Health Care Reform Vs. Health Insurance Reform

Health care reform has been a hot item starting prior to the most recent Presidential Election. The Obama Administration, has now moved health care reform to the forefront of their agenda. Regardless of your political affiliation, the obvious facts are that health care costs have continually increased over the last decade. How should the problem(s) be resolved?

The average person who favors government intervention with health care reform believes that the reform needed is with health insurance. Be careful not to confuse health care reform with health insurance reform. The two issues should be completely different, but it seems the Obama Administration has focused their energies in solving the health care issue by focusing on health insurance.

While there have been few specific plans for the administration’s reform, many experts believe that the reform will involve a major involvement from the government. While there are factions in this nation that favor a “Nationalized Health-care System”, there is equal opposition. Unfortunately, the public divide seems to rest within the “class system”. A majority of those families and businesses in the upper-middle to upper class oppose a nationalized system, while the lower-middle to lower class favor a Nationalized Plan.

I say to those that favor a Nationalized Plan, be wary of what you wish for! The problem with the divide actually resides with education and communication. Too often, those in the lower portion of the class system have been conditioned to believe the Insurance Companies are the big, bad profit mongers that cause your premiums to increase. Let’s be frank, insurance companies are in business to make money. However, if you take a look the profit margins within most health insurance carriers, you will see that most are lucky to achieve a 10% profit.

If the problem with our health care system is not with the health insurance carriers, then where should the blame go? Unfortunately, there is no one cause for the skyrocketing cost of health care. Rather, there are multitude of issues that have caused our health care system to become the inefficient beast you see today. There is no one “magic” pill that will fix our system.

If you take a step back and analyze our system as whole, you have to concur that we have the best health care services in the world. If this were not the case, then why would the world’s wealthiest people fly around the world just to have their medical needs taken care in the United States? The fact is, wealthy people who live in countries with nationalized health care systems do not trust those health care providers with routine procedures, much less the more complex ones.

So if we can agree that the health care professionals and facilities are the best in the world, then you should further assume that those individuals providing that care are deserving of whatever money they make. For my part, I want the guy who is about to open my chest up to perform heart surgery to be paid like a surgeon, and not a garbage man. So how do we fix our system?

The first thing is to focus on the real problem. The real problem is with the inefficiencies present in the system, not with the insurance industry. There are cost savings available through the efficiencies that can be made through the use of technology. By gaining the cost savings within the system itself, health care providers (not the actual professionals) do not have to charge as much money. That means the health insurance carriers do not have to pay as much to the providers. Guess what! That means the health insurance carriers do not have to charge as much in premium. Finally, Joe & Jackie Blow do not have to pay as much for health insurance!

President Obama, focus on the real problem of fixing our system, and health insurance premiums will become more affordable.

Jack Wingate is a Professional Insurance Advisor and Founder of ALLCHOICE Insurance in Greensboro, NC. For more information about Jack Wingate, ALLCHOICE Insurance, or North Carolina Health Insurance please visit http://www.allchoiceinsurance.com

Getting Health Insurance in Texas With a Pre-existing Condition

It can be difficult to get health insurance in Texas if you have a pre-existing condition. In fact, there are some health insurance companies that will not take you if you put that on your insurance application. Or, if you are accepted for health insurance, you will have to pay more because the health insurance company is taking a risk on providing you with health coverage.

There is something you can do to get health insurance in Texas. There is a group called the Texas Health Insurance Risk Pool, otherwise known as the Texas Health Pool, which can provide health insurance in Texas. This Health Pool is mainly for those who are having a difficult time securing health insurance. This pool also insures those that have a pre-existing condition.

You should note that with this health insurance alternative, you can be charged up to two times the normal rate of individual health insurance. One, because there are not a lot of resources like this in the state. Second, because the pool knows that there are not a lot of resources that would easily provide insurance coverage to the uninsurable; they have found a niche here. So, they know that since this group of people doesn’t have much of a choice for getting health insurance in Texas elsewhere, that they will have to join the pool.

The Texas Health pool insurance coverage is used for inpatient hospital admissions, doctor visits and prescription drugs. In addition to that, this health insurance in Texas will pay for mental illness situations (serious ones); However, one exclusion of this state coverage is the pool will not provide coverage for chemical dependency issues.

In order to get health insurance coverage in Texas for this, you must be defined as eligible according to the guidelines of the federal government. You must also have been denied health insurance coverage or related insurance coverage because of your health
(pre-existing condition).

You can be eligible by being a dependent of someone that already has health insurance in Texas through the Texas health pool. You can also be eligible if you have a medical issue that will guarantee your eligibility of health insurance coverage into the health pool. A health insurance agent would have to certify that you are not able to get health care coverage through one of the traditional health insurance companies because of your medical issues.

It’s important that even though your pre-existing condition may prevent you from getting health insurance in Texas, that there is a way around that. Everyone needs health insurance, if for nothing else than going to the doctor. Not begin able to go to the doctor because of no insurance can be frustrating, to say the least. It’s important that the state of Texas has this program designed so that those with pre-existing conditions can be able to get quality care just like those that have the traditional health insurance. The health pool was probably one of the best things that could have happened for the state of Texas as far as health insurance is concerned.

This article about Texas Health Insurance is brought to you by Texas Health and Jordan FeRoss. You need to check out their website: Health Insurance in Texas for really neat health care advice!

Personal Health Records–Who Are the Key PHR Providers and How Are They Handling Laboratory Results?

Several significant events have driven public and industry interest in personal health records. In 2004, President George W. Bush outlined a plan for the implementation of an electronic health record that could be accessed by all Americans. Although numerous companies had been in this market for several years, the announcement provided impetus for growth in this area. In 2007 and early 2008, computer giants Google and Microsoft announced their intentions to enter into this market, Google with Google Health and Microsoft with Microsoft HealthVault.

In March of 2008, laboratory industry leader Quest Diagnostics announced a partnership with Google Health to provide uploading of laboratory testing to Google’s version of a personal health record (PHR).

The U.S. Department of Health and Human Services cites six positive outcomes with the implementation of widespread personal and/or electronic health records.

1. Improved healthcare quality
2. Prevention of medical errors
3. Reduction of healthcare costs
4. Increased administrative efficiencies
5. Decreased paperwork
6. Expanded access to affordable healthcare

Although there are a number of potential barriers to widespread implementation of personal health records, three are the most significant. They are:

1. Interoperability. The various systems need to be able to interact with each other and various computer systems.

2. Privacy and Security. The systems need to provide HIPAA-like compliance, but also have security measures similar to the banking industry and in compliance with a variety of industry standards.

3. Data Modification. In order for physicians to be able to act on medical information, they will need to be confident of the veracity of the medical data. This will at least partly require that they be able to determine the sources and modifications that have occurred to the information in personal health records.

Although there are a number of companies currently in the marketplace offering personal health records, they fall into four broad categories.

1. Standalones. These companies are primarily personal health record companies, such as LifeOnKey or FollowMe. In some cases these companies also specialize or have specialty subcategories, such as MiVia, which was designed for the migrant farmworker population, or LifeOnKey’s Diabetes focus or Women’s Health focus.

2. Spin-Offs of Information Technology or Software Companies. Most notable in this category are Google Health and Microsoft HealthVault.

3. Healthcare Providers. Examples of this are Partners HealthCare’s Patient Gateway and the Group Health Cooperative’s MyGroupHealth.

4. Platform Providers. In some cases, the companies are focused less on being the patient/consumer’s personal health record, than in providing the platform and/or technology for personal health records. MedCommons is an example of this. Microsoft HealthVault may also fall into this category. FollowMe also is willing to customize their product for other companies, which then provide their own branding.

There are five ways personal health record providers are generating revenue.

1. Subscriptions. Typically, standalone PHR providers charge nominal annual subscription rates ranging from about $ 25 to $ 50.

2. Advertising. Google Health and Microsoft HealthVault indicate they will generate income via advertising. It’s not yet clear how Microsoft intends to do this, but Google Health has indicated that their product itself will not contain advertising, but will have search boxes that connect to the traditional Google page, which does have targeted advertising.

3. Data mining. Although often mentioned as a possible source of revenue, few companies indicate they are currently selling non-user-identified health data to researchers or pharmaceutical companies.

4. Increased Service. Healthcare providers, in general, acknowledge that their personal health record systems are just part of the service and a happy client will remain with the system. Google Health indicates they aren’t in the healthcare business and part of their mission is to drive users to Google.

5. Subcontracting and licensing. MedCommons is focusing on providing their services and platform technology for other users and companies that might want to deliver personal health records. It’s not clear if Microsoft HealthVault plans to enter the market in this fashion, but many industry sources suggest it’s likely.

Ultimately, what is clear from looking at a cross-section of PHR providers is that there are a number of approaches to dealing with laboratory results depending on the nature of the PHR. Google Health has recently announced a partnership with Quest Diagnostics.

This is likely to be the first in a number of similar relationships with other laboratory corporations. The real question, one that remains unaddressed yet, is whether competing labs will create partnerships with Google Health and other PHRs or whether it will become an exclusive and competitive marketplace, where some PHRs will find their services locked out of the market.

Another potential question is whether or not a laboratory, independent or affiliated with a particular healthcare provider, is going to be able to provide data uploads to a myriad of different PHRs. Although largely a technical issue, it’s hard to see how a laboratory needing to provide results to twenty or thirty different PHRs in addition to requesting physicians and patients, is going to make laboratory medicine more efficient or cost-effective.

PHRs Gain Momentum
In his January 20, 2004, State of the Union Address, President George W. Bush outlined a plan for the implementation of an electronic health record that could be accessed by all Americans. The system was to be in place by 2015. According to the White House Web site, patient participation would be voluntarily, and “these electronic health records will be designed to share information privately and securely among and between health care providers when authorized by the patient.”

To achieve that goal, the following steps were taken:

1. Health Information Standards were adopted. Under the direction of the Department of Health and Human Services, in cooperation with other Federal agencies and the private sector, voluntary standards were to be identified and endorsed.

2. Health Care Information Technology Demonstration Project funding was increased to $ 100 million.

3. Federal agencies were encouraged to adopt Health Information Technology.

4. A sub-cabinet level position of National Health Information Technology Coordinator was created. This falls under the Office of the National Coordinator for Health Information Technology, part of the Department of Health and Human Services.

It’s important to note that the Bush Administration’s proposal did not break new ground. Numerous companies providing personal health records (PHR), medical health records, and electronic health records or some way of storing and delivering medical information electronically were in existence for several years prior to the Bush Administration’s efforts.

The announcement of launches into the health information technology (HIT) arena by Google and Microsoft has renewed media interest in the area, and may signal a renewed velocity and vigor to the market.

Mark Terry is a staff writer for Washington G2 Reports and author of Lab Industry Strategic Outlook: Market Trends & Analysis 2007 and several other Washington G2 Reports publications. Learn more about Washington G2 Reports.