MILF asked:


how long was your hospital stay from the time you went into labor to the time you were discharged? was it less time because you had state insurance? if everything goes normal for my labor and delivery, and my baby is healthy how long should i expect to stay? i am planning on a vaginal birth with an epidural, i expect i will either get a tear or an episiotomy [

this is my first birth and i have dshs state insurance, i am hoping to stay at the hospital for at least 2 days after giving birth so i can rest and recover.

Changes to COBRA and the State Children’s Health Insurance Program can provide valuable assistance to those recently unemployed.

The rising unemployment rate is causing not just job loss but also the loss of valuable health insurance coverage for many people. In response, the federal government has enacted new legislation to help with COBRA coverage as well as state aid to families with children.

Changes to COBRA

COBRA stands for the Consolidated Omnibus Reconciliation Act of 1986. Under COBRA, if you worked for a company that had more than 20 employees, then you are able to continue on the group health insurance plan for as much as 18 months. The downside of COBRA is that it can be quite expensive. In most states, recipients report that COBRA payments account for more than 75% of their unemployment benefit. However, under the recently passed Economic Stimulus Package, you could be eligible for assistance with 65% of your COBRA premium.

To qualify for the program you must have lost your job between September 1, 2008 and December 31, 2009. Your income must be less than $125,000 for an individual and less than $250,000 a year for a family. If you did not take advantage of COBRA initially, you can still sign up for it. If you did sign up for COBRA coverage, you won’t get any money back for the premiums you have already paid, but you will be eligible for assistance from the point after the law has taken effect. Under the new law you will pay 35% of the premium, and the government pays the other 65%. Your assistance could continue for as much as nine months.

State Children’s Health Insurance Program

Another measure the federal government has taken recently to help people with health insurance coverage is to expand the State Children’s Health Insurance Program or SCHIP. The law will provide $32 billion to the program over the next five years and expand coverage to from 7 to 11 million children. SCHIP is designed to provide health care coverage for children up to age 19 and pregnant women, in families whose income is low, but not low enough to qualify for Medicaid. A portion of the funding will come from an increase in the tax on cigarettes.

Under SCHIP, the federal government provides the states with matching funds to provide health care for families with children. To qualify, families could earn only up to 200% of the poverty level. Under the new law, families can earn up to 300% of the poverty level and still qualify for SCHIP. Each state has set up their program differently, so programs can vary from state to state.

If you find yourself out of a job and out of health insurance, two recent measures by the federal government may provide some assistance. The first are changes to the COBRA program in which the government could pick up to 65% of the cost of your health insurance premium. The other is the expansion of the State Children’s Health Insurance Program. Either of these options could provide short-term assistance with health insurance coverage for the recently unemployed.



By: Kevin Kielty

Isn’t it a thrilling experience to travel abroad? We are sure it is. But what will happen if suddenly a family member of yours falls sick or meets with an accident while traveling abroad? And on top of this mishap you are informed that your travel insurance policy doesn’t cover you against such medical expenses incurred by you!! Won’t that be awful for you?

You might think that you are protected against such medical emergencies by your travel medical insurance policy. However, there are some clauses which are attached to every insurance policy that you purchase. There is high chance that you might overlook these clauses. However, for your own interest and safety, it is absolutely necessary for you to know what exactly your policy will and will not cover for.

If you have pre-existing medical conditions then it will not be accommodated by your travel medical insurance. Such conditions include pregnancy and related conditions, dental or medical conditions for which you are undergoing treatment, surgical or medical condition for which you are under medication. Anxiety, mental disorder, depression, traveling against the consent of your doctor is also considered as exclusion by travelers’ medical insurance.

Medical tourism also falls under the category of exclusion. If you are going abroad for receiving a particular medical treatment, for example cosmetics surgery or a surgery of similar nature, then your medical insurance for travel will not cover you against your medical expenses.

Other circumstances that are excluded from travel health insurance coverage are war or war-like situations, epidemics, natural disasters, nuclear attacks etc. These are a few of the most common exclusions of all travel insurance policies which are offered.

High risk sports also qualify the exclusion list. So if you meet with a mishap while you are busy skydiving, parachuting, bungee jumping, mountaineering, skiing, riding in races, caving etc then your travel medical insurance will not cover you against any such expenses. However, some policies cover travelers’ against such risky sports. This facility is available by paying an extra premium, besides having an extra rider.

Frauds, loss of passport, deception by your travel agent, or any loss arising due to your irresponsibility is not accommodated by medical insurance for travel. Attempt to suicide, drug abuse/alcohol abuse are also not covered by your travel insurance policy.

The best way to secure your future against unforeseen expenses is to buy travel medical insurance. However, different travel insurance companies offer different travel insurance policy and so it is always wise to compare several travel insurance plans online before settling for one. Also keep in mind the fact that the company makes a thorough inspection about your history before giving you the policy.



By: emmalinagrey

According to research, people who smoke while taking oral contraceptives have a higher risk of acquiring cardiovascular diseases. The fertility rate of female smokers is 72% while Male smokers have 50% fertility rate. The chemicals in the tobacco also cause the fluid in the cervix to become toxic, causing the sperm to die faster so that it is difficult to get pregnant.

Did you know that your pulse rate and blood pressure alters when you smoke? It is only after 20 minutes, then it returns to normal.

If you are pregnant, or you already have a baby, and you still smoke, you are putting both your health and your baby’s health at risk. Studies show that the baby is strongly affected by the nicotine the mother gets from smoking. The nicotine that enters the body travels through the bloodstream and whatever travels through the bloodstream reaches the baby inside the mother’s womb. This situation could result in low birth weight, premature delivery, miscarriage and, sometimes, death of the baby.

Babies who have a mother or father who smoke are more prone to bronchitis, asthma and pneumonia. This is because they are exposed to smokers more often. Passive smoke can cause a lot of health problems for the baby.

It is not easy to quit smoking, but it is better if you decide to quit smoking now for the future of your baby. You are not only hurting your baby by smoking while you are pregnant but you will also be causing severe harm to their still developing lungs after they are born by smoking around them. You may as well quit before you even try to get pregnant.

If you quit smoking, the carbon dioxide and nicotine will be eliminated from your system and then you will regain your strength and your blood circulation will improve. You also reduce the risk of getting lung cancer as well.

You should also consider your appearance. Smoking speeds up aging and it makes you smell bad. It is also costly. Imagine how much money you can save if you quit smoking? I have no idea what cigarettes cost where you live but where I am they are nearly $4.00 per pack.

You should also seek support from your family and friends who do not smoke. You can also join support groups in your community or online. The American Lung Association, the American Cancer Society and your health insurance are some of the associations where you can get information about support groups to help you end this noxious habit.



By: Gregg Hall

Health sector Reforms in Andhra Pradesh

    A review on Health sector reforms in India   The health sector reforms in India were started way back in 1970s .The Govt. of India identifies the need HSR and stated in the eighth five year plan. The Eighth Five Year Plan (1992-1997) was the first plan document to state the need for re-structuring of economic management systems, following the macro developments of the 1990s. During this period in the health sector, the concept of free medical care was revoked and people were required to pay, even if partially, for the health services (1). The Ninth Five Year Plan (1997-2002) emphasized the need to review the response of the public, voluntary and private sector health care providers as well as the population themselves to the changing health scenario, to reorganize health services to bring about greater efficiency and effectiveness and to introduce health system reforms to enable the population to obtain optimum care at affordable cost The Ninth Plan sought to increase the involvement of voluntary, private organizations and self-help groups in the provision of health care and ensure inter-sectoral coordination in implementation of health programmes and health-related activities as well as enable the Panchayati Raj Institutions (PRI) in planning and monitoring of health programmes at the local level so as to bring about greater responsiveness to health needs of the people and greater accountability; to promote inter-sectoral coordination and utilise local and community resources for health care(2) .The Tenth Five Year Plan (2002-2007) touches upon reforms at primary, secondary and tertiary level(3).                         Politics influence health systems in significant manner. The goals, priorities, and the strategies, variations in the commitment are largely decided through the political contingencies. There are competing demands on the health systems. The evolution of the health systems is largely shaped by the culture, history, and norms. Client satisfaction is very high. As per NFHS-2 data, an overwhelming majority of clients are satisfied by the services delivered by the public systems. May be the expectations are low or may be our people are so courteous. But on the hand, we have the report from Transparent International, ranked the health system in India is the most corrupt system (4)   The Government has taken several steps for improving the public health care institutions and Strengthening the primary health care infrastructure. However, the situation is compounded by severe resource constraints – financial, technical and human power related, which has resulted in policy makers as well as programme managers at differing levels being faced with difficult choices. In such a situation, attempts are being made through various reform initiatives to ensure that the health needs of the people are met One of the major reform initiatives underway is the Secondary Health System Strengthening Project funded by the World Bank in seven states (Andhra Pradesh, Karnataka, Punjab, West Bengal, Maharashtra, Orissa and Uttar Pradesh). The projects include strengthening FRUs/CHCs and district hospitals so as to improve the availability of emergency care services to patients, to reduce overcrowding at district and tertiary care hospitals, construction works, procurement of equipment, increased availability of ambulances, drugs; improvement in quality of services following skill up gradation training in clinical management, changes in attitudes and behavior of health care providers; reduction in mismatches in health personnel / infrastructure; improvement in hospital waste management, disease surveillance and response system. It is essential to assess both progress and problems in implementation of the reforms in each state and to appropriately modify the content and pace of implementation. Such an overview and analysis of all related issues is necessary to provide evidence to policy makers and other stakeholders in terms of the various dimensions and impact of health sector reform.(5) In the Indian Constitution, health is a state responsibility. During Adjustment, many state governments in India had recourse to Health Systems Development Project loans from the World Bank for carrying out health sector reforms (HSR), of which one of the key policies has been to raise public spending on health care from the abysmally low levels seen up to then. The Health Systems Development Project seeks to develop strategic management capacity; strengthen performance, accountability, and efficiency; and build implementation capacity. Further, it seeks to improve clinical service quality by renovating and expanding district, sub district, and community hospitals and improving access to services. In all seven reforming states, around 15% of the total project cost is borne by the state governments. All the project documents note the low levels of funding for secondary hospitals in the reforming states. This is attributed to the small share of overall public spending allotted to health, the limited portion of total health spending going to hospitals, and, within this, a skewed distribution of funds in favour of the tertiary hospitals. After analysis of the problems of the health sector, the governments of the reforming states have agreed-using terminology ranging from “assurances” to “commitments”-to several undertakings. These are: (i) to enhance the overall size of the health budget; (ii) to redress imbalances in public expenditure between secondary and tertiary care levels; (iii) to safeguard the operations and maintenance components of current expenditure allocations for the secondary health-care sector; (iv) to charge user fees for selected services; and (v) to address workforce issues. The Health Systems Development Project initiated in the seven states recognizes the need for enhanced public spending on health and identifies it as the foremost policy reform to be pursued. Nevertheless, such assurances and conditions have not succeeded in enhancing health sector budgets in states implementing HSR. Worse, HSR has not been able to arrest the decline in the share of health spending within total government spending. The Indian system is especially complicated, as the larger tax resources are controlled by the central government but the major responsibility for health-care spending is bestowed on the states (6).Andhra Pradesh is the first state to go with the HSR.               Health sector reforms in Andhra Pradesh   The state of Andhra Pradesh was formed on 1st November, 1956 under the States’ reorganization scheme. It is the fifth largest State with an area of 2, 76, 754 sq. km, accounting for 8.4 % of India’s territory and also the fifth most populous state with a Population of 75 crores. The state has varied physiographic features ranging from high hills, undulating plains to a coastal deltaic environment. Administratively, Andhra Pradesh is divided into 23 districts, 79 revenue divisions, 1123 mandals, about 27000 villages and 264 towns. AP’s economy grew at 7.2% during 2006-07 — the fourth consecutive year of 6% plus growth. The latest poverty headcount ratio stands at 16%, compared to 23% for India . the third-highest credit rating among the major Indian states; the third best investment climate in the country; and the fourth-lowest corruption level among Indian states Andhra Pradesh was the first Indian state to receive a multi-sector Bank operation – the Andhra Pradesh Economic Restructuring Program for US$ 550 million in 1997 – aimed at helping the state accelerate policy and institutional reforms across a wide range of sectors under a common fiscal framework. It is also the only Indian state where the Bank has disbursed three budget support operations – the First Andhra Pradesh Economic Reform Loan (APERL-1) in March 2002, the Second APERL in February 2004, and the Third APERL in January 2007 – that sought to support the state’s development program.(12) Within AP there are regional, social and gender disparities. Health outcomes are worst among Scheduled Castes (16% of population) and Scheduled Tribes (7% of population), especially those living in underserved areas in North tribal and South drought prone districts, and for women. Effective delivery of quality basic health services is hampered by demand and supply side issues, including poor health infrastructure and staffing.(15)     The reform history in health sector in the State can be traced to Andhra Pradesh First Referral Health System Project, one of the first World Bank aided health system projects in the country. This project, launched in 1995 had been implemented by AP Vaidya Vidhana Parishad (APVVP). Agencies like World Bank and DFID are supporting the reform process in the State. The Bank supported the AP Economic Restructuring Project which included improvement of primary health care as one of the component.(7) The priority reforms focus on improved access to quality and responsive health services, strengthened governance and management in health sector, improved institutional mechanisms for community participation and systems for accountability; and strengthened financial management systems.(15)  The government of Andhra Pradesh [GoAP 1999] Vision 2020 document identifies a seven-point set of priorities for health sector reform: providing universal access to primary healthcare; encouraging private investment in tertiary healthcare; focusing on specific programmes to promote family planning; focusing on improving health levels in disadvantaged groups and backward regions; ensuring a strong prevention focus; enhancing the performance of the public health system; and formulating a state information education and communication (IEC) programme to broadcast information on preventive healthcare.(13) The Government of Andhra Pradesh is embarking on a major health sector reforms to improve health care delivery in the State. D.F.I.D. has expressed its willingness to support these initiatives with a grant of 100 Million pounds over the next five years (2006-2011). The reform initiative will include measures to improve the effectiveness and accountability of public health services, measures to focus on community centric preventive healthcare system and enhance access to quality healthcare for the poorer sections of the population(14) DFID will provide up to £40 million health sector budget support to the DoHMFW, GoAP, over 3 years 2007 – 2010. The sector support will build synergy with National Rural Health Mission (NRHM) which is a health sector reform program of the central government for decentralisation, pro-poor focus, strengthening service delivery(15)     The health sector support will be provided over three years (2007-08 – 2009- 10). It aims at increased use of quality health services, especially by the poorest people and in underserved areas.(16) The main outputs will be: a) Improved access to quality and responsive services, especially in remote and interior areas; b) Governance and management of health sector strengthened; c) Institutional mechanisms for community participation and systems for accountability in functioning; and Financial management systems strengthened and improved public expenditure on health.   The performance of health services would be measured against(17)

* greater effectiveness and improved outcomes of existing programs;

* improved efficiency in the allocation of resources;

* greater access and equity; and

* consumer satisfacfion

Reforms underway in health sector   The major reforms underway are classified under these categories and the activities are noted below and we will look each of them in detail    (I) Reorganization and restructuring of existing government health care system

Establishment of Andhra Pradesh Vaidya Vidhana Parishad Strengthening of referral institutions and fixing of service norms Improvement in drug supplies Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC) Strengthening of PHCs as 24-hour MCH centers Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres

(II) Changes in health system organisation, delivery and Management

Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals Provision of free travel bus passes to pregnant women for antenatal check ups Public Private Partnership

(III) Changes in financing methods

Sukhibhava Scheme (Improvement of Institutional Delivery Services Scheme) User fees

(IV) Reforms related to human resources

Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department

(V) Involving community in health service delivery and Provision

Women Health Volunteers Scheme

(VI) Reforms to quality of care

Performance indicators for grading the PHCs Performance rating of secondary hospitals

    1.Reorganization and restructuring of existing government health care system   A)Andhra Pradesh Vaidya Vidhana Parishad   AP, has created the Andhra Pradesh Vaidya Vidhana Parishad (APVVP) by enacting an Act in the Legislative Assembly in 1986(8) This was done with the objective to lay greater emphasis on development of both preventive as well as curative health care  and to strengthen necessary linkages at appropriate levels to ensure comprehensive medical and health care services. APVVP has undertaken World Bank assisted Andhra Pradesh First Referral Health Systems Project (APFRHSP) in 1994 for a period of seven years. This has been one of the major projects undertaken by APVVP. The objectives of the project included improvement of efficiency in the allocation and use of health resources through policy and institutional developments and enhanced performance of health system by improving the quality, effectiveness and coverage of health services at the first referral level.   B)Strengthening of referral institutions and fixing of service norms   basic service norms for various categories of hospitals under the administrative control of APVVP have been fixed thereby creating a hierarchy of hospitals according to services and facilities. This system of service norms and referral linkages had been developed with a view to optimise utilisation of resources, avoid duplication and wastage of resources, regulate patient flow and reduce cost of treatment by reduction of patient burden at tertiary hospitals. the district hospital has been prescribed to provide services in eleven specialties for which 9 civil surgeon specialists, 18-20 civil assistant surgeons, 54-84 paramedical staff and other supporting staff have been Posted. C)Improvement in drug supplies To ensure regular supply of drugs at all times and in all situations, a system of three sources of drug supply has been put in place for the hospitals under APVVP: (a) centralised drug procurement system under which the institution has been allotted drugs worth a particular amount based on bed strength (Rs 2000 per bed per quarter); (b) an emergency provision for drugs (Rs 100 per bed per month) has been made to every institution from where emergency procurement of drugs is made; (c) drugs which are in short supply and for which regular rate contract suppliers are not available have been stocked at the office of District Coordinators of Health Service. Under the APFRHSP, const-ruction and repair of 160 hospitals including 81 CHCs, 58 area hospitals and 21 district hospitals had been undertaken.(10)         D)Formation of Andhra Pradesh Health, Medical & Housing Infrastructure Development Corporation (APHM&HIDC)   a separate corporation has been set up in 1987 exclusively for developing housing and other infrastructure for medical and paramedical staff and constructing sub centers, PHCs, hospitals, dispensaries, clinics and other health care centers One of the major projects undertaken by APHM&HIDC has been the World Bank assisted India Population Project-VIII launched for improving the medical care facilities in urban slums in 74 municipalities.   E)Strengthening of PHCs as 24-hour MCH centers   In a move to make available maternal and child health care at all times, 470 PHCs in backward districts have been designated as round the clock Mother and Child Health Centre (earlier called women health centres). One staff nurse, one ANM and three support staff have been appointed in each centre on contractual basis. Staff nurses have been trained to conduct normal deliveries and refer emergency cases. Additional facilities like telephone and vehicle have been provided to the PHCs in order to assist communication and transport for referral of emergency cases. Provision has been made to conduct fortnightly specialist clinics of gynaecology and paediatrics in these centres to detect high risk pregnancies and neonates for referral to FRUs.   F)Establishment of Comprehensive Obstetric & Neonatal Care (CEmONC) centres   The State Government has decided to establish 108, CEmONC centres spread across every district so that pregnant mothers requiring emergency care do not have to travel more than 40-50 kms to receive specialist care. Training of MBBS doctors in anaesthesia, neonatal care and blood transfusion is also planned to support this scheme.   2)Changes in health system organisation, delivery and Management A)Formation of Hospital Advisory Committee/ Hospital Development Societies for all PHCs and FRUs/ teaching hospitals   Hospital Development Societies have been constituted in all tertiary hospitals under the control of Directorate of Medical Education.(18) and after implementing NRHM rogi kalyam samithi at every PHC were formed to ensure the adequate participation of local institution,with an aim to improve effective and efficient services with allowed flexible financial powers. These societies are examples for decentralization . Activities of the society include maintenance of the hospital (including sanitation & water supply, electricity, building & civil works and equipment), purchase of drugs & medicine supplies and equipment. The government has set norms and limits for undertaking these works which are to be adhered to by the Society. The ‘system works’, observed an Unicef team which assessed the impact of RKS towards the end of 2000. The system, however, is not without any lacunae. For, it was pointed out that “overall control of the local RKS bodies remain in the hands of the collector and if he is not interested in health care then the whole thing might just drift(13)   B)Provision of free travel bus passes to pregnant women for antenatal check ups(19)   The Government of Andhra Pradesh has started an innovative scheme in order to enable pregnant women in rural areas to avail antenatal check ups at the nearest PHC/area hospital or FRU. It has tied up with the State Road and Transport Corporation to issue free transportation bus tickets pass to be utilised for three visits. The ANM issues the bus passes to the pregnant women on her house visits.       C)Public Private Partnership(20)   ·         Management of Urban Health Centers by NGOs   Under the World Bank assisted Andhra Pradesh Urban Slum Health Care Project (APUSHCP), 192 urban health centers (UHCs) have been established in 74 municipal towns in 21 districts covering 1848 slums. After withdrawal of support by the World Bank, the project has been funded by the state government since 2002. The outcomes of the project show marked improvement in ANC coverage, institutional deliveries, post natal care and immunisation in the slum population.   ·         108 emergency services                           Govt. has tied up with satyam computers to provide emergency transportation which proved to a most successful programme and many states are following the same like Gujarath. The objective of 108 Ambulances is to save people in life emergency . One ambulance is given for three mandals. Each ambulance fitted with equipment worth Rs.17 lakhs renders its services in life emergencies, road and fire accidents (22)   ·         Rajiv arogya sree    The innovative Govt. insurance scheme to serve people of  poor from the serious ailments now attracting the nation as this programme succeeded. this scheme provides financial support to families of BPL upto 2 lakhs per anum for treating serious ailments. it is proposed to cover the entire state by 2nd October 2008 with the govt. paying the insurance premium for all the beneficiaries .an amount of rs.450 crores are provided to implement the scheme during 2008-09. (21)       3)Changes in financing methods   A)Sukhibhava Scheme(23)   Under the Scheme, a cash assistance of Rs.300 (Rs 200 towards transportation charges and Rs 100 for food and incidental expenses) is paid to pregnant women belonging to below poverty line families who come to government hospitals/APVVP hospitals/ teaching hospitals/PHCs/CHCs for delivery serv-ices. This assistance is payable only to those women with no living children or with one living child.   B)User fees:-   If user fees are charged their main use may lie in optimization of expenditure patterns and better allocation between facilities and within facilities(24). Reddy and Vandemoortele (1996), based on a comprehensive review of user financing of basic social services carried out for UNICEF, point to three other discouraging features of user fees: (1) user financing can result in a sharp reduction in the utilization of services, particularly among the poor; (2) gender biases, seasonal variations and regional economic disparities can aggravate the effects of user financing on equity; (3) user financing  quires adequate capacities, effective decentralisation and continued government support; and (4) user financing can undermine political support for the goal of universal coverage of basic social services. In 2001, the Commission on Macroeconomics and Health (2001) also reached a similar conclusion that user fees end up excluding the poor from essential healthservices, in 2005, the Millennium Project’s recent Report to the UN Secretary General (2005) titled “Investing in Development – A Practical Plan to Achieve the Millennium Development Goals” also forcefully argues for abandoning user fees. The health sector in India has acquired a notorious reputation for inefficiency and corruption at all levels. There is little accountability in both the public and private sectors. Quality standards are practically non-existent as are performance measures and honest reporting. A recent report on human resources for health brought out by Harvard University’s Global Equity Initiative (2004) argues that it is people – health workers alone – who can produce an effective health system and deliver good ealth.(25) 4)Reforms related to human resources Integration and responsibilities of functionaries for planning, implementation and monitoring of programmes of HM & FW department At district level, District Health Coordination Committee (DHCC) has been constituted to ensure proper planning, implementation and monitoring of all programmes/activities of HM&FW Department in the district.  The Committee has been entrusted with the primary responsibility of planning, finalizing, implementing and monitoring the District Health Action Plans and institutionwise health plans in a participatory manner including all concerned officials, other concerned departments and NGOs.   5)Involving community in health service delivery and Provision  

Women Health Volunteers Scheme

  One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist – ‘ASHA’ or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHA will be trained to work as an interface between the community and the public health system. Following are the key components of ASHA(26) A woman, usually a daughter-in-law of a house who has studied upto 7th class and preferably from SC/ST community has been selected as WHV by the Gram Panchayat Health Committee. The selected WHV has been given one month training in health care aspects of pregnancy, antenatal, delivery, post natal and new born care, immunisation, diarrhoea, acute respiratory infections, first-aid and treatment of minor ailments. The training has been provided at Telugu Mahila Pranganams for three weeks and one week field level training at PHCs. Academy of Nursing Studies has been designated as the nodal agency for providing training to WHVs.   6)Reforms to quality of care   A)Performance indicators for grading the PHCs   One of the components of World Bank assisted AP Economic Restructuring Project is improvement of primary health care. In order to improve the quality of primary health care services, a system of performance rating has been developed to rate PHCs and CHCs. The grading has been accorded A to C in descending order   B)Performance rating of secondary hospitals   A performance rating system for secondary hospitals under APVVP has been  introduced. The indicators related to general services (outpatients, inpatients, bed occupancy), emergency services (emergency-OP, emergency-IP, emergency major operations, emergency minor operations), clinical services (major/minor operations, tubectomy, deliveries) and diagnostic services (X-ray, ECG, lab tests and USG) have been developed for the purpose. Normative targets for each type of hospital (district hospital, area hospital, community health center) have been fixed against which the performance is measured and rating assigned. Highest grading is A while lowest grading is C.(27)   Conclusion:-   Introduction of user charges and subcontracting of services to the private sector are the main elements of health sector reforms. The health sector reforms are only a part of drastic reforms in other major sectors undertaken as a part of Andhra Pradesh Economic Restructuring Project (APERP) and the overall impact on the health conditions of people and their access to medical care depend more on the changes proposed outside the health sector. For instance, while exempting the white ration card holders i.e. the poor from the user charges in the government hospitals, it proposes to drastically reduce the number of white card holders to half in the state. The net affect would be to reduce the percent of population eligible for free treatment.(29)   On the other hand the success of 108 EMRI services and overwhelming response from Rajiv Arogya sree scheme are the examples for HSR success. Just like every thing has gots its own pros and cons HSR should be done in such a way where the need exist and according to necessities .   Referances:-   (Note:-most part of the article was taken from ref.no 28 otherwise reference specified)

 

(Government of India, Eighth Five Year Plan, (1992-1997) Planning Commission, New Delhi.) (Government of India, Ninth Five Year Plan, (1997- 2002) Planning Commission, New Delhi ) ( Government of India, Tenth Five Year Plan (2002-2007) Planning Commission, New Delhi) ( D. Agarwal Health Sector Reforms: Relevance in India, Indian Journal of Community Medicine Vol. 31, No. 4, October-December, 2006) Health Sector Reforms in India, Initiatives from Nine States ( http://www.idrc.ca/en/ev-118491-201-1-DO_TOPIC.html.The international development research centre) http://www.worldbank.org.in  (The Andhra Pradesh Vaidya Vidhana Parishad Act 1986 (Act No. 29 of 1986 with Amendaments upto 31.03.1989  Dr. MCR Human Resource Development Institute of Andhra Pradesh (Undated). “Andhra Pradesh Vaidya Vidhana Parishad Departmental Manual”  6http://www.aponline.gov.in/apportal/departments/ departments.asp?dep=16&org=98 GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. http://www.worldbank.org.in/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/INDIAEXTN/0,,contentMDK:20970681~pagePK:141137~piPK:141127~theSitePK:295584,00.html#Ongoing_projects Grish kumar,promoting PPP in health services,EPW commentary,july19,2002  (G.O.Ms.No.130, HEALTH MEDICAL AND FAMILY WELFARE (K2) DEPARTMENT. Dated the 24th April, 2006)  ANDHRA PRADESH HEALTH SECTOR REFORM PROGRAMME (APHSRP) Terms of reference for Technical Cooperation (TC) to DoHMFW, GoAP  PRESS INFORMATION BUREAU GOVERNMENT OF INDIA, HEALTHCARE PROJECT IN AP FUNDED BY DFID, New Delhi, March 5, 2008) http://lnweb90.worldbank.org/oed/oeddoclib.nsf/DocUNIDViewForJavaSearch/0CFD6217A8A5BDA2852567F5005D32BD  G.O.Ms.No.403, dated Sept 7th 1998  GoAP (2006), Response to Questionnaire on Health Sector Reforms from MOHFW, GoI. Power Point Presentation of Govt of AP at the 2nd Regional Workshop on Health Sector Reforms: Experiences of Select States at Hyderabad, 14-15th February 2005 and ECTA Working paper 2002/61 Public-Private Partnership: Operational Framework used in Andhra Pradesh and Assam http://www.scribd.com/doc/2208678/AP-Budget-Speech  http://pibhyd.ap.nic.in/er27070702.pdf  Dept. of Health Medical Family Welfare, GoAP (undated), “Sukhibhava (Improvement of Institutional Delivery Services Scheme): Implementation Guidelines to PHC/Hospital  http://mohfw.nic.in/NRHM/Documents/CRM_report_full_report_version.pdf   (A.K.Shiv Kumar,,Budgeting for health ,some considerations) Economic and Political Weekly April 2, 2005  http://mohfw.nic.in/NRHM/asha.htm#abt http://health.ap.nic.in/apvvp/apvvp_stat.html  (http://www.whoindia.org/linkfiles/health_sector_reform_hsr_vol_ii_-_andhra_pradesh.pdf)  (Impact Of Health Sector Reforms On Hospital Services In Andhra Pradesh – A Study Of Trends In The Structures Of Provision And Utilisation Pattern)(centre for economic and social studies) (http://www.cess.ac.in/cesshome/research6b.html)

       

 



By: Dr.v.sudhakaram

 

Finding affordable health insurance these days is very hard, with the economy in the state that it is in people are struggling just to make ends meet. This is why many people feel that health insurance may not be worth price the high monthly premiums that they are used to paying. For many people the having health insurance means that they have to sacrifice money that may be going to something that they feel that they may more likely benefit from. For people with families to support, there are definitely other priorities such as putting food on the table, or making sure the heat is kept on. Now with Aetna Individual Health Insurance, an individual can be insured for a lower monthly premium than ever before.  Aetna Individual Health Insurance not only benefits the person who signs up for insurance, but also everyone who is related to that person. If the person who is signed up for that insurance policy is the provider this means that they will be spending less money on monthly insurance rates and instead they will be putting their hard earned money into other things besides health insurance. Health insurance is one of the most important things that our country has going for it. The rate of uninsured Americans is rising at an alarming rate, mostly due to the state of the economy. Many people can now not afford the cost of health insurance for themselves, never mind their families and loved ones.

With Aetna Individual Health Insurance insuring yourself is easy.  It doesn’t matter if you have just switched out of a group plan, have never been insured, or you are just switching to a new insurance company Aetna Individual health Insurance is ready to help you. There are even different plans for people of all ages for students still in college, for middle age people, and even people who are retired or are nearing retirement. Coverage is available for every type of individual, and plans can be specifically tailored to fit each person’s individual needs. Aetna Individual Health Insurance has been around and helping Americans since 1850, giving customers unbelievable service and value as well as showing great integrity by helping customers get through difficult times. For people who are looking to find affordable individual health coverage Aetna Individual Health Insurance may be the right company for you.

Not only does Aetna Individual Health Insurance provide helpful information and hotlines to call if you have any questions they also provide medical protection if something were to happen to you. Imagine if you something were to happen to you and you didn’t have insurance, and you were not able to work right away. Your family would be stuck paying for your medical bills when you are recovering. You should purchase Aetna Individual Health Insurance in a way to help your family so that if something were to happen to you they would not be stuck footing the bill.

 

By: Ronnie Hamilton

Because premiums, deductibles, copayments, and coinsurance levels for small business group health insurance policies in Texas can vary widely from plan to plan, it pays to shop around.

Have a good understanding of your employees’ healthcare needs before you start shopping. Do they require frequent medical care or do they rarely see the doctor? Are they more concerned about preventive checkups or coverage in case of emergency? Are prescription or maternity benefits important to them? This is an essential first step. You want to purchase a plan that offers the medical benefits your employees need, without a bunch of “extras” your employees won’t take advantage of. You’ll pay for these “extras” in the form of higher premiums.

When shopping for coverage, the Texas Department of Insurance recommends keeping these guidelines in mind:

- Be sure you understand the full extent of each plan’s coverage when comparing plans and rates. If you decide to go with a consumer choice health benefit plan over one with all the state-mandated benefits, the carrier or agent is required to explain in writing which coverages you don’t have.

- Plans with higher deductibles, copayments, and employee share of coinsurance generally will have lower premiums. Keep in mind, however, that your employees will also have to pay more out of pocket when they access services or benefits.

- Consider factors other than cost, such as a company’s financial strength and complaint record. These are indicators of the service you can expect. You can learn a company’s financial rating, as determined by an independent rating organization, by calling the Texas Department of Insurance (TDI) Consumer Help Line. You can also learn information about the frequency of consumer complaints filed against specific companies by calling the Consumer Help Line: 1-800-252-3439/463-5515 in Austin.

- Look into purchasing cooperatives. These are groups of small employers with similar health care needs who join together to negotiate discounted rates for shared plans. For a list of registered purchasing cooperatives in Texas, call the Consumer Help Line.

- Buy only from licensed insurance companies. Selling unlicensed coverage is illegal in Texas. If you buy from an unlicensed carrier, your employees’ claims could go unpaid and you could be held liable for the full amount of your employees’ claims and losses. Guaranty associations pay the claims of licensed carriers that become insolvent. You can learn whether a company is licensed by calling the Consumer Help Line.

- Understand that employee health coverage is different from workers’ compensation insurance, which covers only job-related injuries and illnesses. Although workers’ compensation insurance is not required in Texas, it protects you from high damage awards in the case of workplace accidents. Providing regular health coverage to your employees is not a legal alternative to providing workers’ compensation insurance.

Who Pays and How Much?

The law doesn’t require employers to contribute toward health benefit plan premiums. However, many carriers require employers to pay at least 50 percent of the plan’s premiums. Employers may choose to pay a higher percentage than the carrier requires.

The carrier must offer dependent coverage to all eligible employees. Generally, employers are not required to contribute toward the cost of dependent coverage. If the employer doesn’t contribute, employees may have to pay all of these costs themselves.

Premiums may increase at each renewal term, largely due to rising health care costs and possibly as a result of employee claims experience. Texas law caps small-employer rate increases due to health factors at 15 percent per year.

Insurers cannot require businesses to purchase additional lines of insurance, such as life insurance or disability insurance, as a condition of the sale of a health plan.

Employee Signup and Waiting Period

New employees must be given at least 31 days from their start date to enroll in a plan. After this time, they may be required to wait up to one year for the next “open enrollment period” to join. Carriers must offer a 31-day open enrollment period annually.

You can choose to require your employees who enroll in a plan to wait up to 90 days before being eligible for benefits. During this period, the carrier may not charge you or the employee a premium.

Carriers may require participants to wait a certain amount of time before covering pre-existing medical conditions. In general, plans have different rules for pre-existing conditions. Plans using the open-enrollment requirement cannot make new members wait more than one year before covering their pre-existing conditions.

New enrollees who were covered in the year prior to joining a plan also receive credit toward the waiting period on a month-for-month basis. For example, an employee who was covered under creditable coverage for the entire year before joining a new plan would receive 12 months credit toward a one-year pre-existing condition wait — and would therefore experience no wait at all. For previous coverage to be considered creditable, there may not have been more than a 63-day break between the end of the previous coverage and the start of the new coverage.

A small business employer carrier cannot refuse to provide health coverage for employees on the grounds of employee illnesses or pre-existing conditions. Nor may carriers use health-related factors — such as employees’ prior claims experience or information on conditions arising from violent family situations — to decide whether to provide coverage.

How Small Employer Plan Premiums are Calculated

The rates for any given small employer plan are not solely determined by the benefits and deductibles of the plan itself. Certain objective “case characteristics,” along with any health status-related factors of employees, may also be components in determining the premium rate for the small employer group. Case characteristics consist of age, gender, group size, industry, and geography. Carriers can use some or all of these five objective criteria:

- Age of employees: Older people can reasonably be expected to have more expensive and more frequent health-related claims. Generally, the older your workforce, the more your plan will cost.

- Gender: Females generally incur higher medical costs than males at younger ages, particularly during childbearing years. The variance diminishes with age until medical costs for males begin to exceed those for females as they near ages 50 and 60. If you have a younger, proportionately more female workforce, or one that is older and proportionately more male, expect to pay higher premiums.

- Number of plan participants: Carriers often base rates on group size for two reasons. As size increases, administrative costs per insured decrease. Also, smaller groups tend to buy health coverage based on the targeted needs of participants, increasing the likelihood of claims for the benefits provided. As group size increases, this “custom-tailoring” becomes more difficult and premiums tend to decrease. However, the highest group size factor may not exceed the lowest group size factor by more than 20 percent.

- Industry: Some industries have higher medical claims costs than others because of working conditions and the prevalence of accidents. High employee turnover in some industries can also result in higher administrative costs for the carrier. However, the highest industry factor a carrier charges may not exceed the lowest factor by more than 15 percent.

- Geographic area: Health care costs vary by region due to differences in cost of living and medical practices, as well as the amount of medical competition in the area. Most plans vary rates by either county or ZIP code, using the employer’s business address to set rates.

The rating process for a small-employer group can be described as a two-step process. First, a carrier determines a premium rate based on case characteristics and plan design, without regard to health status-related factors. This produces the baseline price of the policy. Second, the carrier may adjust the rate to reflect health status-related factors of the group. This adjustment must apply uniformly to all members of the group and may not exceed 67 percent of the baseline price of the policy.

Group health insurance can be not affordable for many small businesses, not to mention an administrative headache. Another alternative to group health insurance plans is to offer individual health insurance options to your employees. By law, an employer is not allowed to contribute to these plans, or that would be treated as group insurance under Texas state law. But you can still help your employees become insured in a good plan and improve their health and well-being and also improve employee retention in the process. If you’re a small business owner who would like to offer affordable health insurance plans to your employees, but can’t afford group health insurance, you should consider offering your employees the revolutionary, comprehensive individual health insurance solutions created by companies specifically for young, healthy individuals.



By: Pat Carpenter

You do not want to wait until you are sick or injured to find out what your health insurance policy will not cover. Read the policy carefully. “Exclusions” (also called “Impairment Riders”) are certain injuries, conditions, or procedures for which an insurance policy will not pay any benefits. Possible exclusions include: pre-existing conditions; suicide or other self-caused injury; sexually-transmitted disease; vision correction; noncommercial airline travel; experimental treatments (ask how they are defined); and injuries from war. “Cosmetic Surgery” that is needed because of an injury or congenital defect is usually covered, but covered elective cosmetic surgery generally is excluded.

One of the most common exclusions is for pre-existing conditions. A “Pre-Existing Condition” is a medical condition or injury that was diagnosed or treated prior to the start of the health insurance policy. A policy with an exclusion for pre-existing conditions does not pay for expenses related to pre-existing conditions. Generally, this exclusion lasts for a limited “Waiting Period” after you start your policy.

Pregnancy is not considered a pre-existing condition. Also, health care costs for newborns and adopted children covered within 30 days should not be excluded during a waiting period. Further, employers in interstate commerce with 15 or more employees must provide the same benefits for pregnancy, childbirth, and related medical conditions as for any sickness or injury. For plans offered by other size employers, you should check whether normal pregnancy and childbirth are covered — not just complications.

Waiting periods for pre-existing conditions are intended to discourage people from only signing up for health insurance when they know they will need something expensive in the near future. Unfortunately, waiting periods can also leave people without coverage for chronic conditions when they switch employers. To address this, the “Health Insurance Portability and Accountability Act of 1996″ (HIPAA) helps people avoid duplicative waiting periods for pre-existing conditions when they switch form one insured employer to another.

HIPAA says that employees can switch employers without losing group health insurance or having a new waiting period for pre-existing conditions. Insurers cannot exclude pre-existing conditions with a waiting period longer than 12 months. Also, prior continuous coverage (without a gap of more than 62 days) must be credited toward this 12 months. For example, if you had continuous coverage for 5 months before switching employers, then your new health plan cannot impose on you a waiting period for pre-existing conditions longer than 12-5=7 months. If you had coverage for 12 months before switching employers, then your new health plan cannot impose any waiting period on you. If you are switching employers, then get a “Certificate of Credible Coverage” from your prior health plan to ensure credit for past coverage.

HIPPA also mandates the following. Insurers who serve employer groups with 2-50 employees must offer insurance coverage to all such groups. Insurers must cover inpatient coverage for mother and infant for at least 48 hours after a normal birth or 96 hours after a cesarean section. The tax deductibility of health insurance premiums for the self-employed was increased. Long term care insurance premiums are now tax exempt like those of regular health insurance. HIPAA also created a federal pilot program for Medical Savings Accounts that we will discuss later.

A “Rider” is a separate page attached to a standard policy that documents: coverage for a condition that generally would not be covered by a standard policy; or exclusion of a specific condition that generally would be covered by a standard policy. An “Endorsement” is similar to a rider, but is included in the body of the policy.

By: Dennis Alexander

Health insurance is a complex area and it’s very easy to overlook the special needs of children and students. Finding an affordable health insurance plan that fits your needs is not always easy but, with some guidance, it is possible.

Nearly 10 years ago now Congress passed a plan entitled Title XXI, or the State Children’s Health Insurance Program [SCHIP]. This plan was aimed at dealing with the growing number of children in the United States living without any form of health insurance. Unfortunately, for many families, their income is not sufficient to afford private health insurance but is too high to apply for Medicaid. Under this state plan however the family is charged a maximum of 5% of their gross annual income and, in many cases, can receive medical treatment at no cost at all.

The cover provided under this program varies from state to state, but all states must provide a minimum of cover including such things as well-baby and well-child physicals, immunization and emergency services.

One thing to note is that, if your child is already covered under a health insurance policy, then he or she will not be eligible for the state coverage.

If your children are not eligible for medical care under the state plan then you will need to consider whether they should be covered under a family policy or on their own individual policies. As a general rule, it will normally be more cost-effective to have a family policy although, if you have only one child, an individual policy for that child may prove to be more cost-effective.

When it comes to student health insurance most colleges and universities have their own health care clinic for treating routine ailments such as colds, sore throats and minor sports injuries. However, all students should have some form of health insurance cover for unexpected medical problems including more complex illnesses and surgery.

If possible, you should try to have your children covered on your own individual or family policy and most policies will cover children even when they are away at school. Some policies may however place certain restrictions on coverage and these should be checked carefully.

If you find that your children need their own individual health insurance policies whilst away at college, then there are a number of insurance companies that cater specifically to the needs of students. You should however research this area carefully and make certain that the cover being provided meets your needs.

It is all too easy to assume that the government will take care of the health needs of children and that colleges and universities will likewise take care of their students. Unfortunately, this is not the case and, as parents, it falls to us to ensure that our children get the health care that they need.



By: chris walker

Health insurance costs are on the rise, but you can still get affordable health insurance in Philadelphia if you know where to look. Here’s how …

What types of health insurance are available?

There are two types of health insurance available in Philadelphia:

1. Government Health Insurance Programs

Medical Assistance (Medicaid) – This is a federal health insurance program administered by the state that provides medical care for low-income Philadelphians, pregnant women, children, elderly adults, disabled adults, and people caring for a disabled family member.

adultBasic – This is a state health insurance program for low-income adults who cannot afford private health insurance. This program provides preventive care, doctors services, and hospital coverage.

Chip (Children’s Health Insurance Program) – This is a state health insurance program that provides medical care for uninsured children and teenagers who are not eligible for Medicaid.

For more information on these federal and state programs, visit Pennsylvania’s Department of Public Welfare website at: dpw.state.pa.us

2. Private Health Insurance Plans

Private health insurance plans include:

* Fee-For-Service (FFS) plan – This is a health insurance plan that pays for doctor services, hospital fees, and prescription drugs. With this plan you may choose your doctor and hospital. You are reimbursed for a percentage of your medical expenses (usually 80%) after you pay a deductible ($500 to $2,000). FFS plans are the most expensive health insurance plans.

*Managed Health Care Plans (HMOs, PPOs, POSs) – These plans pay for doctor services, hospital fees, and prescription drugs, but may also pay for preventive care such as health care clinics and fitness center discounts. With these plans you are assigned to a health care network of doctors and hospitals. You pay a co-payment (usually $5 to $10) for each doctor visit. HMOs are the cheapest health insurance plans, followed by PPOs then POSs.

Where can I get affordable health insurance in Philadelphia?

You can get affordable health insurance by going to an online insurance comparison website. There you’ll receive health insurance quotes from a number of companies and can choose the cheapest one.

Visit http://www.LowerRateQuotes.com/health-insurance.html or click on the following link to get affordable Pennsylvania health insurance quotes from top-rated companies and see how much you can save. You can get more insurance tips in their Articles section, and get answers to your questions from an insurance expert by using their online chat service.



By: ryan@thesatellitetvguide.com