Category Archives: health care

3Ps of Ebola: Policy, Panic and Public

Posted on by • Posted in health care, leadership, Politics, Program Administration, sentinel event • 1 Comment
Treating and transporting an Ebola patient is very challenging.

Treating and transporting an Ebola patient is very challenging.

Friday’s decision by Maine’s District Court Chief Judge Charles LaVerdiere was the first indicator of much-needed public discussion & conversation about public health policies, personal liberties and Ebola.
Current CDC’s guidelines (11/1/2014), guidelines based on the latest scientific facts and gathered research data, clearly state that a person who is showing NO signs or symptoms of Ebola exposure, is NOT contagious, NOT infectious thus poses NO threat to public.

This is how World Health Organization (WHO) and the Mayo clinic describe Ebola infection’s symptoms:
“First symptoms are sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools).”
http://www.who.int  and   http://www.mayoclinic.org

People who have been in direct or possible linear contact with Ebola, are under direct/ active direct monitoring (Chief Judge LaVerdiere’s ruling, 10/31/14) and actively cooperating with state and local public health officials since the monitoring of signs and symptoms of Ebola exposure in persons designated as such is now the responsibility of the local and state health authorities. The moment they will start experiencing any of the above symptoms, they are instructed to contact public health officials and appropriate health authorities immediately, and exposure policies and guidelines will be followed, starting with an isolation room with a bathroom.

Government’s No #1 responsibility is to protect the public. In order to do so, public health policies must be set and enforced, yet need to be fluid, periodically re-examined and updated based on new scientific data, such as was the case of the latest updated data on CDC website regarding Ebola spread (10/30/2014).  http://www.cdc.gov

We should be setting responsible health policies based on scientific facts and latest research data, not on fear, panic or apprehension. It is up to us, healthcare professionals, relevant government authorities,
industry leaders and public officials, to clearly communicate with the public about latest events, management of the situation, and what to expect. Nothing fuels panic and fear, or breeds chaos, as a lack of information and the perception of a cover-up!

So let’s continue with appropriate monitoring, gathering data, assessing circumstances, updating policies when appropriate, but most importantly, let’s continue with communicating with the public!

Ukraine Today: Political Realism First, Please!

Ukraine Today: Political Realism First, Please!

Posted on by • Posted in Democratization, emergency response and disaster relief, European Affairs, Geo-political events, health care, International affairs, leadership, Politics, Program Administration • Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , • 1 Comment

(original post on humanitarian situation written on Feb 20th, 2014 in Sacramento, CA, USA. Updated based on last week’s cease-fire and political agreements on Feb 24th, 2014 in Sacramento, CA, USA)

 

czech vlajka znak

I was a young Czech nurse when the atrocities were happening in the Balkans, and NOBODY from the EU moved a finger, nobody helped them! I often asked myself what would have I done…?

While I had no influence over it, as after the Velvet Revolution in Czechoslovakia, after 40 years of oppression, and 20 years of Soviet occupation, I finally was allowed to travel abroad and I left home.

I looked after children, cleaned houses and pubs, learned English by myself at nights, held 2-3 jobs in order to follow my dreams of studying and obtaining my Nursing licenses in Canada & USA, only to go further towards my biggest dreams of earning multiple university degrees in global politics, global health & regional development & administration at prestigious U.S. universities (CSUSM and UM). CSU grad kept her ‘eye on the goal’ – San Diego Union-Tribune San Diego Union-Tribune regional newspaper did an interview with me about my road towards BA in Political Science Magna Cum Laude coming from post-Communist country.

To this day, I am ashamed to be European for our utter failure in the Balkans! Seeing the almost unrepairable damage that conflict left until today, over 18 years later, is utterly heartbreaking. We all bear responsibility.

For better or worse, the ONLY leader who proved to LEAD was U.S. President Clinton, who due to the long-standing ‘Monroe Doctrine’ did not and could not put “boots on the ground” as Americans love to say, but instigated aerial raids. President Clinton’s role in this conflict is being discussed even today, however, speaking as someone who has deep historical roots to Peoples abandoned and left ‘behind’ by the Western powers in their time of need, without any help… (i.e. The Munich Agreement of 1938, The Prague Spring of 1968 -> followed by foreign invasion of my beloved homeland by 5 foreign armies, led by, you guessed it, the Soviets and their criminal leader Leonid Brezhnev). Trust me when I tell you, you want help, any help!

California Capitol Sacramento

It is only here, in this country, where we have the incredible luxury to discuss and criticize actions of which we quite often know very little. BUT, let me finish, it is a part of our political system, it is a part of democracy and as a democracy “groupie” myself, I fully respect and admire this system very much. In fact, I have been actively involved in the post-communist transition to democracy and democratization of institution in Czech Republic on the local political level for past 20 years, and it is Job’s job. It is only when you are on the ground, demonstrating against the power that is usurping you and denigrating you, waving your flags, being beaten and shot that you are looking towards the skies hoping to see some allies and The Allies!

 

For my beloved Czechoslovakia in 1968, the year my amazing parents got married and sadly also the year their HOPE and DREAMS were squashed by the Soviet invasion, there were, for very obvious Cold War reasons, no sky allies or any Allies… And we (as in my fellow countrymen, since I was not even ‘an idea’) were looking up and waiting, every day! In the years afterwards, during the deep Normalization process (just a different word for Communistic indoctrination enforced by the Soviets), we were secretly listening to the Radio Free Europe and Voice of America (both I believed financed by the U.S.) in our basements, faced with hard jail time if caught, waiting for hours to hear our country even being mentioned! And this is how people of Ukraine feel today.

We are amalgamate of our previous experiences, and I really do “FEEL” the past plight, hurts and betrayals of my people and my country. Well, visiting every concentration camp around during yearly school ‘day trips’ since 2nd grade left DEEP scars and nightmares in my soul. At the same time, it also cemented such un-moveable human resolve, built foundation for my ‘Fight-or-Flight‘ (political & systemic) response, and cemented my strong sense of protection, responsibility for others, and especially for those weaker and unable to look after themselves => any more questions why I am a nurse, political operator and a humanitarian? Nope, did not think so.

We have a collective responsibility and we have obligations.

Now as a proud (dual Czech and) U.S. citizen and a highly degreed and educated RN and a political operator, at this point my love & passion for politics, strategy and campaign goes away and my nursing and humanitarian responsibility takes over. That is exactly WHY I DO politics, to PREVENT bloodshed! However, once you cross over a certain threshold, it is no longer about my ability “to do” politics but about my ability to “take care of people”. People need help no matter who is shooting at them and my nursing training and practice precludes me from judging my patients, and that I had some I did not like in my 15+years! Period.

I wrote an article last May 2013 year asking  Should the EU Care About Syria? The Balkans, Anybody?

Now, the question is HOW much, WHO should and WHY “they” should be concerned over Ukraine! ‘They’ as in the now portrayed as Evil The West / EU vs. the always evil East / Russia.

I don’t know about you, but I picked my ‘evil’ long time ago (and we are very happy together, thank you very much). I already lived under devil dominant depressing doormat of freedom-non-existent Soviets. I will pick The West in any shape or form, any time … and yes, I will get lots of criticism for it, but I am strong I can take it.
What I will never do, however, is to apologize for my views of Russia. I lived it, I survived it, I got out. Thank god I now have my beautiful blue U.S. passport!

Ukraine today is at the crossroads.

Country is divided, economically bankrupt, feels betrayed and lied to, plus people are in deep mourning. However, on the other hand, once the elation of a certain part of population over ‘their’ victory will wean off and reality of bad economy, current lack of leadership, deposed president MIA and the looming threat of Russia not far away will set in, people of Ukraine will have a lot to deal with. During my research, I found ONE thing they all agree upon (well, mostly) – they want to keep Ukraine united, as in NOT split in the Western and Easter / Russian parts. If I were at the negotiating table, I would hold on to this and would NOT let go…

 

I do hope those strong and determined people are ready, prepared and aware that much harder task is ahead of them! Sitting across from your political opponents and rival who you hold responsible (and vice-versa) for what just transpired, will truly show how dedicated and serious about DEMOCRACY the people of Ukraine really are.

Knowing how Russian tyrant Putin feels about Ukraine since he considers it to be a part of his Mother Russia and the center of Pravoslav religion, holding them hostage at will over access to natural gas and other resources and aid … and hearing as a freedom loving and globe-trotting Czech the same tyrant Putin saying that he ALSO consider my Czech Republic to be still under his sphere of influence, my heart stopped!

We’ve already been there, it was hell, and nobody wants to go back…

It is my unequivocal belief we all have global roles to play, we all can help and serve wherever we can.

Thus I am able to feel the plight, fear, resolve but also the uncertainty of people of Ukraine today.

Ukraine has difficult times ahead, and nation-buidling, state-craft and democratization of institutions while re-building trust in government and placing transparency into old systems are amongst the MOST difficult and HARDEST of social and political projects. Look at the U.S. how they are struggling with it around the world, and they have been living it for well over 200 years! Now look at the post-communist countries of Eastern Europe having their “freedoms” for about 20 years… Need I say more?

Hippocrates, the Original Public Health Care Worker?

Hippocrates, the Original Public Health Care Worker?

Posted on by • Posted in Geo-political events, health care, International affairs, leadership, Politics, Program Administration, Uncategorized • Tagged , , , , , , , , , , , , • 3 Comments

Recently, I watched a videotaped lecture by the famed Dr. Carl Taylor, MD DrPH (1916-2010), the founding father of then-new academic discipline called International Health. Dr. Taylor’s lecture, taped few years before he died at the age of 93, was called The Key Studies of Primary Health Care and it was available on the Johns Hopkins open access website. This interesting lecture was actually a part of Dr. Taylor’s teaching curriculum at the Department of International Health that he established at his beloved Johns Hopkins. His love, however, was to travel around all corners of the earth and help communities empower themselves!

Johns Hopkins hospital, Baltimore MD

Currently, I am taking Health for All Through Primary Health Care class through Johns Hopkins, and if we realize that by all accounts the most important Alma Ata Conference was held in 1978, that we are faced with a certain crisis of unfulfilled Millennium Development Goals (MDG) by 2015, and that more people live in abject poverty today than ever before – we begin to truly appreciate the genius of Dr. Carl Taylor’s approach and his vision for not only health care as such, but for PRIMARY HEALTH CARE especially!

images-2

WHY is primary or community health care THE point? Simple: If the government doesn’t do it for you (i.e. the Top-Down model) the people must do it for themselves (Bottom-Up model)… Hopefully with some help and guidance from global health or international organizations, sure, but by leading themselves nonetheless.

As for me, I would have never believed I would be interested in a discipline that does not have all the critical & intensive bells and whistles that only Code Blue, cardiac arrests, Swan-Ganz and ICP or resuscitation in hallways can provide and only critical intensive nursing can deliver. However, as my professional development began to move forward, I very slowly started to move away from all that acute rush in hospitals to seeing ‘Public Health’ from not only an administrator point of view, but also from the level of public health policy.

And that’s where it really hits you!

Saving people’s lives one by one thus making a difference in my patients and their families lives in ICU or OR or ER or PACU was wonderful and I loved every minute of my 13+ years on 2 continents and 3 countries! But, if you really want to make a difference, difference on a much broader global scale that is, you must look at the discipline of Public Health – and specifically, International or Global Public Health (as is my Masters Degree) through a different set of eyes and through completely different prism.

And this why I LOVE it so much!

In order to be successful and effective here, you must fully understand the intricacies of health care / patient care delivery, from there you must be abreast on how to deliver said services in a department or an organization, which is finally leading you to realization you can have influence through your earned knowledge and understanding over global issues, politics and public policies that are determined by international decisions via foreign policies. Those in turn deeply affect all those other social determinants of health which decide the actual individual health and well being – or not – of your people. … when they come to ICU and I can save them…

The astounding combination of my 3 professional loves and passions:  [Global] Healthcare, Politics & Administration all lead to my overall passion and I believe a certain inner sense of Global Public Health Administration. And that is why I slowly moved, over the span of several years and large sums of money for university education) from all the bells and whistles in intensive and critical care units to a global view of social determinants of health, determinants affected by political decisions.

296986_10150318999750909_142351656_n

From Dr. Taylor’s lecture, we learned that the idea behind ‘community-based primary health care‘ is as ancient and as old as Hippocrates himself, as he began to treat sick people in the open, as in village squares where every person from the village could come and offer advice on treatment and getting better! While I don’t really agree with openly spreading germs to the village, the fact that Hippocrates did not isolate the sick, that he did not put them somewhere ‘away’ from the others, shows his initial foresight of holistic / community approach to healing and showed his outlook to the future foundation for community-based primary health care.

What I also did not know is that it was Hippocrates who first started to separate medicine from public health as he started to recognize that different geographical areas meant different patterns of diseases. That was a major fork in the road for healthcare where medicine has clearly different goals and different strategies from community-based primary health care.

images-3

Dr. Carl Taylor stated that in the early days, U.S. physicians viewed primary care as ‘individual’ care, while following approach originating in South Africa encompassed and recognized all aspects of health care in its Community Oriented Primary Care approach (COPC). Here again, many years after Hippocrates, we see the resurgence of the core idea that community is at the center of “health” and well-being of an individual thus of the collective “health” of the whole community.

In a historic context, I would compare this community centered resurgence of the South African (and later American and Israeli) approach to the recent resurgence of the principles of the Alma Ata Declaration. Lancet article (Walley et all. 2008) clearly states that the community-based or community-centered approach to public health is going through a re-birth of sorts as more and more studies show that Dr. Taylor’s SEED-scale approach, which clearly encompasses Kerrer’s South African COPC model, is an approach that takes all other, not only health and disease, but also other social determinants of health in account when dealing with “health“.

Walley says: “The emphasis must shift from single intervention to creating integrated, long-term sustainable and ethical health systems…” Nobody, not the U.N. or any NGO, can achieve this Alma Ata-centered goal without dealing with a host of other determinants. Sadly, for our global health care objectives, those determinants are decided and implemented (-or not-) by sovereign national governments.

images-1                   

Herein resides the problem.

Health does not happen in a vacuum! Very rarely do people get sick out of nowhere…

“Health” happens as a result of… or a consequence to… certain political actions or social events.
The primary public health care problem we are discussing here, is a problem originating in poverty, lack of potable water, lack of safe environment, lack of developed infrastructure, lack of knowledge and awareness, and lastly, as a lack of political will.

images

That is why I applaud the resurgence of the Alma Ata principles taught by Dr. Carl Taylor and the ongoing recognition of the variety of other important aspects that influence, directly or indirectly, the overall status of public health and primary health care in particular.

In fact, it was Hippocrates who preceded Alma Ata Declaration with his vision, when he involved and engaged the whole community in the treatment and planning of healing solutions… And that concept is THE cornerstone of  Alma Ata Declaration!

Ukraine Bloodshed: Political Advisor, Manager but Humanitarian and Nurse First n’ Foremost

Posted on by • Posted in Democratization, Emergency preparedness, emergency response and disaster relief, European Affairs, Geo-political events, health care, Humanitarian effort, International affairs, leadership, Politics, sentinel event • Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , • 2 Comments
Feb 20, 2014

Ukraine in flames

February 20th, 2014 in Sacramento, CA. USA

I was a young Czech nurse when the atrocities were happening in the Balkans, and NOBODY from the EU moved a finger, nobody helped them! I often asked myself what would have I done…?

While I had no influence over it, as after the Velvet Revolution in Czechoslovakia, after 40 years of oppression, and 20 years of Soviet occupation, I finally was allowed to travel abroad and I left home.

I looked after children, cleaned houses and pubs, learned English by myself at nights, held 2-3 jobs in order to follow my dreams of studying and obtaining my Nursing licenses in Canada & USA, only to go further towards my biggest dreams of earning multiple university degrees in global politics, global health & regional development & administration at prestigious U.S. universities (CSUSM and UM). CSU grad kept her ‘eye on the goal’ – San Diego Union-Tribune  San Diego Union-Tribune regional newspaper did an interview with me about my road towards BA in Political Science  Magna Cum Laude coming from post-Communist country.

To this day, I am ashamed to be European for our utter failure in the Balkans! Seeing the almost unrepairable damage that conflict left until today, over 18 years later, is utterly heartbreaking. We all bear responsibility.

For better or worse, the ONLY leader who proved to LEAD was U.S. President Clinton, who due to the long-standing ‘Monroe Doctrine’  did not and could not put “boots on the ground” as Americans love to say, but instigated aerial raids. President Clinton’s role in this conflict is being discussed even today, however, speaking as someone who has deep historical roots to the Peoples abandoned and left behind Ukraine needs the change to come from withind by the Western powers in their time of need, without any help… (The Munich Agreement of 1938, The Prague Spring of 1968 -> followed by foreign invasion of my beloved homeland by 5 foreign armies, led by, you guessed it, the Soviets and their criminal leader Leonid Brezhnev). Trust me when I tell you, you want help, any help!

It is only here, in this country, where we have the incredible luxury to discuss and criticize actions of which we quite often know very little. BUT, let me finish, it is a part of our political system, it is a part of democracy and as a democracy “groupie” myself, I fully respect and admire this system very much. In fact, I have been actively involved in the post-communist transition to democracy and democratization of institution in Czech Republic on the local political level for past 20 years, and it is Job’s job. It is only when you are on the ground, demonstrating against the power that is usurping you and denigrating you, waving your flags, being beaten and shot that you are looking towards the skies hoping to see some allies and The Allies!

For my beloved Czechoslovakia in 1968, the year my amazing parents got married and sadly also the year their HOPE and DREAMS were squashed by the Soviet invasion, there were, for very obvious Cold War reasons, no sky allies or any Allies…  And we (as in my fellow countrymen, since I was not even ‘an idea’) were looking up and waiting, every day! In the years afterwards, during the deep Normalization process (just a different word for Communistic indoctrination enforced by Soviets), we were secretly listening to the Radio Free Europe and Voice of America (both I believed financed by the US) in our basements, faced with hard jail time if caught, waiting for hours to hear our country even being mentioned! And this is how people of Ukraine feel today.

We are amalgamate of our previous experiences, and I really do “FEEL” the past plight, hurts and betrayals of my people and my country. Well, visiting every concentration camp around during yearly school ‘day trips’ since 2nd grade left DEEP scars and nightmares in my soul. At the same time, it also cemented such un-moveable human resolve, built foundation for my ‘Fight-or-Flight‘ (political not systemic) response, and cemented my strong sense of protection, responsibility for others, and especially for the weaker and for those who at that time were /are unable to look after themselves => any more questions why I am a nurse, political operator and a humanitarian?   No, did not think so 🙂

We have a collective responsibility and we have obligations.

Now as a proud (dual Czech and) U.S. citizen and highly degreed and educated RN, at this point my love & passion for politics, strategy and campaign goes away and my nursing  and humanitarian responsibility takes over. That is exactly WHY I DO politics, to PREVENT this! However, once you cross over a certain threshold, it is no longer about my ability “to do” politics but about my ability to “take care of people”. People need help no matter who is shooting at them and my nursing training and practice precludes me from judging my patients, and that I had some I did not like in my 15+years! Period.

EU lagging behind, always

I wrote an article last May 2013 year asking Should the EU Care about Syria? The Balkans, anybody..?!?

Now, as if I had a premonition, similar problem is on the border with our Czech brothers, Slovakia! (and Poland, Romania & Moldova on my EU side) and the EU is STILL discussing and issuing statements about ‘freezing assets’ of the bad guys – on both sides. OK… and how is that gonna work from a logistical point of view, and MOST importantly, HOW is this gonna help the dying people of Kiev? This piece is NOT debating blame or who started what, this piece is strictly concerned with the PEOPLE and their medical and human needs. Period.

Knowing how Russian tyrant Putin feels about Ukraine since he considers it to be a part of his Mother Russia, holding them hostage at will over access to natural gas and other resource… and hearing as a freedom loving and globe trotting Czech the same tyrant Putin saying that he ALSO consider my Czech Republic to be still under their sphere of influence, my heart stopped! We’ve already been there, it was hell, and nobody wants to go back…

It is my unequivocal belief we all have global roles to play, we all can help and serve wherever we can. Thus I am able to feel the plight, fear, resolve but also the uncertainty of people of Ukraine. I promised myself, I will never sit on the sidelines, and I never do, should anything like that started to happen again especially in or around my original homeland and Europe.

I believe, this is my calling and my responsibility.

I can never let the Balkans repeat. Ever!

Awareness, Responsibility

http://www.usnews.com/opinion/articles/2014/02/20/ukraine-doesnt-need-sanctions-from-the-united-states-or-the-european-union?src=usn_tw

Tagged:

Stability: International Journal of Security & Development
University of Miami, Master of Arts in International Administration (The MAIA Program)
USAID – US Agency for International Development
International Rescue Committee
FEMA Federal Emergency Management Agency
CDC Emergency Preparedness and Response
People in Need – Official
The Relief Foundation, Inc.
USF Global Disaster Management & Humanitarian Relief
ReliefWeb
Humanitarian Assistance Program
European Commission – Humanitarian Aid & Civil Protection
Human Rights Watch
U.S. Department of Health and Human ServicesSee More

A Mid-Career Czech-up: how do you stack up in 100 words?

A Mid-Career Czech-up: how do you stack up in 100 words?

Posted on by • Posted in career development, Geo-political events, health care, International affairs, leadership, mid-career, personal development, Politics, Program Administration, Uncategorized • Tagged , , , , , , , , , , , , , • Leave a comment

Wondering how your career looks like in 100 words?

Ever wondered how would your career look like all nicely and neatly summarized (since nothing in life is that simple) all the while looking visually appealing ?

I copied & pasted my professional positions, projects & endeavors in public health, healthcare and politics from my LinkedIn profile and used the amazing wordle.net to see what have I been really up to for the past 13 years in my let’s say all-encompassing career and how does it stack up to what I feel are my professional passions & interests with what I think I’ve done and accomplished in my career so far.

I must say I am (one-could-almost-say) pleased to see my career in a shape for which I worked, studied and sacrificed so much, AND most importantly as we continue to evolve, for one that is leading toward a better defined shape that keeps on toning and strengthening those already ‘shapely’ areas, keeps on finding new ways of doing, seeing, understanding things… all the while never seizing an opportunity to learn from wise, humble, accomplished and interesting people along the way… AND yet staying true to my ongoing professional calling, my passion and my dedication.

Yes, ALL this in 100 words, no kidding!

Yes, wordle.net can summarize it way better than me, that’s for sure…

How would your mid-career check-up look like?

Is ‘population diversity & behaviors’ to blame for lower U.S. life expectancy…?

Posted on by • Posted in health care, Program Administration, Uncategorized • Tagged , , , , , , , , , , , , • 3 Comments
Government Spending

Government Spending (Photo credit: Tax Credits)

Last week I posted article asking a pertinent question “If U.S. Spending is so Outrageous, Are We Getting the BEST?”

https://marketahouskova.wordpress.com/2013/04/22/if-u-s-health-care-spending-is-so-outrageous-are-we-getting-the-best-2/

The answer is “kind of”.

We do have the best technological and medical advancements in the world, and our acute care and treatments can deliver miracles.  We don’t have to wait 4-6 month for a surgery, we mostly get timely care, good care, and we do have great outcomes. However, as wonderful as that is, it does not impact the overall measurements of ‘life expectancy’ as it falls under the category of ‘acute care’ and we do really well here.

It is injuries or conditions lasting more than 6 months that are considered ‘chronic’ and require ongoing management, ongoing medication, follow-up doctors visits, repeated test, etc… and that’s where the U.S. is seriously lacking. So yes, while we are very good at acute care, we lack in chronic care management – and that does impact the overall ‘life expectancy’ and quality of life.

Which brings me to the fact that even after spending over $8,000 per capita in overall healthcare expenditure in 2010 (the highest in the world) , the U.S. has a lower life expectancy compared to other OECD nations. Why is that? Is “healthcare”  to blame? Is “public health” to blame? Or is it due to our “population diversity and behaviors“?  I have heard many  blaming it on the “diversity & behaviors” part, but in that case a question remains –  isn’t it the health and life expectancy of the whole population, no matter what diversity groups it includes, that makes for ‘life expectancy’ studies, surveys and measurements?

I agree with you that our diverse population is an integral part of our society, however, it is 21st Century and everybody knows that if you want to live longer and have a good quality of life, when you are not feeling well or have certain episodes – you should go see a doctor. And this is where the crux of “it is population diversity & behaviors fault” argument weakens, as 50 million of low-income working Americans (yes, majority about 80% are working and 82% are legal citizens) DO NOT have options or access to a non-acute or preventive care, so they go without seeing a doctor, without taking medications, and without ongoing management of preventable conditions – NOT because of their population diversity or behaviors – but because under the current system they have no viable option for obtaining health plans!

This clearly and directly impacts the overall life expectancy and thus the overall quality of healthcare we as ‘all Americans’ get.
If 1 in 5 Americans don’t have access to health care – it seriously impacts all of us in terms of loss of economic potential, loss of productivity, and in the end, in an increase in overall health care spending.

I ask again, does $8,000 per capita (twice as much as others developed nations) deliver the best health care to our society? Does it…?

Now, since we established that “population diversity & behaviors” are not to blame for lower U.S. life expectancy, is it a fault of healthcare, or public health? The answer is “yes” as the status of U.S. health care and it’s overall total health care spending and expenditures is a direct result and implication of U.S. health policies implementations. States are responsible for health care but federal government plays its role in Medicare, Medicaid, CHIP & other programs.

Medicaid, for example, by covering health care needs of pregnant women and prenatal care is not only delivering health care, but also implementing a U.S. public health policy. Smoking cessation programs – public health issue, or health care issue? Both, as continued smoking leads to lung cancer, COPD, emphysema etc… and that is very costly in terms of health care spending. Public health programs are offering smoking cessation in order to prevent future health care spending, a clear integration of health care and public health policies.

Without proper public health policies we will not be able to deliver proper health care to our diverse population. Clear and simple.

P.S.

Yes, while certain “diverse” behaviors cause increase in health care spending (i.e. smoking, bad diet etc..), if we look at it closer – these behaviors span all socio-economic levels, not only diverse population often mentioned. So we are back at the beginning, why the U.S. has lower life expectancy that other OECD nations? The one clear answer is that it is not due to “population diversity and behaviors”.

.

If U.S. health care spending is so outrageous, are we getting the BEST?

Posted on by • Posted in health care, Uncategorized • Tagged , , , , , , , , , , , , • 10 Comments

In today’s heated political and economic debates, healthcare reform and healthcare spending remain a hot topic of conversation – and rightfully so!

Why is it that while the U.S. spent over $8,000 per capita on health care in 2010 (almost 50% more than Norway and Switzerland in 2nd and 3rd place), per OECD ratings, we deliver only average level of care based on U.S. lower life expectancy, lower than Switzerland or Norway. Life expectancy graph puts the U.S. roughly in the middle of the developed countries in life expectancy at birth (the longest gevity is in Japan). How Does the United States Compare page 1.

The problem with that is that other developed countries who show even higher life expectancy than the U.S. are able to bring their population to such age for a fraction (or at least for 50% less) of total health care cost than here in the U.S. It shows that the huge per capital spending does NOT necessarily assure or ensure longer gevity delivered through better care or more advanced technological treatments.

So WHY does health care cost so much in the U.S.?

The answer comes under the cloak of science, as the most significant contributor to U.S. health care cost growth is technology innovation & medical advancement. Clear and simple. We have the best diagnostics, imaging, new-surgery-techniques, technological possibilities and acute care treatments & capabilities in the world – bar none. The fact that we are also a wealthy country contributes to our income growth meaning that the wealthier the country – the more of healthcare consumer spending and insurance-induced demand there is.

It stands to reason that while new medical technology may be expensive, when used in time and appropriately, it does extend patients lives, improves their quality of life which in turn makes them live longer and makes them more productive. So technology – it’s a go! But the need for increased healthcare efficiency with curbed spending will bring a major strain on the U.S. health system in the coming years.

While the U.S. has the best diagnostic and acute health services in the world, we are lacking in preventive care and in management of chronic diseases and conditions affecting a large segment of U.S. (aging) population. Additionally, the wealthiest country in the world and we have around 50 million un-insured people from working families! Yes, you heard right, a vast majority are from working families – as in low-income workers unable to afford private or employer-based health plans premiums. Kaiser Family Foundation Primer (2010) states that 50% of ALL health care spending is used to treat 5% of the population and they are the people with 3+ chronic diseases needing ongoing medical & nursing care, list of medications, follow-up doctor’s visits and other services. http://www.kff.org/insurance/upload/7670-03.pdf

Needless to say that the un-insured have overall much worse health conditions as, due to financial constrains, they do not go see doctors with first symptoms, do not get medications to correct or manage conditions, do not go for tests or follow ups to see how such condition(s) can be treated or fixed or improved. So such condition(s) grow in silence and when finally there is a life-threatening event – they will go to emergency rooms where they will get the care including all those technology innovation & medical advancement tests, images, diagnostic procedures and latest treatments, but they will also get a bill for all that technology innovation & medical advancement. And anybody who went through ER and spent a couple of days in a hospital knows the amount I am taking about here! And without insurance plan to help cover the large amount, they are left with a stark total! http://www.kff.org/uninsured/upload/7451-06.pdf

Let’s not forget, these un-insured are not insured not because they don’t want to or feel like getting a health insurance, but because their low-income jobs leave them unable to pay for private or employer-sponsored health plans and not eligible for Medicaid and too young for Medicare (over 65 y.o.)  Yes, it is true, hospitals can write something off, but on average, it still leaves the low-income un-insured with a bill of about 1/3 of the hospital cost. And good luck with that!