges, it cannot pay immediately, will you cut it off, especially if it had been paying you promptly before then? Of course, a lot of that happened in 2009 and 2010 when there was a meltdown in the financial market. It is just that a lot of people did not know that the HMOs actually faced a lot of financial challenges too,” Banjoko says.

In such situations, he notes that the HMOs still have to pay the health providers, adding that any default in the sector may not have been deliberate.

Again, he says the principle of health insurance thrives on large numbers, but that many of the HMOs have few enrolees registered with them.

While only few of the HMOs are big players with developed facilities, he observes that the small ones may actually not be making enough money to do well in business.

Banjoko says unless patronage is improved and more people subscribed to the scheme, most of the providers will still be at the receiving end.

“We should collectively accept the responsibility to get majority of Nigerians into the health insurance scheme. If 10 per cent of Nigerians subscribe and they all pay N10,000; you can imagine the amount of billions in premium that will go to the health fund, which should be properly managed in a scientific way. So, the real problem is that because the pool is not very large, providers are under strain, and so are the HMOs,” he explains.

Banjoko urges the health providers to collaborate with the HMOs to develop the market in their environment.

Citing the example of a low density population area in Lagos, where there are many hospitals, he says it may be difficult for the health providers to get enough patients to stay in business.

“For instance, in Ilupeju, there are six to eight hospitals and Ilupeju is a low density area. So, how do those hospitals actually want to break even? Businesswise, those hospitals are set up for failure except they get referrals from outside the zone. But if all they want to deal with is the population of people in Ilupeju, that is a fundamental problem,” he notes.

The health insurance expert observes that some hospitals that registered early with the HMOs are actually getting about N20m capitation monthly and such will want the HMOs to survive.

These, he says, have been able to build their pool because they got into the business early enough and have been able to accumulate a large number of enrolees as opposed to those who came later and have small numbers.

“If there are defaults, I am sure it is not because people want to be fraudulent, that is far from it,” he adds.

Suggesting the way of out for the hospitals that complain of low capitation being paid by the HMOs, Banjoko says it will be good for the health care industry to come up with unified billing processes to solve the challenge of care givers charging different rates.

He explains that predictability is an essence of insurance, whereby the hospitals must have been able to come to some consensus on their claims pattern because they are predicting based on a particular billing process.

Banjoko notes that in the private sector segment of the scheme, there is a lot of unpredictability because there is no unified tariff system and the claims pattern is not very predictable, adding that the HMOs that are doing private business are really bold.

WAY FORWARD

When contacted to respond to allegations of fraud and measures to sanitise the health insurance system, the NHIS refused to make any comment.

Several weeks after sending enquiries on efforts to ensure that enrolees truly get value for their lives to Mr. Ayo Osinlu and Mr. Terso Adagher of the media department of the NHIS, no response was given.

Nwani, however, suggests that the scheme will be widely acceptable if some measures are put in place such as stepping up quality plans at affordable prices; extensive campaign with emphasis on the product features and benefits; and quality treatment involving carrying out necessary tests before commencing treatment rather than just administering analgesics for chronic ailments.

Others are accreditation of good hospital network that will enhance easy accessibility of the registered hospitals; ensuring prompt response in cases of emergency; and the availability of qualified doctors in the hospitals.

He also suggests that the registered hospitals should submit their bills regularly and the bills should be settled within the agreed period; while the hospitals should be transparent in dealing with the HMOs and desist from sending unrealistic bills.

Nwani stresses that HMO patients should be given good reception at the hospitals and the health providers must stop discriminating between them and their direct patients.

To check the lapses of the HMOs and boost the services of the hospitals, experts say the memorandum of agreement between the Nigeria Employers’ Consultative Association, HMCAN AND HCPAN, which was signed by their representatives in November 2011, should be implemented.

According to HCPAN, this legal instrument, which consists of 16 sections, has not been implemented by the HMOs and providers.


Read More:
NHIS sanctions 39 HMOs over insufficient funds….Sick <b>health</b> <b>…</b>

Nib launches first <b>international</b> policy | Stuff.co.nz

Medical insurer nib hopes to win a larger share of the lucrative workplace insurance market with the launch of the country’s first international health policy.

Part of a giant ASX-listed health insurer, nib says its global health policy will provide comprehensive health and medical insurance cover in most countries around the world.

Traditional health insurance policies only cover treatment in New Zealand, but there is a growing trend of Kiwis travelling and working overseas for extended periods.

Nib’s New Zealand chief executive Rob Hennin said more than 800,000 New Zealanders lived or worked overseas, while more than 45,000 went overseas for an extended period each year.

“Our research has shown that a lot of these people rely on travel insurance or in some cases don’t have any insurance for medical and health expenses when outside of New Zealand.” Those with travel insurance did not understand the limits of the health cover it provided, Hennin said.

“For extended stays, travel insurance is simply not a comprehensive form of insurance to cover health and medical costs, which in some cases can result in significant out-of-pocket health costs and even worse, people not being able to access the level and type of cover they may urgently need.”

Nib recently relaunched into the corporate insurance market in New Zealand and expects its global health cover range to appeal to businesses and other organisations with employees working or travelling overseas.

Nib’s policy would provide access to an international network of hospital and medical services. The company has partnered with global medical insurer AXA PPP International for the policy.

In New Zealand, nib is the second largest health insurer behind Southern Cross.

- The Press

Visit site:
Nib launches first <b>international</b> policy | Stuff.co.nz

Patriot Executive Travel Medical Insurance

Patriot Executive Travel Medical Insurance

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Each Patriot Executive Travel Medical Insurance plan has the following:

Maximum limit of $ 1,000,000, maximum limit for travelers age 70-75 is $ 50,000
$ 250 deductible for each covered illness
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24 hour access to MyImg
World-class medical benefits for in-patient and out-patient medical expenses
Schedule of Benefits
The following are covered Up to the Maximum Limit: Hospital Room and Board, Intensive Care, Medical Expenses, Local Ambulance, Prescription Drugs, Emergency Room Accident, Dental – Due to Accident.
Emergency Room Illness without In-patient Admission – Up to Maximum Limit with additional $ 250 deductible, Dental – Sudden Pain – up to $ 100, Indemnity (for U.S. Citizens only) – up to $ 100 per night.

Additional Benefits
Terrorism: up to $ 50,000 lifetime maximum
Sports and Activities Coverage: up to maximum limit for basic sports
Trip Interruption – up to $ 5,000
Common Carrier Accidental Death – $ 50,000 to beneficiary; maximum of $ 250,000 per family
Accidental Death & Dismemberment – $ 25,000 principle sum
Lost Luggage – up to $ 50 per item of personal property; maximum of $ 250 per Period of Coverage.

International Emergency care
Emergency Medical Evacuation – up to the Maximum Limit
Emergency Reunion – up to $ 15,000
Return of Mortal Remains – up to $ 25,000
Return of Minor Children – $ 5,000
Political Evacuation – up to $ 10,000
Identify Theft Assistance – up to $ 500 per Period of Coverage.

Considering the low rates for purchasing either the a Patriot Executive International Travel Medical Insurance or the a Patriot Executive America International Travel Medical Insurance and the aforementioned benefits, both of the Patriot Executive Travel Medical Insurance plans could be very valuable to the traveling executive and their company or organization. For more information or to buy on-line visit the links below. http://www.GlobalTravelCoverage.com.

Thank you for your time and I hope that you read more of my articles in the future.

Specializes in Travel Medical Insurance, Trip Insurance, Global Health Insurance and all of the derivations(Mission, Marine, Student, etc.). For your Travel Medical Insurance needs visit us at: Global Medical Coverage.

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Patriot Executive Travel Medical Insurance

Real Fiscal Responsibility 3; Carter: Inflation and Health Care

By Joe Firestone

Here’s the third post in my series evaluating the fiscal responsibility/irresponsibility of the Governments of the United States (mostly the Congress, the Executive Branch, and the Federal Reserve) by Administration periods beginning in 1977 with the Jimmy Carter period. My first post explained why I chose to start my evaluation with the Carter period, and also laid out my related definitions of fiscal sustainability, and fiscal responsibility.

It explained why fiscal responsibility is closely connected to the idea of public purpose, which I’ve laid out here. I also claimed that the Government of the United States has been fiscally irresponsible in every Administration period since 1977.

In my second post, I began by examining the problems of ending economic stagnation, and providing full employment at a living wage, and, I hope, by showing that the Government, during the Carter period, failed to solve either problem because of its commitment to deficit reduction, and budget balancing, in the service of hoped for inflation moderation. The remaining posts in this series will continue to document the claim that all the US Governments since 1977 have been fiscally irresponsible. This, one, the third in the series, will examine how the US Government failed in its efforts to create and maintain price stability, and also failed to provide a solution to the problem of providing the right of receiving health care to every American in need.

Creating and Maintaining Price stability

The Carter Administration sought price stability, and was convinced, mistakenly, that reducing the deficit and eventually balancing the budget would also bring the cost-push inflation in oil prices under control. In the pursuit of price stability, the President used his veto power (p. 40) on a heavily Democratic Congress of supposed allies when he vetoed a public works bill providing for $5 Billion in water projects in 1978, because be thought it was inflationary and full of pork. In addition, he vetoed or pocket vetoed a number of other bills passed by the Democratic Congress in pursuit of smaller Federal deficits and Government frugality.

Not that the Government ran very large deficits in those days in light of current ideas about large deficit spending. In fact, Congress, the President, and the Federal Reserve combined to reduce deficits very quickly after the Ford Administration. After 8 quarters when the Federal Government deficit ranged from 2.88%* of GDP to 6.50%, with 7 quarters exceeding 3% of GDP, the deficit was reduced during the Carter Administration to under 3% of GDP in the first quarter of 1977 and remained in the 0% to less than 3% range, with a low of 0.47%, for the rest of President Carter’s term.

These small Federal deficits were accompanied by small trade deficits by contemporary standards, ranging from a high of 1.21% of GDP to a low of 0.10%. In addition, there were five quarters of small trade surpluses during the Carter Administration, as well. In spite of this generally favorable context, the Government could not achieve price stability because its leaders in all branches were ideologically biased against using the right methods to control the cost-push oil inflation being caused by the spike in oil prices due to Saudi policy during these years. In fact, the Government mostly executed a textbook case of what not to do.

Cost-push inflation cannot be eliminated without killing the economy if one relies on increased taxes, reduced Government spending and high interest rates, which is the deficit hawk prescription. All that will and did do is to move toward macroeconomic and microeconomic austerity. The way cost-push inflation has to be fixed is through bringing alternative sources of supply, wage and price controls, and rationing online.

We know these last two measures are hard to take for Americans and hard to enforce. But they worked during WWII (pp. 95 – 120) even in a time of full employment, and would have worked again if the Congress and the Carter Administration would have employed them sufficiently vigorously. But even though the Administration and Congress did implement wage and price “guidelines” in 1978, and then moved on to tighter controls later, implemented by a Council of Wage and Price Stability, the prices affected were limited in scope, amounting to about half the prices in the economy, and the enforcement of standards wasn’t thoroughgoing, in part because the regulatory staff implementing the program was only 10% of the size of a comparable staff during the Nixon Administration.

As for bringing new supplies online, that is the best cure for cost-push inflation, but the problem with it is that it can take a good deal of time to work. Ironically, Jimmy Carter did initiate this cure for Saudi-induced oil inflation during his Administration, when he de-regulated natural gas production. The problem was that the new supplies did not begin to have an impact for some time. Eventually they did, but only after President Carter was defeated by Ronald Reagan, and only after the availability of more natural gas created an international oil glut, the primary reason for the fall of inflation in the Reagan Administration.

The secondary reason for the fall of inflation was Volcker backing off the Federal Funds rate. The Reagan recovery couldn’t have occurred without that; but, on the other hand, Volcker’s move wouldn’t have been effective if the oil price hadn’t already fallen.

So, the bottom line here, is that the Government did mostly fiscally irresponsible things in seeking price stability during the Carter Administration, while wrapping itself in the moral sanctimony of preaching the necessity for sacrifice. The one clearly good thing it did was to de-regulate natural gas. That eventually worked, and if Congress and the President had combined that with oil rationing and strict enforcement of price controls on domestic supplies, export controls on domestic oil, application of price controls on oil imports, and perhaps limited wage controls, then the economy could have survived without Paul Volcker’s Fed drying up the credit flow and producing a prolonged recession.

Implementing the right of health care for everyone

Carter promised passage of a national health insurance plan during his campaign, but when he was elected he backed off that idea as soon he was warned about the perceived likely inflationary impact of such legislation. This fear dogged his Administration and was a major factor in his inability to come to agreement with Teddy Kennedy and Russell Long on a bill that all three could support.

As his term passed, hesitation and delay resulted in his chance of passing a Medicare for All or other national health insurance bill slipping away, even though he had enormous Democratic majorities in both Houses during his first two years, and healthy majorities in his last two. His fear of inflation and concerns for fiscal responsibility as he defined it, prevented him from making a deal with Democrats supporting a single-payer system. He also insisted that any health reform bill had to safeguard a role for the private insurers.

At the time spending on health care amounted to 9% of GDP. Now that figure is at 18%. In retrospect, it is clear that the same beliefs about fiscal responsibility bothered him in this area as in the economic stagnation, full employment, and price stability issue areas. And also that his insistence on his mistaken fiscal responsibility notion, led to fiscally irresponsible policies, that, in turn, eventually led to the health care sector doubling the proportion of GDP it consumes on an annual basis, and also to many years of unnecessary fatalities, bankruptcies, foreclosures, and family breakups due to lack of universal health insurance.

In retrospect, this is one of areas of the Government’s biggest failures during the Carter Administration. The President was reluctant to make changes that excluded private interests, and to use the Government’s recently acquired greater policy space existing because the Government was now a sovereign fiat currency issuer to spend for the public purpose. His lack of faith in the ability of the Government to do things well, and his ideological faith in the superiority of the private sector to the Government as an agent of change, undermined his effectiveness in this as well as the other areas discussed thus far. It also has bestowed a very high cost on most Americans since 1981.

The Government, led by Carter during this period, could not even conceive of just letting the twin deficits (Trade and Budget) float, and accommodating the trade and import desires of the private sector. Had he been able to do so, he might have been been able to overcome stagflation, create prosperity, and produce low-cost universal health insurance for everyone.

Watch for my next post on the Government’s failure to legislate enduring educational reform during the period 1977 – 1981.

*My thanks to Professors Scott Fullwiler and Stephanie Kelton for kindly providing me with their quarterly time series data on Sectoral Financial Balances which I’ve drawn upon for the deficit, and GDP numbers I’ve used in this post.

See original article:
Real Fiscal Responsibility 3; Carter: Inflation and Health Care

Sick <b>health insurance</b> scheme leaves patients helpless – The Punch

Minister of Health, Professor Onyebuchi Chukwu

Minister of Health, Professor Onyebuchi Chukwu

The crave for profitability by operators of the National Health Insurance Scheme is breeding bad ethics and eroding quality health care delivery for subscribers, NIKE POPOOLA writes

DISGRUNTLED ENROLEES

Mrs. Aderonke Korede works in a telecommunications firm that registered its employees with a Health Maintenance Organisation under the National Health Insurance Scheme.

She expected her health plan with the HMO to allow her to deliver her baby through Caesarean section. However, when the delivery time came, the HMO refused to bear the responsibility, claiming that her health plan did not cover such a procedure.

After unsuccessfully persuading the HMO to live up to its responsibility, her husband agreed to pay the hospital bill when his wife’s health showed signs of deterioration. The Koredes felt the HMO’s refusal to pick the bill had defeated the essence of having a health insurance in place.

Aderonke’s husband, Babatunde, says, “The experience was really traumatic. I could not stand the attitude of the HMO and risk the lives of my wife and our unborn baby; so, I had to go back to the money we were saving to roof the small house we are building in Ikorodu to fund the operation.

“Almost a year after, we’ve not been able to raise enough money to roof the house because of other contending issues. The development has left us at the mercy of our troublesome landlord and my wife is even sceptical of going to the hospital even for services covered by her health insurance package with the HMO.”

Different complaints emerge daily from both the enrolees, who are registered with the HMOs, and the hospitals, which are designated as health care providers under the NHIS.

On the other hand, the HMOs are also complaining about the treatment that the hospitals are meting out to them, especially when it comes to money matters. The relationship between the HMOs and the hospitals can best be described as that between a cat and a mouse, because they are always suspicious of each other.

The strained relationship between the HMOs and the hospitals has left the enrolees at the receiving end of terrible services.

Yet, amid the challenges militating against the ability of the scheme to provide quality health care services, little is being done to address the issues by the regulator of the scheme.

Unlike the financial services sector, where the regulators take strict and decisive actions, players in the health insurance sector in the country have continued to do things their own way.

The NHIS ensures the pooling of funds from different sectors of the economy, with many people contributing money but only a few of them expected to fall ill at a particular time. The essence is to guarantee free health care for the contributors whenever the need arises.

While the importance of a virile health insurance scheme cannot be over emphasized, experts are of the view that majority of those on the NHIS enjoy cover only for minor ailments.

When there is a need for surgery or an expensive treatment, the HMOs always require the hospitals to take permission from them. If not, they end up not paying for the enrolee’s treatment.

In most cases, enrolees have to pay from their pockets for such treatment. In times of emergencies, the hospitals may either have the challenge of reaching the HMO; or the HMO simply refuses to pay.

An enrolee, who works in an oil company, Mr. Tunde Atolagbe, will rather pay for his treatment than to depend solely on his health insurance plan because he lacks confidence in the cheap services being rendered by the hospitals in their bid to make profits.

“I use a particular hospital alongside my colleagues in the office through our HMO, but you find that the types of drugs that they are giving you may be different from when you are paying from your pocket,” he says.

Mr. Adeolu Oyeniran works in an oil company. He says he stopped getting free treatment in his hospital last November.

“Whenever I go to the hospital, they say they cannot treat me because the HMO has stopped service to my organisation. I am sure my employer has not been paying the HMO and this money is removed from my salary,” he laments.

HMOs VERSUS HOSPITALS

Common complaints by the hospitals against the HMOs include default in paying capitation (the amount payable per head irrespective of whether the person draws from pool of funds or not for a certain period of time); paying ridiculously low capitation; and delay in payment, even when the HMOs have collected their premium from the enrolees.

The hospitals are in a dilemma because they stand to be disengaged if they make official reports of HMOs indebtedness to them.

This hostile condition of doing business is forcing the hospitals to render very cheap services that may leave the patients worse off.

According to the result of a health insurance survey conducted by the Lagos Chamber of Commerce and Industry, majority of the enrolees are absolutely displeased with not receiving commensurate treatment for the premiums paid compared to when they visit their family or personal hospitals where they pay on the go.

The Director, Research and Advocacy, LCCI, Mr. Vincent Nwani, says the survey found out that many enrolees were actually opting out of being treated by HMO-registered hospitals, preferring to patronise their personal doctors for better treatment.

The average enrolee, according to the survey, thinks that he is fully covered by the scheme irrespective of the nature of the ailment.

Nwani says the hospitals are complaining that the capitation fees being paid to them are very small; adding that the present monthly capitation that the HMOs pay per person to the hospitals is between N500 and N750, but adds that some enrolees make regular visits to the hospitals even for minor complaints.

Those with serious diseases and infections want perfect treatment with the N500 or N750 paid by their HMOs monthly, he says.

The LCCI investigation shows that complaints are not limited to the hospitals. The HMOs too are not happy, because they say that sometimes when their corporate clients go to the hospitals for inspection, they get bad reception.

Some hospitals, Nwani says, accumulate bills for up to three months before sending them, and at the end of the day, they complain of delayed payment.

He also observes that the HMOs do not really explain in details to their clients the plans they registered for. This, he says, makes patients with the most basic plan to go to the hospital demanding major surgeries to be performed on them, or comparing their level of treatment to others with more comprehensive plans.

Recently, one of the hospitals being owed a large sum, in a mail to one of the HMOs, narrated how several attempts made to recover the money had proved abortive, and how the employees of the HMO had been lackadaisical to its plight despite sending monthly bills.

In response, the HMO made it clear that it was doing the health care provider a favour by having it on its register, and expressed frustration that its gesture was not appreciated!

Presently, about 5.5 million Nigerians are registered under the NHIS. Seventy-five per cent of these are Federal Government employees who are mandatorily insured, while the remaining are private sector employees.

The health insurance scheme, whose implementation began about 16 years ago with the signing into law of the NHIS Act, 1999, has continued to grow at a very slow pace.

Under the scheme, 77 HMOs are licensed and they are working with about 7,000 health care providers. The health care providers are hospitals that should be well equipped, but because most of them render services on credit, it has been extremely difficult for them to meet set standards.

At the commencement of the scheme, the minimum required capital base for each HMO was N30m. It was later reviewed to N100m, and it is now N400m.

RISING FRAUDULENT ACTIVITIES

Instead of prioritising quality health care delivery, fraudulent activities are prevalent among professionals in the health insurance scheme. For instance, Nwani says the results of investigations carried out by the LCCI WERE really displeasing.

He says, “One of the HMOs we visited during the fieldwork informed us that it had been receiving unrealistic bills from the hospitals. A mystery shopping was carried out by the HMO by sending one of its members of staff as a patient to one of the suspected hospitals that normally sent exorbitant bills. The disguised patient was treated for a very minor ailment and was given drugs.

“The staff kept the drugs, waiting for the hospital to send the bill. When the bill was received, it was discovered that the hospital had inflated it and added some drugs that were not given to him. The HMO took the drugs and the bill to the hospital as a proof that it had been sending unrealistic bills,” he notes.

Narrating another case, Nwani says, “One of the registered hospitals sent a bill to a HMO that a client was treated for dog bite. When the HMO called the parents of the boy to sympathise with them, it was discovered that the boy was never bitten by a dog. The hospital cooked up the case in order to extort the HMO.”

BETWEEN HMOS AND ENROLEES

The Managing Director, Healthcare International, Mr. Tosin Awosika, says HMOs actually have structures in place to ensure quality health care delivery to the enrolees.

“Before we accredit hospitals, we would have inspected them to ascertain what they can do and what they cannot do. On a regular basis, we do quality assurance visits to check what they are doing and how they are treating the clients. We have a feedback system; if there is an issue, we expect the clients to get back to us,” he says.

According to him, HMOs have the right to delist hospitals that are not doing well and transfer the patients to other hospitals for better care. With these measures in place, Awosika says the hospitals will ensure efficiency because they will not want to be delisted.

Many enrolees also erroneously believe that once they pay a certain premium, they will enjoy full treatment for any ailment throughout the year, but are shocked that their health plans sometimes operate like the mobile phone that goes off ones its credit has been exhausted.

The President, Actors Guild of Nigeria, Ibinabo Fiberesima, says, “Some of my members, after the first and second visits to the hospital, do receive text messages from the hospital that they have exhausted their plan.”

The Managing Director, MetroHealth, HMO Limited, Mr. Kola Awokoya, stresses the need to build the health insurance scheme on trust. “The responsibility of enlightening the enrolee on the coverage of his health plan lies with the HMO and the employers,” he explains.

It has been found out that the quality structures put in place by the HMOs are not working perfectly. A survey conducted by The PUNCH, using questionnaires to collect information from enrolees of different HMOs, showed that most of them subscribed to the cheapest plans, which do not provide treatment for the illnesses killing majority of Nigerians presently.

It was discovered that none of the enrolees had ever been called by their HMOs to either enquire about their welfare or ask if they were satisfied with their health plans.

Despite the fact that their employers subscribed to health insurance on their behalf, 30 per cent of respondents preferred to go to their family doctors than visit the hospitals recommended by their HMOs.

Mr. Gbenga Ilemobayo enrolled his family of five with a HMO and paid a premium price for choosing a band ‘B’ hospital and subscribing to the ‘Gold’ plan, but when one of his sons required an urgent surgery for a medical condition called hernia, the hospital could not obtain authorisation from the HMO to carry on with the procedure for more than 16 hours. The HMO’s customer care lines rang for hours without anybody picking up the calls.

Ilemobayo explains, “Due to the severity of the boy’s condition, the senior doctor at the hospital told me that the operation had to be done immediately and I had to approach my brother to lend me some money, which I could deposit.

“It was a difficult period for my family because I had just paid the school fees of my three children, who are all in private schools. Their mother has been out of job for about three years and my income leaves no room for any serious savings.”

MULTIPLE COMPLAINTS

The immediate President, Nigerian Medical Association, Dr. Osahon Enabulele, accuses some of the HMOs of not paying their capitation to the health providers, adding that the issue was raised during the Presidential Summit on Universal Health Coverage held in Abuja in March this year.

“At the last presidential summit on universal health coverage, the same allegation was made. It is very criminal for any HMO to withhold the capitation of the provider because that invariably will not motivate the provider to provide the needed quality services,” he says.

As a result of default, he says that the HMOs are short changing the insurance scheme and the health care system, which will invariably impact on the patients, who may get poor services resulting from lack of motivation.

Enabulele says a lot of disgruntled doctors have reported their HMOs to the NHIS, adding that the NHIS leadership has asked the doctors to provide information to establish that some of the HMOs are actually owing the providers their due capitation.

“It is criminal for any HMO to withhold capitation to the provider and the NMA frowns seriously on that, and we charge the leadership of the NHIS scheme to fish out such HMOs and appropriately discipline them so that the scheme does not die a natural death as a result of the poor assimilation of the providers of care due to the antics and acts of some of the HMOs,” he says.

The NMA boss notes that if a HMO is having grievances against an employer who refuses to pay his premium, such complaints should be tendered before the governing board of the NHIS.

Enabulele explains that it is not in the power of the HMOs to deny anyone of the services that they have promised to provide if the customer has paid the agreed premium.

“The HMOs have to pay their own capitation to the subscribers; once a portal has been allocated to a provider for health care facility, it is under obligation. For anybody to be allocated to a provider, it is assumed that the person has paid up his premium and subscribed to the care,” he says.

The Healthcare Providers Association of Nigeria is the umbrella body of the hospitals registered under the NHIS.

The National President, HCPAN, Dr. Adenike Olaniba, says the major frictions between the HMOs and the providers are low capitation, abysmally low tariff, indebtedness to the providers by the HMOs, slashing of hospitals’ bills and non-payment of capitation, among others.

Olaniba, who is also a consultant public health physician, observes that many private providers’ clinics are closing down as they cannot cope with the financial burden imposed on them by health insurance.

She explains that in February 2012, a joint consultative meeting was held in the premises of Healthcare International HMO between the Health and Managed Care Association of Nigeria (the umbrella body of the HMOs) and HCPAN.

Some of the items on the agenda of the meeting, she says, were the implementation of the new NHIS capitation, HMOs’ indebtedness to the providers, slashing of bills, care of the chronically ill and standardised contractual agreement between the HMOs and care providers.

“In order to fast track the review of capitation and tariff, the HCPAN forwarded the report of its tariff and pricing committee to the forum for consideration. No feedback has been received from the HMCAN on this document,” she adds.

If the issues are positively addressed, Olaniba says the relationship between the two stakeholders will improve tremendously.

Copyright PUNCH.
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.

Contact: editor@punchng.com

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Sick <b>health insurance</b> scheme leaves patients helpless – The Punch

Sick <b>health insurance</b> scheme leaves patients helpless (1)

Minister of Health, Professor Onyebuchi Chukwu

Minister of Health, Professor Onyebuchi Chukwu

The crave for profitability by operators of the National Health Insurance Scheme is breeding bad ethics and eroding quality health care delivery for subscribers, NIKE POPOOLA writes

DISGRUNTLED ENROLEES

Mrs. Aderonke Korede works in a telecommunications firm that registered its employees with a Health Maintenance Organisation under the National Health Insurance Scheme.

She expected her health plan with the HMO to allow her to deliver her baby through Caesarean section. However, when the delivery time came, the HMO refused to bear the responsibility, claiming that her health plan did not cover such a procedure.

After unsuccessfully persuading the HMO to live up to its responsibility, her husband agreed to pay the hospital bill when his wife’s health showed signs of deterioration. The Koredes felt the HMO’s refusal to pick the bill had defeated the essence of having a health insurance in place.

Aderonke’s husband, Babatunde, says, “The experience was really traumatic. I could not stand the attitude of the HMO and risk the lives of my wife and our unborn baby; so, I had to go back to the money we were saving to roof the small house we are building in Ikorodu to fund the operation.

“Almost a year after, we’ve not been able to raise enough money to roof the house because of other contending issues. The development has left us at the mercy of our troublesome landlord and my wife is even sceptical of going to the hospital even for services covered by her health insurance package with the HMO.”

Different complaints emerge daily from both the enrolees, who are registered with the HMOs, and the hospitals, which are designated as health care providers under the NHIS.

On the other hand, the HMOs are also complaining about the treatment that the hospitals are meting out to them, especially when it comes to money matters. The relationship between the HMOs and the hospitals can best be described as that between a cat and a mouse, because they are always suspicious of each other.

The strained relationship between the HMOs and the hospitals has left the enrolees at the receiving end of terrible services.

Yet, amid the challenges militating against the ability of the scheme to provide quality health care services, little is being done to address the issues by the regulator of the scheme.

Unlike the financial services sector, where the regulators take strict and decisive actions, players in the health insurance sector in the country have continued to do things their own way.

The NHIS ensures the pooling of funds from different sectors of the economy, with many people contributing money but only a few of them expected to fall ill at a particular time. The essence is to guarantee free health care for the contributors whenever the need arises.

While the importance of a virile health insurance scheme cannot be over emphasized, experts are of the view that majority of those on the NHIS enjoy cover only for minor ailments.

When there is a need for surgery or an expensive treatment, the HMOs always require the hospitals to take permission from them. If not, they end up not paying for the enrolee’s treatment.

In most cases, enrolees have to pay from their pockets for such treatment. In times of emergencies, the hospitals may either have the challenge of reaching the HMO; or the HMO simply refuses to pay.

An enrolee, who works in an oil company, Mr. Tunde Atolagbe, will rather pay for his treatment than to depend solely on his health insurance plan because he lacks confidence in the cheap services being rendered by the hospitals in their bid to make profits.

“I use a particular hospital alongside my colleagues in the office through our HMO, but you find that the types of drugs that they are giving you may be different from when you are paying from your pocket,” he says.

Mr. Adeolu Oyeniran works in an oil company. He says he stopped getting free treatment in his hospital last November.

“Whenever I go to the hospital, they say they cannot treat me because the HMO has stopped service to my organisation. I am sure my employer has not been paying the HMO and this money is removed from my salary,” he laments.

HMOs VERSUS HOSPITALS

Common complaints by the hospitals against the HMOs include default in paying capitation (the amount payable per head irrespective of whether the person draws from pool of funds or not for a certain period of time); paying ridiculously low capitation; and delay in payment, even when the HMOs have collected their premium from the enrolees.

The hospitals are in a dilemma because they stand to be disengaged if they make official reports of HMOs indebtedness to them.

This hostile condition of doing business is forcing the hospitals to render very cheap services that may leave the patients worse off.

According to the result of a health insurance survey conducted by the Lagos Chamber of Commerce and Industry, majority of the enrolees are absolutely displeased with not receiving commensurate treatment for the premiums paid compared to when they visit their family or personal hospitals where they pay on the go.

The Director, Research and Advocacy, LCCI, Mr. Vincent Nwani, says the survey found out that many enrolees were actually opting out of being treated by HMO-registered hospitals, preferring to patronise their personal doctors for better treatment.

The average enrolee, according to the survey, thinks that he is fully covered by the scheme irrespective of the nature of the ailment.

Nwani says the hospitals are complaining that the capitation fees being paid to them are very small; adding that the present monthly capitation that the HMOs pay per person to the hospitals is between N500 and N750, but adds that some enrolees make regular visits to the hospitals even for minor complaints.

Those with serious diseases and infections want perfect treatment with the N500 or N750 paid by their HMOs monthly, he says.

The LCCI investigation shows that complaints are not limited to the hospitals. The HMOs too are not happy, because they say that sometimes when their corporate clients go to the hospitals for inspection, they get bad reception.

Some hospitals, Nwani says, accumulate bills for up to three months before sending them, and at the end of the day, they complain of delayed payment.

He also observes that the HMOs do not really explain in details to their clients the plans they registered for. This, he says, makes patients with the most basic plan to go to the hospital demanding major surgeries to be performed on them, or comparing their level of treatment to others with more comprehensive plans.

Recently, one of the hospitals being owed a large sum, in a mail to one of the HMOs, narrated how several attempts made to recover the money had proved abortive, and how the employees of the HMO had been lackadaisical to its plight despite sending monthly bills.

In response, the HMO made it clear that it was doing the health care provider a favour by having it on its register, and expressed frustration that its gesture was not appreciated!

Presently, about 5.5 million Nigerians are registered under the NHIS. Seventy-five per cent of these are Federal Government employees who are mandatorily insured, while the remaining are private sector employees.

The health insurance scheme, whose implementation began about 16 years ago with the signing into law of the NHIS Act, 1999, has continued to grow at a very slow pace.

Under the scheme, 77 HMOs are licensed and they are working with about 7,000 health care providers. The health care providers are hospitals that should be well equipped, but because most of them render services on credit, it has been extremely difficult for them to meet set standards.

At the commencement of the scheme, the minimum required capital base for each HMO was N30m. It was later reviewed to N100m, and it is now N400m.

RISING FRAUDULENT ACTIVITIES

Instead of prioritising quality health care delivery, fraudulent activities are prevalent among professionals in the health insurance scheme. For instance, Nwani says the results of investigations carried out by the LCCI WERE really displeasing.

He says, “One of the HMOs we visited during the fieldwork informed us that it had been receiving unrealistic bills from the hospitals. A mystery shopping was carried out by the HMO by sending one of its members of staff as a patient to one of the suspected hospitals that normally sent exorbitant bills. The disguised patient was treated for a very minor ailment and was given drugs.

“The staff kept the drugs, waiting for the hospital to send the bill. When the bill was received, it was discovered that the hospital had inflated it and added some drugs that were not given to him. The HMO took the drugs and the bill to the hospital as a proof that it had been sending unrealistic bills,” he notes.

Narrating another case, Nwani says, “One of the registered hospitals sent a bill to a HMO that a client was treated for dog bite. When the HMO called the parents of the boy to sympathise with them, it was discovered that the boy was never bitten by a dog. The hospital cooked up the case in order to extort the HMO.”

BETWEEN HMOS AND ENROLEES

The Managing Director, Healthcare International, Mr. Tosin Awosika, says HMOs actually have structures in place to ensure quality health care delivery to the enrolees.

“Before we accredit hospitals, we would have inspected them to ascertain what they can do and what they cannot do. On a regular basis, we do quality assurance visits to check what they are doing and how they are treating the clients. We have a feedback system; if there is an issue, we expect the clients to get back to us,” he says.

According to him, HMOs have the right to delist hospitals that are not doing well and transfer the patients to other hospitals for better care. With these measures in place, Awosika says the hospitals will ensure efficiency because they will not want to be delisted.

Many enrolees also erroneously believe that once they pay a certain premium, they will enjoy full treatment for any ailment throughout the year, but are shocked that their health plans sometimes operate like the mobile phone that goes off ones its credit has been exhausted.

The President, Actors Guild of Nigeria, Ibinabo Fiberesima, says, “Some of my members, after the first and second visits to the hospital, do receive text messages from the hospital that they have exhausted their plan.”

The Managing Director, MetroHealth, HMO Limited, Mr. Kola Awokoya, stresses the need to build the health insurance scheme on trust. “The responsibility of enlightening the enrolee on the coverage of his health plan lies with the HMO and the employers,” he explains.

It has been found out that the quality structures put in place by the HMOs are not working perfectly. A survey conducted by The PUNCH, using questionnaires to collect information from enrolees of different HMOs, showed that most of them subscribed to the cheapest plans, which do not provide treatment for the illnesses killing majority of Nigerians presently.

It was discovered that none of the enrolees had ever been called by their HMOs to either enquire about their welfare or ask if they were satisfied with their health plans.

Despite the fact that their employers subscribed to health insurance on their behalf, 30 per cent of respondents preferred to go to their family doctors than visit the hospitals recommended by their HMOs.

Mr. Gbenga Ilemobayo enrolled his family of five with a HMO and paid a premium price for choosing a band ‘B’ hospital and subscribing to the ‘Gold’ plan, but when one of his sons required an urgent surgery for a medical condition called hernia, the hospital could not obtain authorisation from the HMO to carry on with the procedure for more than 16 hours. The HMO’s customer care lines rang for hours without anybody picking up the calls.

Ilemobayo explains, “Due to the severity of the boy’s condition, the senior doctor at the hospital told me that the operation had to be done immediately and I had to approach my brother to lend me some money, which I could deposit.

“It was a difficult period for my family because I had just paid the school fees of my three children, who are all in private schools. Their mother has been out of job for about three years and my income leaves no room for any serious savings.”

MULTIPLE COMPLAINTS

The immediate President, Nigerian Medical Association, Dr. Osahon Enabulele, accuses some of the HMOs of not paying their capitation to the health providers, adding that the issue was raised during the Presidential Summit on Universal Health Coverage held in Abuja in March this year.

“At the last presidential summit on universal health coverage, the same allegation was made. It is very criminal for any HMO to withhold the capitation of the provider because that invariably will not motivate the provider to provide the needed quality services,” he says.

As a result of default, he says that the HMOs are short changing the insurance scheme and the health care system, which will invariably impact on the patients, who may get poor services resulting from lack of motivation.

Enabulele says a lot of disgruntled doctors have reported their HMOs to the NHIS, adding that the NHIS leadership has asked the doctors to provide information to establish that some of the HMOs are actually owing the providers their due capitation.

“It is criminal for any HMO to withhold capitation to the provider and the NMA frowns seriously on that, and we charge the leadership of the NHIS scheme to fish out such HMOs and appropriately discipline them so that the scheme does not die a natural death as a result of the poor assimilation of the providers of care due to the antics and acts of some of the HMOs,” he says.

The NMA boss notes that if a HMO is having grievances against an employer who refuses to pay his premium, such complaints should be tendered before the governing board of the NHIS.

Enabulele explains that it is not in the power of the HMOs to deny anyone of the services that they have promised to provide if the customer has paid the agreed premium.

“The HMOs have to pay their own capitation to the subscribers; once a portal has been allocated to a provider for health care facility, it is under obligation. For anybody to be allocated to a provider, it is assumed that the person has paid up his premium and subscribed to the care,” he says.

The Healthcare Providers Association of Nigeria is the umbrella body of the hospitals registered under the NHIS.

The National President, HCPAN, Dr. Adenike Olaniba, says the major frictions between the HMOs and the providers are low capitation, abysmally low tariff, indebtedness to the providers by the HMOs, slashing of hospitals’ bills and non-payment of capitation, among others.

Olaniba, who is also a consultant public health physician, observes that many private providers’ clinics are closing down as they cannot cope with the financial burden imposed on them by health insurance.

She explains that in February 2012, a joint consultative meeting was held in the premises of Healthcare International HMO between the Health and Managed Care Association of Nigeria (the umbrella body of the HMOs) and HCPAN.

Some of the items on the agenda of the meeting, she says, were the implementation of the new NHIS capitation, HMOs’ indebtedness to the providers, slashing of bills, care of the chronically ill and standardised contractual agreement between the HMOs and care providers.

“In order to fast track the review of capitation and tariff, the HCPAN forwarded the report of its tariff and pricing committee to the forum for consideration. No feedback has been received from the HMCAN on this document,” she adds.

If the issues are positively addressed, Olaniba says the relationship between the two stakeholders will improve tremendously.

Copyright PUNCH.
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.

Contact: editor@punchng.com

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Sick <b>health insurance</b> scheme leaves patients helpless (1)

U.S. <b>Health Care</b> Violates <b>International</b> Laws Against Racism

A black and white drawing of women of color protesting, holding a sign that says "We demand reproductive freedom for all women."A new report has been released by powerhouse reproductive justice organizations the Center for Reproductive Rights, the National Latina Institute for Reproductive Health and Sistersong Women of Color Reproductive Justice Collective, titled “Reproductive Injustice: Racial and Gender Discrimination in U.S. Health Care.” This potentially ground-breaking report targets the U.S. government and United Nations, arguing that U.S. health care is in violation of the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD).

The report highlights the devastating rate of maternal mortality and associated risk factors for Latinas and African-American women in the U.S. Among many horrific statistics, it demonstrates that in areas of the U.S., women of color suffer from maternal mortality rates higher than countries like Rwanda and Kenya. I hope you’ll take a minute to read through Miriam Zoila Pérez’s great analysis of the report, but I’ll highlight a particularly salient quote from it:

With the Latina immigrant women in “Reproductive Injustice,” the major issue was denial of health care based on immigration status, which the report deems a form of discrimination. Recent Texas policies have eliminated funding for women’s reproductive health care that many could receive regardless of immigration status or a lack of insurance. The report states that “immigrant women of reproductive age are approximately 70 percent more likely than their U.S-born peers to lack health insurance.

Even documented immigrants are barred from accessing health care benefits. Federal policy imposes a five-year waiting period for documented immigrants before they can be eligible for Medicaid. Texas goes a step further and refuses to extend Medicaid coverage to legal immigrants even after five years. Recent cuts to family planning funding in Texas have had a significant impact on immigrant women who live there. For example, in the Rio Grande Valley, the Southernmost part of Texas along the U.S.-Mexico border, the funding cuts and resulting closure of clinics has resulted in a 72 percent decrease in women receiving services, according to “Reproductive Injustice.”

Read more over at Colorlines.

Image Credit.

29. August 2014 by Juliana
Categories: Reproductive Health | Tags: health, maternal mortality, report, reproductive justice, women of color | Leave a comment

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U.S. <b>Health Care</b> Violates <b>International</b> Laws Against Racism

Why I Joined Samaritan Ministries <b>International</b> – Granny Miller

My husband and I are both self-employed.
Neither of us has had any type of health insurance for about 8 years.

Fact is we don’t need health insurance.
Fact is we don’t want health insurance.

We seldom get sick.
When we do need medical care we pay as we go and pay in cash.
Because “Cash is King”, we pick our own doctors, and our doctor does what he/she thinks is best for us without any 3rd party interference.
Doctors love cash and always do a steep discount for fast on-the-spot payment.

Believe it or not in the last 8 years we have saved over $110,000 by not having so called health insurance. That’s enough to buy a house or pay for two heart attacks in cash.

We spend about $450 – $550 a year in total for health care.
That’s all doctors, drugs and 3 times a year dental check ups and teeth cleaning. My husband’s Lyme disease only costs us $280.

Interestingly enough, by not buying into the big insurance fear mongering we’ve become more self-reliant.
We are now more responsible and much more proactive about our own health.
Ditching corporate health insurance was a smart move for us.

But this year we face Obamacare income tax penalties.
Well I’m not about to pay one dollar more to the IRS due a corrupted Supreme Court.

Samaritan Ministries

Samaritan Ministries Logo

So in June I joined Samaritan Ministries International. It was the smartest thing I’ve done in a long time.
Only I wish I’d done it sooner.
Samaritan Ministries is health care for people of faith. Samaritan is exempt from Obamacare.

It costs me $180 a month as a single person. Now that my husband has recently stopped smoking he’ll be joining me at Samaritan. The total cost for two people is $360 per month.
The cost for a family of any size has never exceeded $405 a month. The cost for a single parent family is $250.

There are requirements to join Samaritan.
Members must be professing Christians who attend church regularly. They must agree to abstain from sinful practices such as drug and alcohol abuse and sexual immorality. The use of tobacco is forbidden. Members must be accountable to their pastor or other church leader for the medical needs they submit.

For me it’s been a privilege to be able to help share in another person’s health care bills and pray for them.

I also feel good that not a penny of my hard earned money goes to pay for abortions, questionable psychiatric drugs and idiot treatments that go against my beliefs and common sense.

Evil Corporate Insurance Fat Cats and Washington, D.C. Morons and Control Freaks stay out of my doctor’s direct care for me.
If you don’t know about Samaritan Ministries International maybe it’s time to find out more about them.
Watch the video below to learn more. You’ll be glad you did.

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Why I Joined Samaritan Ministries <b>International</b> – Granny Miller

Expansion of Mental <b>Health Care</b> Hits Obstacles – <b>International</b> <b>…</b>

TimesMentalHealth

Click Here to Read  Expansion of Mental Health Care Hits Obstacles By Abby Goodnough in The New York Times on August 28, 2014.

Terri Hall talks about her struggles with depression, and the care she has been receiving since she signed up for health insurance. Video Credit By Abby Goodnough on Publish Date August 28, 2014.

Explore posts in the same categories: Audio/Video, General News

This entry was posted on Thursday, August 28th, 2014 at 9:22 am and is filed under Audio/Video, General News. You can subscribe via RSS 2.0 feed to this post’s comments. You can comment below, or link to this permanent URL from your own site. Your comments will be moderated but will appear as soon as humanly possible.

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Expansion of Mental <b>Health Care</b> Hits Obstacles – <b>International</b> <b>…</b>

Invest In Your Future With These Personal Finance Tips

by on Monday, August 25th, 2014 | Comments Off

TIP! If you often wonder where your money goes, try writing down your daily expenditures for a month to gain a true picture of where you are overspending. However, if you document it somewhere you are never going to look, it will do you no good.

Do you wish to handle money better in the future starting now? Anyone can change their spending habits and manage their personal finances, it just takes some knowledge. The article below will give you some basic information to make sure that you are financially responsible.

International News

TIP! To maintain a good credit score, use more than one credit card. Remember, however, not to go overboard; do not have more than four credit cards.

Stay tuned to world news so you are aware of possible global market movements. It’s problematic to ignore international news in favor of U.S. news if you’re trying to trade currencies. Knowing about international news will help improve your strategy for the market.

TIP! If your debt has been turned over to a collection agency, keep in mind that if the debt is not collected, it will eventually expire. Ask a financial expert to find out when the debt you owe will elapse and do not make a payment to a collection agenct if they are working to collect an old debt.

Try to eat in the restaurants that are frequented by the local people in order to eat economically when you visit foreign countries. Your hotel restaurant, and any other restaurants in tourist areas, are likely to be way overpriced, so do some research and find out where the locals eat. You can find quaint restaurants with lower prices and great tasting local cuisine.

TIP! Find a checking account that is free. You can try banks in your area or even a credit union.

Make solid plans for keeping your personal finances orderly for your future. Having a solid plan is an effective motivational tool, as it helps you to keep a reward in sight, which is more satisfying than pointless spending.

TIP! Don’t take out large amounts of student loan debt unless you expect to be in a financial situation to pay it back. You could wind up in serious debt if you pick a costly private school when you don’t even know what career path you want to take.

Be prepared by having the correct health insurance policy at hand. Everyone, at some point in life, will get sick. For this reason, it is vital to have good health insurance. You may find hospital bills in the amount of $20,000, or even more. You will have a big issue if you cannot carry health insurance.

TIP! Don’t waste money on lottery tickets. Put the money in your savings account instead.

If your spouse has a great credit score, use this to your advantage. If you have a bad credit rating, you should try your best to rebuild your rating by using any credit cards that you own regularly and paying them off in full each month. Once both of you have good credit scores, you can jointly apply for loans that evenly share your debt.

TIP! Having an account for rainy days is a wise way to prepare for emergencies. Depending on your situation, you may choose to save in order to get out of debt or for a future expense.

Having a garage sale is a great way to make some spending money and also rid the house of clutter. Also, talk to neighbors to find out some of the items that they would like to sell. You can be as entrepreneurial as you want during a garage or yard sale.

TIP! You should use a flexible spending account to your advantage. Using the flexible spending account to pay down medical bills or daycare can actually help you save money in the long run.

When obtaining student loans, make sure that you will be able to pay them back when all is said and done. Choosing a costly private college without having declared a major is a good way to land yourself in perpetual debt.

TIP! If you pay attention to your cash, you will have well controlled properties. Monitor your income as well as your spending, and also analyze how your property performs from an investment standpoint each month.

Some people spend $20 to $30 each week in lottery drawings hoping to ‘win it big.’ Instead, invest that same amount of money in a savings account. This will ensure that you do not lose any money and will improve your financial situation by increasing your savings.

Credit Card

TIP! It may take a little more effort and distance, but you can save a great deal of money over time by using only the ATMs of your bank, credit union, or thrift. Many financial institutions impose fees for using ATMs of non associated banks.

If you’re not yet 21 years of age and are looking for a credit card, you should know that things have changed recently. It used to be easy for college-age students to get a credit card. Today, you must have verifiable income or a co-signer to qualify. Before you apply for an account, learn its specific restrictions.

TIP! If you do not like the hassle of balancing your checkbook manually, you can easily do all the work online. These programs can track your income and expenses, as well as creating a budget plan for you with minimal effort.

The way you look at your finances should be changed at this point. Now that you have read all of this, you will have what it takes to have a better financial future. All you can do now is have lots of determination to succeed in your goal. Don’t allow anything to interfere with your efforts.

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Invest In Your Future With These Personal Finance Tips

International law firms in India offering legal services to ensure professionalism

Martand Law firm India provide marvelous services to determine all legal issues. A law firm is a business unit formed by a group of lawyers who advise the clients about the legal rights and responsibilities. Martand Law firm with the dedicated team provides excellent services to the clients. Our experts have the ability to anticipate and resolve all kinds of legal issues. Our dedicated team put maximum effort to understand your expectations and requirements and provide marvelous services to fulfill all your needs.         

The Legal solution offered by Martand Law Firm to the clients

  • Business immigration
  • Corporate Law
  • Civil litigation Act
  • Construction defects
  • Criminal Act
  • Child welfare and adoptions
  • Collection Act
  • Elder Act
  • EEOC Act
  • Estate or trust Administration Rule
  • Estate Planning
  • Guardianship and probate
  • Legal Drafting
  • Legal Research
  • International law firm 

We have a dedicated team of experienced attorneys, who are able to resolve any legal issue. Our services are for all kinds of industries either larger or smaller. We support you in all activities and assignments including providing help in protecting your strategic and commercial interests. Expert lawyers respond with great patience and always provide the exact solution for any of your queries. Our services help you to manage your organization and formulate financial strategy. We help you to claim your insurance for life insurance, motor vehicle accidents, business loss, health insurance and many more. If any kind of loss occurs in your business insurance policy helps you to overcome that loss. Our lawyers are highly experienced in solving marriage cases. The matrimonial lawyers can effectively sort out any issue related to marriage and divorced law of different religions. We provide excellent legal advisory services to establish your business. Our services cover all aspects of trade and commerce from registration of your company to agreements need to make related to the sale. Any form of criminal background is the biggest impediment for finding a job. Our criminal lawyers have wide knowledge in solving the criminal cases. We assist people to come out of situations like paying fines, imprisonment, and such others.

Martand Law Firm has a team of well skilled and experienced lawyers who treasure the value of diligence and knowledge as well as creativity and innovation in addressing their client’s needs. Our experts offer excellent legal advices that meets the clients needs and expectations.

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International law firms in India offering legal services to ensure professionalism

The Complete Guide to Travel Insurance for the Over 65s UK

With people now living longer, healthier and more active lives, there’s little to stop retired people from living out their dreams by retiring abroad, or taking that round the world cruise. Finding the right travel insurance can be a challenge for the over 65s, however, as much of the insurance industry shies away from cover for this age group.

The good news, however, is that some companies welcome older policy holders, and some cater especially to the senior market. You can find the right travel insurance for your retirement dreams – you just need to understand what you’re looking for.

What type of travel insurance policy do you need?

If your holiday is for less than 30 days, and you’re only planning to go once or twice a year, then a single

Trip policy is probably the most cost effective for you. If you’re planning on taking more than 2 trips a year, a multi-trip travel insurance policy is more likely to fit the bill. Annual policies are also available which will cover you for an unlimited number of trips per year – but most restrict each individual journey to 30 days or less. If you’re going away for more than 30 days, you should look for long stay travel insurance.

If you’re going to retire abroad, look for an expatriate travel policy which will address your unique needs as you settle into your new life.

Websites such as Traveler Friendly Insurance offer a range of Patriot Travel Medical Insurance plans and policies to cater to any length of trip or combination of trips.

What to look for in your travel insurance policy?

All travel insurance policies for the over 65s will include the standard kind of cover you’ve had on every other holiday earlier in life – but you should pay particular attention to the level of travel health insurance cover available. Emergency repatriation cover is essential; should something happen, the costs of getting you back safely to the UK can be astronomical.

Ensure that you are covered for any pre-existing conditions. This may push the price up, but it will be worth it for your peace of mind. Don’t be tempted to lie about your standard of health, as this will invalidate your policy if the worst should happen.

Look for a policy with a 24 hour helpline, to ensure that you don’t need to panic if anything goes wrong.

Do you need cover for loss of medication, or for mobility aids?

Don’t be tempted to skimp on cover

If you’re travelling within Europe, the free EHIC card will entitle you to free or reduced cost health treatment in most European countries, but it does not cover repatriation costs, and should not replace proper travel health insurance. Although travel insurance for the over 65s can be expensive, it’s simply a must-have if you’re to enjoy your retirement travels. The costs of dealing with an illness, accident or emergency without it would be huge. There’s not only the financial cost to consider – a repatriation from the US, for instance, can cost around £60,000 – but the stress and anxiety too. So don’t skimp on your travel insurance cover – but do go ahead and enjoy the trip of a lifetime.

Contact Info:

855-765-6555

Info@TravelerFriendlyInsurance.com

http:/ / www.travelerfriendlyinsurance.com

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The Complete Guide to Travel Insurance for the Over 65s UK

Transcending Obamacare: A Patient-Centered <b>Plan</b> for Near <b>…</b>

 

TRANSCENDING OBAMACARE

A Patient-Centered Plan for Near-Universal Coverage and

Permanent Fiscal Solvency

August 2014


Avik Roy, Senior Fellow, Manhattan Institute

 

EXECUTIVE SUMMARY

In 2010, President Obama signed into law the Patient Protection and Affordable Care Act, also known as the “Affordable Care Act,” the “ACA,” or “Obamacare.” The ACA will reduce the number of Americans without health insurance— an important goal—but it will do so by increasing the cost of U.S. health coverage. Increasing the cost of health coverage, in turn, will worsen two of the nation’s most important policy problems.

The first of those problems is the increasing unaffordability of private health insurance, a problem that is straining the budgets of middle-income Americans, and hampering social mobility. The second problem is the nation’s grave long-term fiscal instability, a problem primarily driven by government spending on health insurance and health care.

Indeed, the ACA will especially drive up the cost of private health insurance that individuals purchase directly. The law will dramatically expand Medicaid, a program with the poorest health outcomes of any health insurance system in the industrialized world. And the ACA, despite spending over $2 trillion over the next decade, will leave 23 million lawful U.S. residents without health insurance, according to estimates from the Congressional Budget Office (CBO).

In other words, the U.S. health care system remains in need of substantial reform, in ways that address the ACA’s deficiencies as well as the system’s preexisting flaws.

The ACA’s supporters wrongly contend that the health law requires only minor tinkering in order to succeed. But the ACA’s critics, in seeking to repeal Obamacare, would not necessarily address the underlying problems that predate the ACA. Furthermore, while it is possible to “repeal and replace” the ACA with a better health care system, it is desirable to develop policy proposals that do not require the disruption implied by repeal in order to put U.S. health spending on a sustainable path.

With these considerations in mind, the proposal contained herein—dubbed the Universal Exchange Plan (“the Plan”)—seeks to substantially repair both sets of health-policy problems: those caused by the ACA and those that predate it. It is the latter set of problems that have denied affordable, high-quality health care to millions of Americans, while presenting the government with crushing health care bills.

The Universal Exchange Plan’s reforms are perfectly compatible with the “repeal and replace” approach, but they do not require the full and formal repeal of the ACA in order to be enacted.

The Universal Exchange Plan would introduce major changes to the broad set of federal health care entitlements: Obamacare, Medicare, and Medicaid. While the Plan is compatible with the “repeal and replace” approach favored by Republicans, it does not require the formal repeal of the Affordable Care Act. Indeed, the Plan uses a reformed version of the ACA’s health insurance exchanges as the basis for far-reaching entitlement reform.

The Plan would repeal many of the ACA’s cost-increasing insurance mandates, including the individual mandate. But it would preserve the ACA’s guarantee that every American can purchase coverage regardless of preexisting conditions. And it would utilize the concept of using federal premium support subsidies, on a means-tested basis, to defray the cost of private health coverage.

It would gradually migrate most Medicaid recipients, along with future retirees, onto these reformed exchanges. This change would dramatically increase the quality of health coverage offered to Americans at or below the poverty line, and preserve the guarantee of health coverage for low- and middle-income seniors, while ensuring the fiscal sustainability of both federal health care commitments. The Plan proposes minor changes to the treatment of employer-sponsored health coverage, while giving workers additional tools to lower their health care bills. It would curb the pricing power of hospitals, cap malpractice damages, and accelerate medical innovation.

Taken together, these changes could usher in a new era of consumer-driven, patient-centered health care.

According to our estimates, the Universal Exchange Plan would, by 2025, increase the number of U.S. residents with health coverage by 12.1million, relative to the Affordable Care Act. Over time, we project that the Plan would outperform the ACA by an even wider margin.

The Plan would also expand economic opportunity for those struggling with high medical bills. It would improve the quality of health care delivered to the poor, and put America’s finances on a permanently stable course.

LEARNING FROM THE BEST INTERNATIONAL HEALTH SYSTEMS

The plan has its roots in real-world examples of market-oriented, cost-effective health reform. Notably, two wealthy nations—Switzerland and Singapore—spend a fraction of what the United States spends on health care subsidies; yet they have achieved universal coverage with high levels of access and quality.

In 2011, the Singaporean government spent $851 per capita on health care: less than a quarter of what the U.S. spent, adjusted for purchasing power parity. Singapore has achieved its savings using a universal system of consumer-driven health care. The government funds catastrophic coverage for every Singaporean, and reroutes a portion of workers’ payroll taxes into health savings accounts that can be used for routine expenses.

Switzerland offers its citizens premium support subsidies, on a sliding scale, for the purpose of buying private health insurance; there are no “public option” government insurers. Low-income individuals are fully subsidized; middle-income individuals are modestly subsidized; and upper-income individuals are unsubsidized. The sliding scale addresses a key challenge posed by welfare programs: mitigating the disincentive for welfare recipients to seek additional work, for fear of losing their benefits.

The Universal Exchange Plan’s Key Reforms
Repeals ACA individual mandate, employer mandate, & all tax hikes except ‘Cadillac Tax’
Emancipates exchanges from costly federal regulation • Combats hospital monopolies
Migrates most Medicaid enrollees and future retirees onto reformed exchanges

Projected Fiscal and Coverage Outcomes
30-year deficit reduction of $8 trillion • 30-year revenue reduction of $2.5 trillion
Makes Medicare Trust Fund permanently solvent • Reduces private-sector premiums
For Medicaid population, improves provider access by 98%; medical productivity by 159%
By 2025, increases coverage by 12.1 million above ACA levels

The Swiss system shares some of the unattractive features of the ACA, including the individual mandate. But because Switzerland focuses its public resources solely on lower-income individuals, the federation’s universal coverage system is far more efficient than America’s. In 2012, Switzerland public entities spent approximately $1,879 per capita on health care: 45 percent of U.S. public spending. Put another way, if U.S. government health spending was proportional to Switzerland’s, the U.S. would be able to eliminate its budget deficit.

Of course, the U.S. is neither Switzerland nor Singapore. Each country has its own political system, its own culture, and its own demography. Those differences, however, are not large enough to erase the gains that would accrue here by adapting the most relevant features of the Swiss and Singaporean health care systems to that of the United States.

UNIVERSAL EXCHANGES: A NEW OPTION

The Universal Exchange Plan, contemplated in this monograph, has five goals: (1) to expand coverage well above ACA levels, but without an individual mandate; (2) to improve the quality of coverage and care for low-income Americans; (3) to make all U.S. health care entitlement programs permanently solvent; (4) to reduce the federal deficit without raising taxes; and (5) to reduce the cost of health insurance.

The Plan would achieve each of these goals in a manner that is minimally disruptive to those who favor their current arrangements. As noted above, it would employ a revised version of the ACA’s subsidized insurance exchanges as a mechanism for reforming entitlements, expanding coverage, and improving health care quality.

The Plan has five core elements:

Exchange reform. The Plan repeals the ACA’s individual mandate requiring most Americans to purchase government-certified health coverage. The Plan restores the primacy of state-based exchanges and state-based insurance regulation. It expands the flexibility of insurers to design exchange-based policies that are more attractive to consumers, because they are of higher quality at a lower cost. The Plan expands access to health savings accounts. Because these reforms lower the cost of insurance for younger and healthier individuals, they have the potential to expand coverage, despite the lack of an individual mandate.

Employer-sponsored insurance reform. The Plan repeals the ACA’s employer mandate, thereby offering employers a wider range of options for subsidizing workers’ coverage. The Plan preserves the ACA’s “Cadillac tax” on high-cost health plans, but it repeals other taxes, and reforms other regulations that artificially drive up the cost of employer- based insurance.

Medicaid reform. The Plan migrates the Medicaid acute-care population onto the reformed state-based exchanges, with 100 percent federal funding and state oversight. (Medicaid acute care is a form of conventional insurance for hospital and doctor services.) In exchange, the Plan returns to the states, over time, full financial responsibility for the Medicaid long-term care population. (Long-term care funds nursing home stays and home health visits for the elderly and disabled.) This clean division of responsibilities will improve coverage for the poor; reduce waste, fraud and abuse; and provide fiscal certainty to state governments.

Medicare reform. The Plan gradually raises the Medicare eligibility age by four months each year. The end result is to preserve Medicare for current retirees, and to maintain future retirees—in the early years of their retirement—on their exchange-based or employer-sponsored health plans. (Today, the government does not allow the newly retired to remain on their old plans; instead, it forces them to enroll in Medicare or forfeit their Social Security benefits.) In total, these changes would make the Medicare Trust Fund permanently solvent.

Other reforms. The Plan tackles the growing problem of hospital monopolies that take advantage of their market power to charge unsustainably high prices. The Plan reforms malpractice litigation in federal programs. And it accelerates the pace of medical innovation through reform of the Food and Drug Administration.

ASSESSING THE PLAN’S FISCAL EFFECTS

We estimated the fiscal effects of the universal Exchange Plan by utilizing several methodologies, including a model developed by the Health Systems Innovation Network, and drew on data projections from the Congressional Budget Office and the Centers for Medicare and Medicaid Services. We assumed that the Plan is implemented in 2016 and estimated federal budget outcomes for three decades, from 2016 through 2045.

As with projections generated by the CBO, estimates of the Universal Exchange Plan’s performance beyond the first decade harbor considerable uncertainty. However, given the gradual nature of the Plan’s reforms, assessing its long-term impact on the health care system is critical to evaluating its merits.

Relative to the ACA, we estimate that the proposal will do the following:

  • Over the first ten years, the Plan will reduce federal spending by $283 billion and federal revenues by $254 billion, for a net deficit reduction of $29 billion.
  • Over the first ten years, the Plan will reduce state tax revenues by $331 billion, offset by a larger reduction in net state Medicaid spending due to the transfer of acute-care Medicaid enrollees onto the federally funded exchanges.
  • Over the first 30 years, the Plan will reduce federal spending by approximately $10.5 trillion and federal revenues by approximately $2.5 trillion, for a net deficit reduction of approximately $8 trillion.
  • The Plan will render the Medicare Trust Fund permanently solvent, if the entirety of the proposal’s Medicare savings were applied to the trust fund instead of toward deficit reduction.

We do not model the effects of this proposal on Treasury bond prices: the benchmark for the federal government’s borrowing costs. However, it would be reasonable to assume that the proposal’s substantial fiscal consolidation would lead to lower interest rates, and thereby less federal spending on interest payments.

Lower interest rates—in combination with a reduced tax burden, lower hiring costs, and lower health insurance premiums—should lead to higher economic growth, and thereby additional tax revenue and deficit reduction. We did not model these effects, instead assuming that the Plan has no impact on the CBO’s 2014 long-term GDP projections.

COVERING MORE PEOPLE, MORE AFFORDABLY, AT HIGHER QUALITY

Policymakers and researchers focus intensely on the number and proportion of U.S. residents with health insurance coverage. There is, however, far less focus on the quality of the coverage that Americans receive. As noted above, enrollees in Medicaid—and, to a lesser extent, Medicare—suffer from poorer access to physician care, and thereby poorer health outcomes, compared with individuals with employer-sponsored private coverage.

A central tenet of the Universal Exchange Plan is that offering exchange-based coverage to the population currently eligible for Medicaid will improve the degree to which low-income Americans can gain access to physician care, and thereby improved health outcomes.

In order to gauge the impact of the Plan on these individuals, we employed two indices developed by Stephen Parente and colleagues at the University of Minnesota: the Patient to Provider Access Index (PAI), measuring the breadth of choice of doctors and hospitals in a given plan; and the Medical Productivity Index (MPI), measuring health outcomes for different coverage arrangements.

Over the entire non-elderly adult population, relative to current law, we estimate that the Universal Exchange Plan will increase average provider access—as measured by PAI—by 4 percent. Those individuals who migrate from the traditional Medicaid acute-care program onto the reformed ACA exchanges are estimated to experience a substantial improvement in PAI: 98 percent.

Over the entire non-elderly adult population, relative to current law, the Universal Exchange Plan is estimated to increase average health outcomes— as measured by MPI—by 21 percent.

As with PAI, those individuals who migrate from the traditional Medicaid acute-care program onto the reformed ACA exchanges are estimated to experience a much more dramatic improvement in PAI: 159 percent.

The HSI microsimulation model indicates that the Universal Exchange Plan’s reforms to the ACA exchanges would reduce the average cost of commercial insurance premiums by 17 percent for single policies and 4 percent for family policies. Despite the lack of an individual mandate, HSI models the Universal Exchange Plan as increasing health insurance coverage. If the Plan were adopted in 2016, 12.1 million more individuals would gain health insurance coverage by 2025 relative to current law.

A FAR-REACHING HEALTH-REFORM PROPOSAL

The Universal Exchange Plan contemplates a broad range of far-reaching reforms to the U.S. health care system.

We have estimated the fiscal effects of the Plan over three decades, but considerable uncertainty surrounds all long-term projections. The Congressional Budget Office assumes that, from 2016 to 2035, U.S. economic output will grow at an average nominal rate of 4.2 percent per year, and that inflation over the same period will approximate 2.5 percent per year. If long-term inflation is higher, and/or long-term economic growth is slower, the U.S. fiscal picture will worsen considerably, affecting the reach of our proposed reforms.

No proposal to reform the U.S. health care system is immune from trade-offs, and the Universal Exchange Plan is no different. What it tries to do is to stitch together ideas from all sides to fix flaws in the system, new and old. It would increase the progressivity of health care–related federal outlays and tax expenditures. It would spend less subsidizing insurance for high-income employed and retired individuals, but spend more on insurance for the poor and the uninsured. However, it would do so not by employing a single-payer, government-run system, but rather by migrating low-income Americans and younger retirees into private, consumer-driven insurance plans.

Many people have justly criticized the ACA for its complexity and length. Legislative language for the Universal Exchange Plan, while not nearly as complex, will not fit onto two pages. The Plan seeks to expand coverage and reduce costs while minimizing disruption to the currently insured, an approach that requires addressing the existing complexities of a health care system that consumes $3 trillion a year.

Those who believe that there is no legitimate role for the federal government in funding health coverage for the uninsured may not find it satisfactory that the Plan preserves that role. Also left unsatisfied may be those who believe that the existence of private insurers is morally illegitimate.

In contrast to some other areas of public policy, however, it is possible for both progressives and conservatives to achieve important objectives under the Universal Exchange Plan.

The Plan brings us closer to true universal coverage. It permanently stabilizes the fiscal condition of the United States, by reducing the federal deficit by approximately $8 trillion over its first three decades and, over the long term, by encouraging U.S. gross domestic product to grow at a faster rate than federal health care spending.

Most important, it sows the seeds for a consumer-driven health care revolution, one that could substantially improve the quality of health care that every American receives, and restore America’s place as the world’s most dynamic economy.

ABOUT THE AUTHOR

AVIK ROY is a senior fellow at the Manhattan Institute and the Opinion Editor at Forbes. In 2012, Roy served as a health care policy adviser to Mitt Romney. NBC’s Chuck Todd, on Meet the Press, described Roy as one “of the most thoughtful guys who has been debating” health care reform.

Roy is also principal author of The Apothecary, the influential Forbes blog on health care policy and entitlement reform. MSNBC’s Chris Hayes calls The Apothecary “one of the best takes from conservatives on that set of issues.” Ezra Klein, in the Washington Post, called The Apothecary one of the few
“blogs I disagree with that I check daily.”

In addition, Roy writes regularly for National Review Online on politics and policy. His work has appeared in The Atlantic, USA Today, National Affairs, and The American Spectator, among other publications. He is a frequent guest on television news programs, including appearances on Fox News, Fox Business, NBC, MSNBC, CNBC, Bloomberg, PBS, and HBO.

He is the author of How Medicaid Fails the Poor, published by Encounter Books in 2013, and a member of the Advisory Board of the National Institute for Health Care Management.

At the Manhattan Institute, Roy’s research interests include the Affordable Care Act, universal coverage, entitlement reform, international health systems, and FDA policy.

Roy is the founder of Roy Healthcare Research, a consulting firm in New York. Previously, he served as an analyst and portfolio manager at Bain Capital, J.P. Morgan, and other firms.

He was born and raised near Detroit, Michigan, and graduated from high school in San Antonio, Texas. USA Today named him to its All-USA High School Academic First Team, honoring the top 20 high school seniors in the country.

Roy was educated at the Massachusetts Institute of Technology, where he studied molecular biology, and the Yale University School of Medicine.

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Transcending Obamacare: A Patient-Centered <b>Plan</b> for Near <b>…</b>

Pro-government MPs reject Dr Shakeela&#39;s re-nomination as <b>health</b> <b>…</b>

Pro-government MPs reject Dr Shakeela’s re-nomination as health minister thumbnail

Dr Mariyam Shakeela failed to secure parliamentary consent today after MPs of the ruling Progressive Party of Maldives (PPM) and ally Maldives Development Alliance (MDA) voted against approving her as Minister of Health.

Of the 73 MPs in attendance, 61 voted against endorsing her reappointment to the cabinet while 11 voted in favour and one abstained.

PPM reportedly issued a three-line whip against approving Shakeela following a secret ballot at a parliamentary group meeting this afternoon.

The health ministry has been under fire following a series of protests over regional healthcare services and mishaps in Malé.

The state-owned Indira Gandhi Memorial Hospital (IGMH) – long criticised for lack of qualified doctors and inadequate medical facilities – transfused HIV positive blood to a patient in February due to an alleged technical error.

In June, Fuvahmulah councillors called for Shakeela’s resignation after a case of stillbirth, an interrupted caesarean, and the death of a soldier on the island. A few weeks later, over 300 protestors demonstrated in Haa Dhaal Kulhudhuffushi over deteriorating conditions at the regional hospital.

Shakeela was up for parliamentary approval today for a second time after President Abdulla Yameen modified her initial portfolio as Minister of Health and Gender.

During a debate today on a report by the independent institutions committee – which narrowly recommended endorsing her appointment – PPM MP Mohamed Musthafa accused Shakeela of reversing a decision by the previous minister to raise wages for doctors under a 48-hour work week.

He claimed that Shakeela had reduced working hours to 45 hours and lowered salaries.

“The consequence was all specialists working at IGMH and doctors in hospitals in the atolls and health centres leaving the Maldives,” he said, adding that the health minister should bear responsibility for the alleged exodus.

Musthafa suggested that “circumstances have changed” since President Yameen nominated Shakeela for the post.

MPs of the opposition Maldivian Democratic Party (MDP) also voted against the health minister while Jumhooree Party (JP) MPs voted in favour.

MDP MP Rozaina Adam accused the health ministry of taking measures against health sector employees who provide information to opposition MPs. Such workers were threatened with dismissal and accused of “pestering” the government, she claimed.

Rozaina also strongly objected to the committee being unable to interview Shakeela due to a Supreme Court ruling.

JP MP Hussain Mohamed meanwhile noted that appointing cabinet ministers was a prerogative of the president, suggesting that the parliament’s confirmation role was a formality.

The party decided to endorse her as Shakeela’s reappointment implied that the president must have had confidence in her ability to implement his health policy, he said.

Health policy

Meanwhile, at a press conference yesterday, Shakeela said that the health sector had been strengthened despite “pressure” from elements within the government.

Shakeela insisted that she would not resign in the face of “obstacles and challenges” and said that President Yameen had not asked her to do so.

Shakeela contended that she had inherited a health sector “in ruins” with limited human resources and crumbling health centres and medical equipment.

She alleged that senior officials “within the system” were “obstructing” the ministry’s efforts.

Shakeela said she would “respect” the PPM MPs’ decision, but insisted that it would not be based on her performance.

Defending her track record, Shakeela said the ministry has formulated and submitted legislation to parliament on health services, health professionals, medical negligence, and medical devices.

The administrative framework of the health sector had been reviewed and revised, she said.

Shakeela said 70 percent of infrastructure had been damaged when the current administration took office, which has commenced repair work on 24 health centres at a cost of MVR14.1 million (US$914,397) while projects for repairing a further 49 centres were in the tendering process.

Contracts have been signed for constructing an 11-storey building for IGMH and upgrading the dialysis unit, she continued, adding that efforts were also underway to upgrade the Vilimalé health centre to a hospital.

Moreover, the ministry was purchasing equipment to upgrade the Hithadhoo and Kulhudhufushi regional hospitals to tertiary level, she said.

Among other ongoing projects were a quarantine facility and halfway house in Hulhumalé, a maternity waiting home in Kulhudhufushi, and newborn care centres.

A project to repair speedboats was also underway, Shakeela said, which has seen 13 out of 28 speedboats resume service. Four sea-ambulances have also been launched to fulfil a PPM campaign pledge, she noted.

While only 42 of 199 ambulances were functioning when she assumed office, Shakeela said 110 were now being used.

Noting that 80 percent of employees in the health sector were expatriates, Shakeela said the government was finding it hard to recruit professionals from overseas due to loss of confidence in the health sector by foreign workers.

A four-year long term plan for the health sector was being implemented, she noted.

Work has also begun on integrating a general practitioners service with the government’s ‘Aasandha’ health insurance scheme, Shakeela said.

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Pro-government MPs reject Dr Shakeela&#39;s re-nomination as <b>health</b> <b>…</b>

Universal <b>Health Insurance</b> – a win for the pharmaceutical industry <b>…</b>

According to the former Minister for Health Dr. James O Reilly Universal Health Insurance means that ‘everyone will be a winner’. However the real winners will be the pharmaceutical industry, the medical profession and the insurance industry.

They would like us to belive the myth, that universal health insurance equates to ‘free health care for everyone’. Imagine free health care for everyone! This is not the case. Instead we are all being forced to take out compulsory health care insurance. So now along with paying tax, we are now going to pay twice for health care!

The IMO president Prof. Trevor Duffy said the Government is misleading the public by describing its proposed insurance model as a type of health care with free care for all.

Dutch citizens are paying up to a quater of their income on healthcare. A family iwht a combined income of under €50,000 a year are paying almost €11,500 in health care costs in 2012 or 23.5 per cent of income according to the Dutch Health Performance Report.

In Ireland the Department of Public Expenditure and Reform have estimated that a family of two adult and two children will have to pay €1,600 per year. However the new Minister for Health Leo Varadkar said that a family of two adult and two children would have to pay €3,600 for UHI. This is an increase from the exiting average of €900 paid by the same family type.

Healthcare spending in the Netherlands has doubled in the last 11 years from €47 billion in 2000 to €90 billion in 2011 according to the report.

It seems to me that the only purpose of univeral health insurance is to increase healthcare expenditure, with the main beneficiaries being the pharmaceutical industry and the medical profession. I dont believe that universal health insurance will lead to more cures or a healthier nation. It will lead to more tests, more drugs, more side effects, more hospital visits and more fear.

The second myth being promoted by Government is that, after paying our tax and health insurance, we will get a better health care. Really! Medical negligence from misdiagnosis, hospital infections, side effects from pharmaceuticals are common in the current model of health care dominated by biomedicine and pharmaceutical medicine.

International studies have shown that medical accidents are the leading cause of death in modern western society. Figures show that between four and 11 per cent of all hospital admissions will suffer from some form of negligence. With four million hospital admissions each year in Ireland, that works out at potentially 160,000 patients injured or killed at least every year (source).

As an herbalist I haven’t been to see a GP since 2002 and that was to get my cholesterol checked. I haven’t taken antibiotics since 1995. My health is my responsibility and not the Governments. I know that if I deal with stress, eat healthy and exercise, I will continue to reduce my risk of developing health problems. As someone who has a history of heart disease on my father’s side of the family, I take Hawthorn berry tincture that I make from berries I pick myself. I take herbs like Skull Cap to deal with anxiety and stress. I have reduced my intake of dairy products and gave up meat for three years. I am currently off sugar again! Well except for a little bit of dark chocolate with a cut of tea!

If you continue to follow this blog, you will learn more about how to stay healthy, happy and avoid the hidden power of powerful vested interests that want to control you without your consent.

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Universal <b>Health Insurance</b> – a win for the pharmaceutical industry <b>…</b>

<b>International</b> expat <b>health</b> – complete guide – CNN iReport

Expat (expatriate) is a term used to describe a person that is citizen of one country but resides in another country (permanently or provisionally). The term is similar to term immigrant, but it is a little bit narrower because expats are usually qualified professionals that reside in foreign countries because of their job. They usually have skills that are rare or non existing in the country where they are sent by their companies unlike immigrants who usually go to foreign countries to work whatever job they can find. The number of people that can be described as expats is growing every year and this raises an important question – what about their health insurance? Most countries require expats to get their own expat health insurance even though they will get a national health insurance too. Luckily there are many insurance companies that can provide these services and one of the most popular in the United Kingdom is Now Health International – an insurance company that is already taking care of hundreds of expats.

Since people go abroad mainly because of work, in many cases it is the companies that obtain the international health insurance for the employees. But, in some cases the expat has to choose his or her own health insurance. Since there are different types of health insurance and there are different insurance companies, expats should be aware about few things before they purchase insurance.

First of all, not all insurance packages cover the same things. Of course, the more the package cost the more it covers. However, there are some things that you might not need while abroad. A good example is maternity cover – you don’t have to cover that if you are not planning to become a mother while abroad.

Make sure to check which locations the health insurance covers. If you are travelling a lot you should consider purchasing a package that covers those areas where you need to travel. Furthermore, if you want to save some money the best option is to pay the insurance upfront at once instead of paying in installments. The first option is always cheaper.

With the advance of technology and especially the internet, you can now choose whether you want to purchase expat health insurance using your computer or do it in a traditional way – by visiting an agent. Many people choose the internet over any other method because it is more convenient (you don’t have to live the comfort of your home) and on top of that you can always expect some online discount. While we are talking about discounts make sure to check all the promotions and discounts because insurance companies often provide interesting offers. Once again, remember to check if you really need insurance that is covering what they have to offer.

Traditional insurance companies are offering various types of insurance, but it’s good to point out that there are specialized insurance companies like Now health International that deal only with expat health insurance. This field is very specific so it is always a good idea to make a deal with professionals that have experience in this area. Their agents have years of experience in international health insurance and they will be ready to answer all the questions you have.

Finally, just like any other type of insurance, consider it as a necessity not as a luxury. Accidents can happen anywhere and your health should always be a priority. In addition, consider purchasing an insurance package before you travel abroad. You can experience the first health problems even right after you step in the foreign country and that’s why you must be prepared.

What do you think of this story?

Select one of the options below. Your feedback will help tell CNN producers what to do with this iReport. If you’d like, you can explain your choice in the comments below.

Be and editor! Choose an option below:

See the article here:
<b>International</b> expat <b>health</b> – complete guide – CNN iReport

International expat health – complete guide

Expat (expatriate) is a term used to describe a person that is citizen of one country but resides in another country (permanently or provisionally). The term is similar to term immigrant, but it is a little bit narrower because expats are usually qualified professionals that reside in foreign countries because of their job. They usually have skills that are rare or non existing in the country where they are sent by their companies unlike immigrants who usually go to foreign countries to work whatever job they can find. The number of people that can be described as expats is growing every year and this raises an important question – what about their health insurance? Most countries require expats to get their own expat health insurance even though they will get a national health insurance too. Luckily there are many insurance companies that can provide these services and one of the most popular in the United Kingdom is Now Health International – an insurance company that is already taking care of hundreds of expats.

Since people go abroad mainly because of work, in many cases it is the companies that obtain the international health insurance for the employees. But, in some cases the expat has to choose his or her own health insurance. Since there are different types of health insurance and there are different insurance companies, expats should be aware about few things before they purchase insurance.

First of all, not all insurance packages cover the same things. Of course, the more the package cost the more it covers. However, there are some things that you might not need while abroad. A good example is maternity cover – you don’t have to cover that if you are not planning to become a mother while abroad.

Make sure to check which locations the health insurance covers. If you are travelling a lot you should consider purchasing a package that covers those areas where you need to travel. Furthermore, if you want to save some money the best option is to pay the insurance upfront at once instead of paying in installments. The first option is always cheaper.

With the advance of technology and especially the internet, you can now choose whether you want to purchase expat health insurance using your computer or do it in a traditional way – by visiting an agent. Many people choose the internet over any other method because it is more convenient (you don’t have to live the comfort of your home) and on top of that you can always expect some online discount. While we are talking about discounts make sure to check all the promotions and discounts because insurance companies often provide interesting offers. Once again, remember to check if you really need insurance that is covering what they have to offer.

Traditional insurance companies are offering various types of insurance, but it’s good to point out that there are specialized insurance companies like Now health International that deal only with expat health insurance. This field is very specific so it is always a good idea to make a deal with professionals that have experience in this area. Their agents have years of experience in international health insurance and they will be ready to answer all the questions you have.

Finally, just like any other type of insurance, consider it as a necessity not as a luxury. Accidents can happen anywhere and your health should always be a priority. In addition, consider purchasing an insurance package before you travel abroad. You can experience the first health problems even right after you step in the foreign country and that’s why you must be prepared.

What do you think of this story?

Select one of the options below. Your feedback will help tell CNN producers what to do with this iReport. If you’d like, you can explain your choice in the comments below.

Be and editor! Choose an option below:

See the original article here:
International expat health – complete guide

Your 5-Step Medical Tourism Checklist | Oxstones Investment Club™

Why Is U.S. Health Care So Much More Expensive?

After years of research and many conversations with health policy experts, I see three key culprits of expensive health care in the U.S.

In no particular order, they are the third-party payer system (i.e., employer-provided health care), malpractice suits, and administra­tive support costs/paperwork.

The unintended consequence of in­stitutionalized employer-provided health care — a third-party payer for over 80% of the population — is to remove the pricing element from patients’ decision making.

“Medical tourism is not a new phe­nomenon. Canadian and British patients have been traveling for decades in order to escape their universal health care systems.”

Take Lasik eye surgery as a counter-example. Lasik is an elective proce­dure and, therefore, is NOT covered by insurance. The result is in just one decade, the average price has decreased from approximately $2,500 per eye to $400–1,500 per eye, depending on your location and the technology used.

All while the average employer-sponsored health insurance pre­mium for a family rose 29% over the last four years, according to a recent Kaiser Family Foundation and Health Research & Educa­tion Trust study.
But before deciding if medical tour­ism as a valid option for you or your family…

Is Medical Tourism Safe?

Medical tourism is not a new phe­nomenon. Canadian and British patients have been traveling for decades in order to escape their universal health care systems, in which extensive surgical wait times are the norm.
Important safety facts about medical tourism:

  • Many international hospital staff and doctors are educated and board certified in U.S.
  • MedRetreat uses only hospitals accredited by the Joint Commis­sion on Accreditation of Health­care Organizations (JCAHO). This is the same organization that accredits top U.S. hospitals.

So a JCAHO hospital is required to follow the same standards, procedures, and protocols as U.S. hospitals

  • Hospitals employ the same ad­vanced prosthetics, equipment, and medical devices as U.S. hospitals
  • Hospitals cross-train with John Hopkins, the Mayo Clinic, Harvard Medical, and others.

So if your insurance deductible is too high or you are denied access to the surgical procedure that you need, it may be time to consider packing your bags and heading off to a foreign hospital.

But before you do so, I suggest you follow this five-step checklist. It will save you time, money, and hassle.

The 5-Step Medical Tourism Checklist

Step 1: The $6K rule. Determine the approximate cost of your procedure to ensure that it will cost more than $6,000. If your procedure will cost you $6,000 or less out of pocket, you will not financially benefit once you factor in travel-related expenses.

Step 2: Obtain a com­plete diagnosis, along with your doctor’s report and images. Include any X-ray, MRI, CAT, and/or PET work. You will use these to obtain a detailed price quote and treatment plan from your selected foreign hospital.

Step 3: Determine if you want to go directly to the hospital or work with a medical tourism fa­cilitation agency. Directly means you will research, plan, and make all arrangements on your own. A medical tourism facilitator will guide you through all the planning and arrangements.

Step 4: Inform your doctor of your decision to travel abroad for your procedure. Verify if he or she would be willing to see you for follow-up care upon your return. Who knows, they may even try to compete with the foreign hospital on price.

Step 5: Obtain a firm quote and treatment plan from the foreign hospital before booking your travel arrangements.

If medical tourism sounds like a good option for you, send me an email at janglin@medretreat. com and I will send you a copy of MedRetreat’s comprehensive facilitation process to best guaran­tee a safe and pleasurable medical retreat.

Sincerely,

Jud Anglin

Jud Anglin is founder of MedRetreat.com and a board member of the Laissez Faire Club.

Tags: expensive health care, international hospital, medical tourism, MedRetreat, U.S. health care system

Link:
Your 5-Step Medical Tourism Checklist | Oxstones Investment Club™