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Group Insurance Health Care

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HIPAA stands for Health Insurance Portability and Accountability Act. When I hear people talking about HIPAA, they are usually not talking about the original Act. They are talking about the Privacy Rule that was issued as a result of the HIPAA in the form of a Notice of Health Information Practices.

The United States Department of Health & Human Services official Summary of the HIPAA Privacy Rule is 25 pages long, and that is just a summary of the key elements. So as you can imagine, it covers a lot of ground. What I would like to offer you here is a summary of the basics of the Privacy Rule.

When it was enacted in 1996, the Privacy Rule established guidelines for the protection of individuals’s health information. The guidelines are written such that they make sure that an individual’s health records are protected while at the same time allowing needed information to be released in the course of providing health care and protecting the public’s health and well being. In other words, not just anyone can see a person’s health records. But, if you want someone such as a health provider to see your records, you can sign a release giving them access to your records.

So just what is your health information and where does it come from? Your health information is held or transmitted by health plans, health care clearinghouses, and health care providers. These are called covered entities in the wording of the rule.

These guidelines also apply to what are called business associates of any health plans, health care clearinghouses, and health care providers. Business associates are those entities that offer legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services.

So, what does a typical Privacy Notice include?

  • The type of information collected by your health plan.
  • A description of what your health record/information includes.
  • A summary of your health information rights.
  • The responsibilities of the group health plan.

Let’s look at these one at a time:

Information Collected by Your Health Plan:

The group healthcare plan collects the following types of information in order to provide benefits:

Information that you provide to the plan to enroll in the plan, including personal information such as your address, telephone number, date of birth, and Social Security number.

Plan contributions and account balance information.

The fact that you are or have been enrolled in the plans.

Health-related information received from any of your physicians or other healthcare providers.

Information regarding your health status, including diagnosis and claims payment information.

Changes in plan enrollment (e.g., adding a participant or dropping a participant, adding or dropping a benefit.)

Payment of plan benefits.

Claims adjudication.

Case or medical management.

Other information about you that is necessary for us to provide you with health benefits.

Understanding Your Health Record/Information:

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.

This information, often referred to as your health or medical record, serves as a:

Basis for planning your care and treatment.

Means of communication among the many health professionals who contribute to your care.

Legal document describing the care you received.

Means by which you or a third-party payer can verify that services billed were actually provided.

Tool in educating health professionals.

Source of data for medical research.

Source of information for public health officials charged with improving the health of the nation.

Source of data for facility planning and marketing.

Tool with which the plan sponsor can assess and continually work to improve the benefits offered by the group healthcare plan. Understanding what is in your record and how your health information is used helps you to:

Ensure its accuracy.

Better understand who, what, when, where, and why others may access your health information.

Make more informed decisions when authorizing disclosure to others.

Your Health Information Rights:

Although your health record is the physical property of the plan, the healthcare practitioner, or the facility that compiled it, the information belongs to you. You have the right to:

Request a restriction on otherwise permitted uses and disclosures of your information for treatment, payment, and healthcare operations purposes and disclosures to family members for care purposes.

Obtain a paper copy of this notice of information practices upon request, even if you agreed to receive the notice electronically.

Inspect and obtain a copy of your health records by making a written request to the plan privacy officer.

Amend your health record by making a written request to the plan privacy officer that includes a reason to support the request.

Obtain an accounting of disclosures of your health information made during the previous six years by making a written request to the plan privacy officer.

Request communications of your health information by alternative means or at alternative locations.

Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Group Health Plan Responsibilities:

The group healthcare plan is required to:

Maintain the privacy of your health information.

Provide you with this notice as to the planâEUR(TM)s legal duties and privacy practices with respect to information that is collected and maintained about you.

Abide by the terms of this notice.

Notify you if the plan is unable to agree to a requested restriction.

Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. The plan will restrict access to personal information about you only to those individuals who need to know that information to manage the plan and its benefits. The plan will maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your personal information. Under the privacy standards, individuals with access to plan information are required to:

Safeguard and secure the confidential personal financial information and health information as required by law. The plan will only use or disclose your confidential health information without your authorization for purposes of treatment, payment, or healthcare operations. The plan will only disclose your confidential health information to the plan sponsor for plan administration purposes.

Limit the collection, disclosure, and use of participant’s healthcare information to the minimum necessary to administer the plan.

Permit only trained, authorized individuals to have access to confidential information.

Other items that may be addressed include:

Communication with family. Under the plan provisions, the company may disclose to an employee’s family member, guardian, or any other person you identify, health information relevant to that person’s involvement in your obtaining healthcare benefits or payment related to your healthcare benefits.

Notification. The plan may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, general condition, plan benefits, or plan enrollment.

Business associates. There are some services provided to the plan through business associates. Examples include accountants, attorneys, actuaries, medical consultants, and financial consultants, as well as those who provide managed care, quality assurance, claims processing, claims auditing, claims monitoring, rehabilitation, and copy services. When these services are contracted, it may be necessary to disclose your health information to our business associates in order for them to perform the job we have asked them to do. To protect employee’s health information, however, the company will require the business associate to appropriately safeguard this information.

Benefit coordination. The plan may disclose health information to the extent authorized by and to the extent necessary to comply with plan benefit coordination.

Workers compensation. The plan may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Law enforcement. The plan may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Sale of business. If the plan sponsor’s business is being sold, then medical information may be disclosed. The plan reserves the right to change its practices and to make the new provisions effective for all protected health information it maintains. Should the company’s information practices change, it will mail a revised notice to the address supplied by each employee.

The plan will not use or disclose employee’s health information without their authorization, except as described in this notice.

In Summary:

As an employee, you should be aware of your rights and feel confident that your employer is abiding by the guidelines of the Privacy Rule.

As an employer offering group insurance health care benefits, you should make your employees aware of their rights and should give them an avenue to obtain more information or to report a problem.

When you get your health insurance coverage through a broker that specializes in employee benefits, they should provide you with all of the necessary information and Privacy Notice to make sure you comply with the HIPAA guidelines.

Sexual Health of Men

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The sexual health of men is not as complicated as that of women. Show a man a certain type of image and if his brain and nervous system are working properly to produce nitric oxide, then a response will usually occur. That’s not to discount any mental, emotional, and spiritual components but it is the physical component that has the greatest impact on man’s sexual health. This article will focus on what men can do to improve the physical component of their sexual health. The side benefit is that these suggestions can also positively impact your overall wellness and how you age.

In all the information I gathered to prepare for this article, two overriding issues kept surfacing. These two health issues were consistently present. The first is hormone levels. The second is cardiovascular health. Most men would understand how hormone levels could apply but few ever consider cardiovascular health.

Cardiovascular Health!

Your cardiovascular health is as important to your sexual health as it is to your overall health. The reason why centers on the health of the endothelial cells that line the blood vessels of your body. The creation of nitric oxide occurs in these endothelial cells. Nitric oxide researchers believe that nitric oxide can correct up to 90% of all penile dysfunction. When the endothelial cells are damaged by high blood pressure, high sugar levels, cholesterol, and smoking this decreases nitric oxide production. Endothelial cells and their ability to produce nitric oxide are critical to the sexual health of men.

Hormone Levels!

At its simplest level, sex is just a hormone driven function designed to perpetuate the species. With that said, the sexual health of American men is in trouble. Testosterone levels have been decreasing over the last 20 years. Testosterone is the primary male sex hormone. It plays an important role in maintaining bone and muscle mass. Low levels of testosterone have been linked to lowered libido and diabetes. Diabetes can affect the endothelial cells of the blood vessels compounding the problem of lower testosterone levels.

Over the past two decades, the level of testosterone in American males has decreased by 16 percent. Researchers don’t know why. But there are some clues. The recent Nurses’ Health Study revealed some important truths as they apply to women. Some of those truths also apply to the sexual health of men because they affect both hormonal levels and cardiovascular health.

Additionally, as testosterone levels have decreased this has resulted in reduced muscle mass and tone, reduced metabolism and energy and an increase in body fat. Not a sexy combination! You can accept it and do nothing about it. Or, you can begin to live life by making healthier eating and exercise choices. Choices that will help your body actually be younger physically than your chronological age.

You Have Control Over the Process!

Every day you replace approximately 1% of your cells. That means that 1% of your body is new today, 1% is new tomorrow, and 1% is new each and every day of your life. You choose whether those new cells will be nourished properly or poorly. You choose whether you will have healthy and vibrant cells that act young. Or, sickly and sedentary cells that act old.

The sexual health of your body will be affected by the choices you make. I call it “The 1% Solution!” and it will positively affect the cardiovascular and sexual health of your body.

Choices Affecting Sexual Health!

The Nurses’ Health Study highlighted five critical lifestyle and diet behaviors. They are:

o Carbohydrates – Slow verses Fast!

o Fats – Natural verses Artificial!

o Protein – Animal or Plant!

o Body Weight – Your BMI!

o Exercise – Is It Important?

If you look at this list, three critical components emerge: Diet, Weight, and Exercise! Now you might think that this only applies to women. It doesn’t! Each of these factors will affect your cardiovascular health and hormonal balance. Each of these factors also affects the health of your endothelial cells and their ability to produce nitric oxide. Nitric oxide production is the most important component to the sexual health of men. Let’s look at how all of these factors impact your sexual health.

The Diet Component!

You are what you eat and drink. The sexual health of your body and the cardiovascular health of your circulatory system will be greatly determined by your food and drink choices. These choices will also impact the potential for disease and how you age.

Your first choice is in the area of carbohydrates. Are you choosing foods and drinks that are high in fast carbs (simple sugars)? If you are, then you need to understand that:

o Fast carbs disrupt hormone levels.

o Fast carbs create the potential for high blood sugar that can lead to diabetes.

o High blood sugar can damage the endothelial cells of your blood vessels reducing the production of nitric oxide which is critical for good sexual and cardiovascular health.

Learn to consume foods that are high in slow carbs (complex carbohydrates). Slow carbs will help to keep your blood sugar levels normal and your hormonal levels balanced. Drink water instead of sugary drinks and diet sodas. Drinking water hydrates your system, helps you balance your hormone levels, and aids in weight management.

Your second choice is in the area of fats. Eliminate all trans fats from your diet and replace them with natural, heart-health fats. The Nurses’ Health Study clearly showed how disruptive trans fats are to fertility in women. As little as four grams of trans fat (the equivalent of two tablespoons of stick margarine, one medium order of French fries or one doughnut) began to disrupt their hormonal balance.

How much of your diet consists of trans fats from fast food restaurants? How many orders of French fries and doughnuts have you consumed at work? Although I can’t give you any hard research on men, it makes sense that we can be as affected by trans fats as women are. It’s time that you incorporate foods that are rich in omega-3 fatty acids (such as wild, cold-water fish, walnuts, and flax seeds) since essential fats help to balance hormone levels and promote healthy cell function.

Your third choice is in the area of protein. According to the Nurses’ Health Study, women who got their protein from plant sources rather then from animals took a big step toward improved fertility. Animal protein can adversely affect your sexual health. It also has a direct influence on cancer!

If you’re not willing to give up your beef, pork or chicken, then invest the time, energy and extra cost to make sure that these sources of protein are hormone free. This also applies to your dairy products. Much of the industry still relies on hormonal injections into their livestock to help increase food production. Eating meat from these animals and their byproducts will affect your hormonal levels. If you’re not willing to switch to plant-based protein sources, then make sure your meat and dairy sources are hormone free.

The Weight Component!

Like it or not weight impacts the sexual health of your body. Why? Because fat interferes with your hormonal balance! Fat also stresses your cardiovascular system. This additional stress on your cardiovascular system will compromise the sexual health of your body. Currently, 66% of Americans are overweight with at least a third being obese. Diets are not the answer. America has been dieting for the last 50 years. It has had no real impact on slowing down overweight and obesity rates.

You need a paradigm shift from “dieting” to “healthy eating”. Make food choices based on how it will improve your health and wellness, not on how it will impact your weight. Most people who do this see their weight stabilize or decrease.

The Exercise Component!

Exercise is important for both sexual and cardiovascular health. Inactivity saps the body of its ability to respond to insulin and makes you less efficient in absorbing blood sugar. A study from the Electronic Journal of Human Sexuality highlighted that people who exercised on a regular basis:

o Feel better about themselves.

o Think they are more sexually desirable.

o Experience greater levels of satisfaction.

It’s always important to check with your physician or health care provider before you start an exercise program. Once you have their OK, than strive to get at least 30 minutes of exercise per day. Aerobic exercises like walking, jogging, biking, and swimming are important and seem to increase circulation to the pelvis and the reproductive organs. But don’t forget about strength training exercises. Strength training exercises will help you maintain bone health and density. Additionally, strength training exercises will increase your spatial awareness. This is a very positive feeling that improves your overall well being.

The Nitric Oxide Component!

You cannot live without nitric oxide. Your cardiovascular system could not function properly without nitric oxide. The sexual health of your body revolves around the production of nitric oxide. Nitric oxide production is dependent upon the health of the endothelial cells of your blood vessels, and adequate supplies of the essential amino acid L-arginine.

High blood pressure, high sugar levels, high cholesterol levels and smoking all affect your endothelial cells in a negative way. Damage to these endothelial cells will reduce nitric oxide production. This can compromise the blood flow to the sexual organ resulting in reduced sensitivity and/or erectile dysfunction.

Since nitric oxide is synthesized from the essential amino acid L-arginine, your diet needs to include protein sources and/or supplements that contain this amino acid. It needs to be emphasized that L-arginine is not a hormone and it is not testosterone. However, when properly brought into the body it can cross the blood-brain barrier to signal the hypothalamus to naturally trigger the pituitary gland to produce growth hormone. This is the key to eliminating any negative side effects typically associated with hormone supplements like DHEA and HGH.

Please note that L-arginine has a dark side and can cause some serious side effects. Read my article, “L-arginine, Nitric Oxide and Sexual Health!” for more information on this essential amino acid.

Conclusion!

If you continue a life of inactively, animal protein intake, sugary drinks, foods made from refined grains, increased body fat, and inadequate nitric oxide production, then you will become part of the new reality for America. This new reality includes epidemic increases in diabetes, continued high levels of cardiovascular disease and stroke, continued high levels of cancer, and poor sexual health especially for those over the age of 40. As Aristotle said, “We Are What We Repeatedly Do!”

By taking the necessary steps to improve your diet, manage your weight, exercise properly and increase your body’s ability to produce nitric oxide you will experience positive changes in the sexual health of your body. If you repeatedly take these positive steps you will also improve your wellness and slow down your aging.

One Final Thought!

Although the hormonal balance between men and women are different, the process of change is the same. Many of the steps that improve the sexual health of men will also help improve the sexual health of women. Encourage your spouse or partner to implement these changes with you. If you both take the steps to improve your health, then you will both be reward in the bedroom, and in living your life to its fullest.

How Your Attitude to Health Can Help

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What is Health?

How do you define health? Is it a state of complete physical, mental and social well-being? Is it merely the absence of disease or infirmity? Or is health a resource for everyday life, rather than the objective of living; a positive concept, emphasising social and personal resources as well as physical capabilities?

Good health is harder to define than bad health (which can be equated with the presence of disease), because it must convey a concept more positive than mere absence of disease, and there is a variable area between health and disease. Health is clearly a complex, multidimensional concept. Health is, ultimately, poorly defined and difficult to measure, despite impressive efforts by epidemiologists, vital statisticians, social scientists and political economists. Each individual’s health is shaped by many factors, including medical care, social circumstances, and behavioural choices.

Health Care

While it is true to say that health care is the prevention, treatment and management of illness, and the preservation of mental and physical well-being, through the services offered by the medical, nursing and allied health professions, health-related behaviour is influenced by our own values, which are determined by upbringing, by example, by experience, by the company one keeps, by the persuasive power of advertising (often a force of behaviour that can harm health), and by effective health education. Healthy individuals are able to mobilise all their physical, mental, and spiritual resources to improve their chances of survival, to live happy and fulfilling lives, and to be of benefit to their dependants and society.

Achieving health, and remaining healthy, is an active process. Natural health is based on prevention, and on keeping our bodies and minds in good shape. Health lies in balancing these aspects within the body through a regimen consisting of diet, exercise, and regulation of the emotions. The last of these is too often ignored when health advice is dispensed, but can have a pronounced effect on physical well-being.

Diet

Every day, or so it seems, new research shows that some aspect of lifestyle – physical activity, diet, alcohol consumption, and so on – affects health and longevity. Physical fitness is good bodily health, and is the result of regular exercise, proper diet and nutrition, and proper rest for physical recovery. The field of nutrition also studies foods and dietary supplements that improve performance, promote health, and cure or prevent disease, such as fibrous foods to reduce the risk of colon cancer, or supplements with vitamin C to strengthen teeth and gums and to improve the immune system. When exercising, it becomes even more important to have a good diet to ensure that the body has the correct ratio of macronutrients whilst providing ample micronutrients; this is to aid the body in the recovery process following strenuous exercise.

If you’re trying to lose weight by “dieting”, don’t call it a diet, first of all – successful dieters don’t call what they do a “diet”. A healthy diet and regular physical activity are both important for maintaining a healthy weight. Even literate, well-educated people sometimes have misguided views about what makes or keeps them healthy, often believing that regular daily exercise, regular bowel movements, or a specific dietary regime will alone suffice to preserve their good health. Despite the ever-changing, ever-conflicting opinions of the medical experts as to what is good for us, one aspect of what we eat and drink has remained constantly agreed by all: a balanced diet.

A balanced diet comprises a mixture of the main varieties of nutriments (protein, carbohydrates, fats, minerals, and vitamins). Proper nutrition is just as, if not more, important to health as exercise. If you’re concerned about being overweight, you don’t need to add the extra stress of “dieting”. No “low-fat this” or “low-carb that”; just healthful eating of smaller portions, with weight loss being a satisfying side effect. Improve health by eating real food in moderation. (For many reasons, not everyone has easy access to or incentives to eat a balanced diet. Nevertheless, those who eat a well-balanced diet are healthier than those who do not.)

Exercise

Physical exercise is considered important for maintaining physical fitness and overall health (including healthy weight), building and maintaining healthy bones, muscles and joints, promoting physiological well-being, reducing surgical risks, and strengthening the immune system. Aerobic exercises, such as walking, running and swimming, focus on increasing cardiovascular endurance and muscle density. Anaerobic exercises, such as weight training or sprinting, increase muscle mass and strength. Proper rest and recovery are also as important to health as exercise, otherwise the body exists in a permanently injured state and will not improve or adapt adequately to the exercise. The above two factors can be compromised by psychological compulsions (eating disorders, such as exercise bulimia, anorexia, and other bulimias), misinformation, a lack of organisation, or a lack of motivation.

Ask your doctor or physical therapist what exercises are best for you. Your doctor and/or physical therapist can recommend specific types of exercise, depending on your particular situation. You can use exercises to keep strong and limber, improve cardiovascular fitness, extend your joints’ range of motion, and reduce your weight. You should never be too busy to exercise. There’s always a way to squeeze in a little exercise, no matter where you are. Eliminate one or maybe even two items from your busy schedule to free up time to fit in some exercise and some “YOU” time. Finding an exercise partner is a common workout strategy.

Emotions

You may have heard about the benefits of diet and exercise ad nauseam, but may be unaware of the effect that your emotions can have on your physical well-being and, indeed, your longevity. Like physical health, mental health is important at every stage of life. Mental health is how we think, feel, and act in order to face life’s situations. Prolonged psychological stress may have a negative impact on health, such as weakening the immune system.

Children are particularly vulnerable. Caring for and protecting a child’s mental health is a major part of helping that child to grow into a normal adult, accepted into society. Mental health problems are not just a passing phase. Children are at greater risk for developing mental health problems when certain factors occur in their lives or environments. Mental health problems include depression, bipolar disorder (manic-depressive illness), attention-deficit / hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia and conduct disorder. Do your best to provide a safe and loving home and community for your child, as well as nutritious meals, regular health check-ups, immunisations and exercise. Many children experience mental health problems that are real and painful, and they can be severe. Mental health problems affect at least one in every five young people at any given time. Tragically, an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide. A variety of signs may point to a possible mental health problem in a child or teenager. Talk to your doctor, a school counsellor, or other mental health professionals who are trained to assess whether your child has a mental health problem.

Control your emotions. If a driver overtakes you on the wrong side, or pulls out of a side road in front of you, don’t seethe with rage and honk your horn; You’re hurting no one but yourself by raising your blood pressure. Anger has been linked to heart disease, and research has suggested that hardening of the arteries occurs faster in people who score highly in hostility and anger tests. Stay calm in such situations, and feel proud of yourself for doing so. Take comfort in the knowledge that such aggressive drivers only increase their own blood pressure. Your passengers will be more impressed with your “cool” than with your irascibility.

If you are in a constant rush, feeling that every second of your life counts, just slow down a little. Yes, every second does count, but consider the concept of quality of life. Compare how you feel when you’re in a hurry with how you feel when you’re not. Which feels better? Rushing everywhere increases your stress level. The body tries to overcome stress by making certain physiological adjustments. Some time after you slow down, the physiological adjustments and the stress symptoms revert to normal. If you don’t ever slow down, the physiological adjustments and the stress symptoms persist. It is this persistence of the body’s response that matters. You may develop physical, physiological or psychological problems, and may not be able to lead a normal life. Many cases of stress are somehow connected with money, or rather the lack of it. Such people struggle to make ends meet or to acquire more material possessions. This brings us to our final discussion: attitude.

Attitude

It is always pleasant to enjoy the fruits of our labours, of course. Sometimes, however, it seems that whatever we do, it’s just not enough to be able to afford that new car or that foreign holiday. So, what do we usually do then? We work harder, longer; we increase the stress on our minds and bodies; we spend less time with our families and friends; we become more irascible and less likeable people. If you find yourself in this situation, just stop for a moment, and consider: Is it all worth it? What is the purpose of life? Surely it is to be happy. You’ll probably be happier if you adopt the philosophy that true quality of life is not to be found in material things. If you convince yourself that you want less, you’ll need less. If you need less, you’ll cope with life more easily, and the happier, and therefore healthier, you’ll be. Buddha called this “enlightenment”. Enjoy a “good-health attitude”. Focus on your abilities instead of disabilities. Be satisfied with what you have, rather than be dissatisfied about what you don’t have and probably never will have.

If you simply cannot cope with a healthy diet, exercise and emotional control, but genuinely prefer to eat junk food, be permanently drunk, be under constant stress, and be disliked by others, then enjoy your life while it lasts, but understand that the trade-off is that it will probably not last long. If you accept this willingly, you’ll be happy. There is some merit in the philosophy that it is better to live a short, happy life than a long, miserable one.

Conclusion

Personal or individual health is largely subjective. For most individuals and for many cultures, however, health is a philosophical and subjective concept, associated with contentment, and often taken for granted when all is going well. The evidence that behavioural factors such as diet, physical activity, smoking and stress influence health is overwhelming. Thus, health is maintained and improved not only through the advancement and application of health science, but also through the efforts and intelligent lifestyle choices of the individual and society. Perhaps the best thing you can do for your health is to keep a positive attitude. Optimal health can be defined as a balance of physical, emotional, social, spiritual and intellectual health. Maintain a positive attitude!

Redefining Health

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What we can’t define, we can’t find; for our definition determines our destination. One of humanity’s greatest debacle is the allegiance to history as a standard for the present and the future. Humanity is so much indebted to old thoughts to the point where, thinking something new seems like a disloyalty to the legends of old. History should not be a status quo or an imperative standard for the present and the future, but an inspiration for the correction of the present and the redirection of the future for a better destiny for mankind. With respect to achieving health for all in the 21st century, humanity must outgrow old thoughts and ways, to the expounding of new methods, approaches, ideologies, and strategies in securing health for mankind. “The significant problems we are facing cannot be solved at the same level of thinking we where at when we created them.

In the past, health was defined as having both body and mind working in good order, free from diseases and pains. If this assertion has been unable to provide humanity with insight on securing health for humanity, then it is expedient for humanity to think out of the status quo. There is no way humanity can resolve the health challenges of the 21st century except in the courage of exploring the unknown. With respect to the 21st century health plan, health is defined as an integrated state of being, of the human body, soul, and spirit functioning in absolute soundness. Thus, health is not necessarily the absence of pains or physical symptoms of sicknesses and diseases. There are individuals with no symptoms of pains, sickness and diseases, yet they are close to their grave. There are equally people who died without having any physical symptoms of pains or disease. Though they seemed to be fine, yet they died suddenly because they were not healthy.

Health is much more than the absence of pains or disease, but an integrated state of being with the human body, soul, and spirit functioning in absolute soundness. Health is an integrated effect with a cause; which implies, health is not a coincidence or an accidental occurrence but the resultant effect of the relative functioning of the human body, soul and spirit in absolute soundness. Let me make this clear, health is not a challenge we can resolve by our shallow efforts. That is why despite all human efforts in achieving health, health has remained a severe challenge. To achieve health for all in the 21st century, humanity must stop joking. We must realize that, we are dealing with a challenge which if not resolved, billions of humans may be wiped out before the end of this century. For health to be achieved in the 21st century, humanity must adopt a more comprehensive and integrated approach taking into consideration the total human being; body, soul and spirit. I hope by now we are civilized enough to know that the human being is not an animal but a complex being with three related dimensions (body, soul and spirit).Any health plan which focuses only on one dimension of the human being will end in failure. A human being must improve in his body, soul and spirit to enjoy health.

Insight on the Human Being:

The human being is the most complex specie in all of existence. Until now, little has been discovered about the human being. What is in existence as information concerning the human being is but “skeleton”. The human being is a world yet unexploited. The ignorance about the totality and the truism of the human being is the greatest challenge to human evolution and progress. The full understanding of the truism of the human being will be the end of human misery and frustration. The human being is essentially a supernatural being, possessing a soul and living inside a body. This assertion is a universal truth agreed upon by all Universalists and equally confirmed in the universal lab manual or the divine constitution. The spirit of man is the ‘real estate’ of man, with the soul as the intermediary between the spirit of man and the body. The human spirit possesses the science of life, which defines humans as having the supremacy over all external factors.

When this consciousness is transferred to the human soul and body, human immunity and resistance against sicknesses and diseases is enhanced. The fact that the human body is the only visible dimension of the human being does not define the body as the sole constituent of man. Limiting the human being to just his physical body can be the most tragic error. Humans are not animals. The most tragic academic mistake is that of classifying humans and animals under the same group. This academic mistake is due to the limited perspective about the human being. This perspective considers the human body as the sole constituent of man. This academic mistake has produced a low mentality and consciousness among humans. Today, humans live and behave as animals because of this error. Humans even suffer the same fate as animals. The day has finally come to eradicate this human ignorance.

Health versus healing

One of the errors humanity has made for several centuries is that of substituting health for healing. This error has lasted for so long that humanity has unconsciously resorted to healing programs in the name of health programs.
Healing itself being the gradual recovery of a sick or diseased human is different from health, which is a state of absolute soundness (body, soul and spirit). Substituting health for healing makes humanity more reactive than pro-active. When we focus on health, we become more pro-active and preventive than reactive.

Focusing on healing entails allowing the human being to first of all be attacked by sickness and disease before looking for her recovery. While health involves pro-active investment to have a human being sound in body, soul and spirit as an integrated effort towards freedom from sicknesses and diseases. Healing is a recovering and a relief from pains but health is a state of being. One can be healed today and sick tomorrow but health implies, an individual is sound in body, soul and spirit. Friend, healing as to health is relatively cheap and sometimes easy to come by, but health is a breakthrough which demands a lot of focus and concentration on one’s body, soul and spirit conditions.

With respect to the 21st century health plan, sickness and disease is considered as an effected state of being, caused by a deficiency in one’s body, soul and spirit condition. This implies, an individual is unhealthy, sick and diseased as long as there exists a deficiency in his/her body, soul, and spirit condition. This explains why people sometime die without any sort of outward sickness or pains. The issue is that, we think a sick person must be under some kind of pains. There are people looking relatively OK, but terribly sick. This is because not all diseases are physical. Body sicknesses can be easily diagnosed, but sicknesses of the soul and of the spirit can not be diagnosed through any medical means. Thus, for a person to be termed healthy, such must maintain a relative state of soundness in body, soul and spirit. Equal and relative functioning of the human body, soul and spirit in perfect harmony and soundness is the everlasting access to health.

Most of what is described as health centres today are but healing centres yet to arrive the full status of a health centre. A healing centre is any centre, be it medical, psychiatric or religious centre where the sick and diseased are cater for or ministered to. While a health centre is a centre of integrated science, where profound and prolific insight on the human being (body, soul and spirit) are communicated and imparted; so as to empower humans both in their body, soul and spirit to forever triumph over sicknesses and diseases. Such a centre must be a research centre which progressively researches on both academic, scientific and insightful divine information and intelligence needed for human supremacy over sicknesses and diseases. Healing requires medication but health requires much more than medication. The greatest investment in health realization is information.

I am not talking here of ordinary knowledge; I am talking of advanced academic, scientific and divine knowledge containing the truth which unveils the truism of the human being (body, soul and spirit) with all their relative needs and demands. Thus, when you find a true health centre, you will see a place where the total science of the human being is unveiled, with teachers and doctors who are inter-comprehensive, possessing rare insight on the total science of human existence and functionality. Presently, such centres are non existent. This is the greatest challenge of the 21st century.

The entire world is doted with healing centres catering and administering to the sick and diseased without any investment in their education with respect to achieving health. This has led to the situation we have today of human beings constantly victimized and perpetually dependent on drugs and other healing mediums without ever graduating to health. You may ask what my proposition is: my proposition is for every healing centre to combine her efforts of relieving those who are sick and diseased with educating the people on health sciences. This is the only way we can triumph over sicknesses and diseases in the 21st century. Healing – Health = a victimized human, one perpetually dependent on drugs, instead of the truism of health.

It seems to me that, humanity is losing faith on pursuing total health. We have been cowed by numerous health challenges to the point where, we are instead studying how to function in abnormalities. The general slogan in most places today is how to live with AIDS, malaria, or any other disease. Such cowardly approach and attitude can not be rewarded with insight on human triumph over sicknesses and diseases. While seeking for better ways in relieving the sick and the diseased, we should not fail to embark on continuous research, so as to uncover the truth which will forever empower humans to triumph over sicknesses and diseases. This is the challenge of the 21st century.

It was believed that, no one could ever reach the summit of Mount Everest; thousands attempted and failed; and their failure reinforced the belief of the world. When the world slept in their pessimism, a man by name Edmond Hilary forced the world to change their belief; by getting to the top of Mount Everest. It was equally believed that a metal object could not fly. The Wright brothers equally forced the world to change their belief by their invention of the aero plane. The world presently believes that total health is impossible for the human being. I believe we are that generation to change that assertion. Let’s muster enough courage and faith. We can make it. Health is an integrated state of being, with the human body, soul and spirit functioning in absolute soundness.

Health Care Fraud

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Today, health care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or endeavor touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

– “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

– The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

– The National Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. [NHCAA, web-site] NHCAA was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David Hyman, professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from payor to payor – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated (ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used when seeking compensation from payors for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs recognize – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed, payors of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased pre- and post-payment audits of selected providers to detect fraud, and have created consortiums and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act (HIPAA). It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse. HIPAA purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.

In 2009, the Health Care Fraud Enforcement Act appeared on the scene. This act has recently been introduced by Congress with promises that it will build on fraud prevention efforts and strengthen the governments’ capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance by sentencing increases; redefining health care fraud offense; improving whistleblower claims; creating common-sense mental state requirement for health care fraud offenses; and increasing funding in federal antifraud spending.

Undoubtedly, law enforcers and prosecutors MUST have the tools to effectively do their jobs. However, these actions alone, without inclusion of some tangible and significant before-the-claim-is-paid actions, will have little impact on reducing the occurrence of the problem.

What’s one person’s fraud (insurer alleging medically unnecessary services) is another person’s savior (provider administering tests to defend against potential lawsuits from legal sharks). Is tort reform a possibility from those pushing for health care reform? Unfortunately, it is not! Support for legislation placing new and onerous requirements on providers in the name of fighting fraud, however, does not appear to be a problem.

If Congress really wants to use its legislative powers to make a difference on the fraud problem they must think outside-the-box of what has already been done in some form or fashion. Focus on some front-end activity that deals with addressing the fraud before it happens. The following are illustrative of steps that could be taken in an effort to stem-the-tide on fraud and abuse:

– DEMAND all payors and providers, suppliers and others only use approved coding systems, where the codes are clearly defined for ALL to know and understand what the specific code means. Prohibit anyone from deviating from the defined meaning when reporting services rendered (providers, suppliers) and adjudicating claims for payment (payors and others). Make violations a strict liability issue.

– REQUIRE that all submitted claims to public and private insurers be signed or annotated in some fashion by the patient (or appropriate representative) affirming they received the reported and billed services. If such affirmation is not present claim isn’t paid. If the claim is later determined to be problematic investigators have the ability to talk with both the provider and the patient…

– REQUIRE that all claims-handlers (especially if they have authority to pay claims), consultants retained by insurers to assist on adjudicating claims, and fraud investigators be certified by a national accrediting company under the purview of the government to exhibit that they have the requisite understanding for recognizing health care fraud, and the knowledge to detect and investigate the fraud in health care claims. If such accreditation is not obtained, then neither the employee nor the consultant would be permitted to touch a health care claim or investigate suspected health care fraud.

– PROHIBIT public and private payors from asserting fraud on claims previously paid where it is established that the payor knew or should have known the claim was improper and should not have been paid. And, in those cases where fraud is established in paid claims any monies collected from providers and suppliers for overpayments be deposited into a national account to fund various fraud and abuse education programs for consumers, insurers, law enforcers, prosecutors, legislators and others; fund front-line investigators for state health care regulatory boards to investigate fraud in their respective jurisdictions; as well as funding other health care related activity.

– PROHIBIT insurers from raising premiums of policyholders based on estimates of the occurrence of fraud. Require insurers to establish a factual basis for purported losses attributed to fraud coupled with showing tangible proof of their efforts to detect and investigate fraud, as well as not paying fraudulent claims.

5. Insurers are victims of health care fraud

Insurers, as a regular course of business, offer reports on fraud to present themselves as victims of fraud by deviant providers and suppliers.

It is disingenuous for insurers to proclaim victim-status when they have the ability to review claims before they are paid, but choose not to because it would impact the flow of the reimbursement system that is under-staffed. Further, for years, insurers have operated within a culture where fraudulent claims were just a part of the cost of doing business. Then, because they were victims of the putative fraud, they pass these losses on to policyholders in the form of higher premiums (despite the duty and ability to review claims before they are paid). Do your premiums continue to rise?

Insurers make a ton of money, and under the cloak of fraud-fighting, are now keeping more of it by alleging fraud in claims to avoid paying legitimate claims, as well as going after monies paid on claims for services performed many years prior from providers too petrified to fight-back. Additionally, many insurers, believing a lack of responsiveness by law enforcers, file civil suits against providers and entities alleging fraud.

6. Increased investigations and prosecutions of health care fraud

Purportedly, the government (and insurers) have assigned more people to investigate fraud, are conducting more investigations, and are prosecuting more fraud offenders.

With the increase in the numbers of investigators, it is not uncommon for law enforcers assigned to work fraud cases to lack the knowledge and understanding for working these types of cases. It is also not uncommon that law enforcers from multiple agencies expend their investigative efforts and numerous man-hours by working on the same fraud case.

Law enforcers, especially at the federal level, may not actively investigate fraud cases unless they have the tacit approval of a prosecutor. Some law enforcers who do not want to work a case, no matter how good it may be, seek out a prosecutor for a declination on cases presented in the most negative light.

Health Care Regulatory Boards are often not seen as a viable member of the investigative team. Boards regularly investigate complaints of inappropriate conduct by licensees under their purview. The major consistency of these boards are licensed providers, typically in active practice, that have the pulse of what is going on in their state.

Insurers, at the insistence of state insurance regulators, created special investigative units to address suspicious claims to facilitate the payment of legitimate claims. Many insurers have recruited ex-law enforcers who have little or no experience on health care matters and/or nurses with no investigative experience to comprise these units.

Reliance is critical for establishing fraud, and often a major hindrance for law enforcers and prosecutors on moving fraud cases forward. Reliance refers to payors relying on information received from providers to be an accurate representation of what was provided in their determination to pay claims. Fraud issues arise when providers misrepresent material facts in submitted claims, e.g. services not rendered, misrepresenting the service provider, etc.

Increased fraud prosecutions and financial recoveries? In the various (federal) prosecutorial jurisdictions in the United States, there are differing loss- thresholds that must be exceeded before the (illegal) activity will be considered for prosecution, e.g. $200,000.00, $1 million. What does this tell fraudsters – steal up to a certain amount, stop and change jurisdictions?

In the end, the health care fraud shell-game is perfect for fringe care-givers and deviant providers and suppliers who jockey for unfettered-access to health care dollars from a payment system incapable or unwilling to employ necessary mechanisms to appropriately address fraud – on the front-end before the claims are paid! These deviant providers and suppliers know that every claim is not looked at before it is paid, and operate knowing that it is then impossible to detect, investigate and prosecute everyone who is committing fraud!

Lucky for us, there are countless experienced and dedicated professionals working in the trenches to combat fraud that persevere in the face of adversity, making a difference one claim/case at a time! These professionals include, but are not limited to: Providers of all disciplines; Regulatory Boards (Insurance and Health Care); Insurance Company Claims Handlers and Special Investigators; Local, State and Federal Law Enforcers; State and Federal Prosecutors; and others.

Steps to Begin Transforming Your Health & Body Today

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While yes, our team is born in a world of intense high athletic goals such as bodybuilding, it is not our goal to support people to become bodybuilders – FAR FROM IT!;-) So you can relax now!! But it IS our goal to share with you why the lessons from our experience of mastering human health & the body, & how developing a bodybuilder “mentality” for your own life can literally skyrocket you into a level of personal health you never thought possible, while showing you the shortcuts in how to get there! Sound good? Heck, it sounds GREAT to us, because we already know how it can CHANGE YOUR LIFE.

If you are serious about stepping into your greatness of feeling & looking great, take 3 minutes & glean our insight, because this is the single-most MISSING LINK that we see people repeatedly leaving out of their game plan to great health & why they continue to fail at achieving quality health for their lives.

When you have had an experience of taking your mental, emotional & physical self to the level that bodybuilding competition requires, as a coach for others it then allows you to see potential for your clients that they could never envision for themselves without you by their side AND TAKE THEM THERE, and that is the beauty of the gift that we REJOICE in offering others in order to achieve optimal health, energy, & joy for their lives. But to get there…to create a successful transformation of your health & body, you HAVE to begin INSIDE with our 5 MUST-HAVE Steps! Yes, that’s right – the focus begins in the MIND. Time & again we see this process work, and it’s our UNIQUE coaching psychology method that sets us apart, & why we are capable of producing jaw-dropping results with the level of motivational mentality we provide. You can have all the knowledge in the world, but if you fail to develop the DESIRE & MINDSET to IMPLEMENT it, you will never succeed.

Want the insider view to our winning approach to learn how to transform your own health & body? We’re here to offer you the scoop because it’s our desire to support you fully to achieve authentic, preventative health from the inside, out in your lifetime. So where do we begin? There is a prolific spiritual author named John Maxwell, maybe you’ve heard of him, maybe you haven’t – but he writes of numerous spiritual topics & speaks on how we create TRUE transformation for our lives. Below we adapt his words for our article today because it’s a brilliant synopsis of just why & how we work with clients to coach them through mastering their personal health, as there are so many levels to the process.

When we discuss transformation of the physical body, to be successful we cannot deny that mind, body & spirit are woven tightly together in our being & therefore EACH needs to be considered – not just one. Often people when wanting to conquer health or healing goals immediately BEGIN at the physical, they think weight loss, nutrition, exercise…but that is their first step to failure because they’re joining the race before they’ve even laced their shoes!! When we fail to address mind & spirit in the health process we eventually lose the vision of why we’re addressing the physical in the first place & sadly fall off course when interest wanes, times get tough, or we lose our way because the how-to’s become unclear or appear out of reach. But if we start INSIDE & work OUTWARDS friends, GAME ON!!

Our 5 Expert Insider Steps to Transforming Your Health & Body

So these 5 KEY STEPS must be addressed in order to achieve a complete & SUCCESSFUL health & body transformation, and they must also be achieved in order as follows…

1. When you change your (health & body) thinking, you change your (health & body) beliefs.

If you think what you’ve been taught is healthy by the mainstream media is where your learning stops, then don’t expect to achieve great illness-free, authentic preventative health because they don’t teach proactive health approach, they teach reactive wait til you get sick & then act health approach. Begin to change your thinking to change your belief system about your body and health potential.

2. When you change your (health & body) beliefs, you change your (health & body) expectations.

Once you begin to expand your thinking, start to also seek out experts in areas of health & body who have shown & continue to show PROVEN ABILITY TO CREATE TRANSFORMATION RESULTS in their own health & body that you would like to emulate. Begin to sponge knowledge from them vs. what mainstream media claims leads to great health results, & you’ll in turn raise the bar on what you expect from your own health. You’ll see your new mentor/s are just ordinary people too like you, who decided to blaze their own health path about the quality of health they wanted to achieve for their life by taking the road less followed for their own health in life, and YOU CAN TOO – if you follow in their footprints.

3. When you change your (health & body) expectations, you change your (health & body) attitude.

Once your mind becomes opened by experts to your new health possibilities, you’ll have a renewed attitude & confidence about your abilities & empowerment around your personal health & begin to realize that anything you put your MIND to, your BODY can achieve -with the right tools in your toolbox. And THAT is exciting!

4. When you change your (health & body) attitude, you change your (health & body) behavior.

Now that you come to the table with a revitalized health attitude of possibilities & an arsenal from your health mentor, your entire being & behavior begins to shift because your mentor connects you with your own personal ability to achieve great results for your health, and as that continues to happen over and over, your self-efficacy GROWS & GROWS around your capabilities to manage your own personal health, as you transition into your own personal mini-health-expert!

5. When you change your (health & body) behavior, YOU CHANGE YOUR LIFE.

Now that you’ve achieved health & body mastery, you will begin to see an entire energetic, mental & emotional shift in your life that FAR EXCEEDS the physical. Yes, you will look & feel great, but the ways optimal health radiate outwards to all facets of your life will be astounding, as you attain a personal joy in life through health that you’ve never experienced before. No pills, no roller coaster of energy, no food cravings, no more blah approach to life, no more hiding from life within your own body,…you emerge a renewed person, ready to take on your full potential in this life.

This list is the perfect example of why health coaching with experienced experts not only WORKS, but offers you AMAZING, permanent results you could never envision or achieve on your own. With the support of your coaches seasoned & proven mentality of success in health & body transformation, you develop a similar mindset, outlook & body of knowledge in order to reach external goals of physical health & body success!

Which Health Insurance Plan Is Best for Me

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Health insurance has proven itself of great help and financial aid in certain cases when events turn out unexpectedly. In times when you are ill and when your health is in grave jeopardy and when finances seem to be incapable to sustain for your care, health insurance is here to the rescue. A good health insurance plan will definitely make things better for you.

Basically, there are two types of health insurance plans. Your first option is the indemnity plans, which includes the fee-for-services and the second is the managed care plans. The differences between these two include the choice offered by the providers, the amount of bills the policy holder has to pay and the services covered by the policy. As you can always hear there is no ultimate or best plan for anyone.

As you can see, there are some plans which may be way better than the others. Some may be good for you and your family’s health and medical care needs. However, amidst the sweet health insurance plan terms presented, there are always certain drawbacks that you may come to consider. The key is, you will have to wisely weigh the benefits. Especially that not among these plans will pay for all the financial damages associated with your care.

The following are a brief description about the health insurance plans that might be fitting for you and your family’s case.

Indemnity Plans

Flexible Spending Plans – These are the types of health insurance plans that are sponsored when you are working for a company, or any employer. These are the care plans inclusive in your employee benefit package. Some of the specific types of benefits included in this plan are the multiple options pre-tax conversion plan, medical plans plus flexible spending accounts, tax conversion plan, and employer credit cafeteria plans. You can always ask your employer of the benefits included in your health care/insurance plans.

Indemnity Health Plans – This type of health insurance plan allows you to choose your own health care providers. You are given the freedom to go to any doctor, medical institution, or other health care providers for a set monthly premium. The insurance plan will reimburse you and your health care provider according to the services rendered. Depending on the health insurance plan policy, there are those that offers limit on individual expenses, and when that expense is reached, the health insurance will cover for the remaining expenses in full. Sometimes, indemnity health insurance plans impose restrictions on services covered and may require prior authorization for hospital care and other expensive services.

Basic and Essential Health Plans – It provides a limited health insurance benefit at a considerably low insurance cost. In opting for this kind of health insurance plan, it is necessary that one should read the policy description giving special focus on covered services. There are plans which may not cover on some basic treatments, certain medical services such as chemotherapy, maternity care or certain prescriptions. Also, rates vary considerably since unlike other plans, premiums consider age, gender, health status, occupation, geographic location, and community rated.

Health Savings Accounts – You own and control the money in your HSA. This is the recent alternative to the old fashioned health insurance plans. These are savings product designed to offer policy holders different way to pay for their health care. This type of insurance plan allows the individual to pay for the current health expenses and also save for untoward future qualified medical and retiree health costs on a tax-free basis. With this health care plan, you decide on how your money is spent. You make all the decisions without relying on any third party or a health insurer. You decide on which investment will help your money grow. However, if you sign up for an HSA, High Deductible Health Plans are required in adjunct to this type of insurance plan.

High Deductible Health Plans – Also called Catastrophic Health Insurance Coverage. It is an inexpensive health insurance plan which is enabled only after a high deductible is met of at least $1,000 for an individual expense and $2,000 for family-related medical expense.

Managed Care Options

Preferred Provider Organizations – This is charged in a fee-for-service basis. The involved health care providers are paid by the insurer on a negotiated fee and schedule. The cost of services are likely lower if the policy holder chooses an out-of-network provider ad generally required to pay the difference between what the provider charges and what the health insurance plan has to pay.

Point of Service – POS health insurance plans are one of the indemnity type options in which the primary health care providers usually make referrals to other providers within the plan. In the event the doctors make referrals which are out of the plan, that plan pays all or most of the bill. However, if you refer yourself to an outside provider, the service charges may also be covered by the plan but the individual may be required to pay the coinsurance.

Health Maintenance Organizations – It offers access to a network of physicians, health care institutions, health care providers, and a variety of health care facilities. You have the freedom to choose for your personal primary care doctor from a list which may be provided by the HMO and this chosen doctor may coordinate with all the other aspects of your health care. You may speak with your chosen primary doctor for further referrals to a specialist. Generally, you are paying fewer out-of-pocket fees with this type of health insurance plan. However, there are certain instances that you may be often charged of the fees or co-payment for services such as doctor visits or prescriptions.

Government-Sponsored Health Insurance

Indian Health Services – This is part of the Department of Health and Human Services Program offering all American Indians the medical assistance at HIS facilities. Also, HIS helps in paying the cost of the health care services utilized at non-HIS facilities.

Medicaid – This is a federal or s state public assistance program created in the year 1965. These are available for the people who may have insufficient resources to pay for the health care services or for private insurance policies. Medicaid is available in all states. Eligibility levels and coverage benefits may vary though.

Medicare – This is a health care program for people aging 65 and older, with certain disabilities that pays part of the cost associated with hospitalization, surgery, home health care, doctor’s bills, and skilled nursing care.

Military Health Care – This type includes the TRICARE or the CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affair). The Department of Veterans Affair (VA) may also provide this service.

State Children’s Health Insurance Program – This is available to children whose low-income parents were not able to qualify for the Medicaid.
State-Specific Plans – This type of plan is available for low income uninsured individuals.

Occupational Health

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The rapid development of workplace health protective and preventive services has been driven by government strategies and recommendations, as well as by the European Union legislation in the areas of health and safety at work and by the European Commission programme in public health. This was also largely due to the new demands and expectations from employers, employees and their representative bodies as they recognize the economic, social and health benefits achieved by providing these services at the workplace, thus providing the available knowledge and evidence necessary for the continuous improvement of workplace health management. Comprehensive workplace health management is a process involving all stakeholders inside and outside any business. It aims at empowering them to take control over their own health and their family’s health considering environmental, lifestyle, occupational and social health determinants and quality of health care. It is based on health promotion principles and it creates a great challenge to health, environment and safety professionals providing services, advice, information and education to social partners at work. It involves also taking care of considerable socioeconomic interest of all involved stakeholders. It has been shown in several instances that the business utilizing a well managed research based occupational health service can gain a competitive advantage by:

  • Protecting human health against health and safety hazards occurring in the work environment.
  • Promoting human health workplaces for all ages and healthy aging by appropriate work culture, work organization and support to social cohesion.
  • Promoting mental health, healthy lifestyle and preventing major non-communicable diseases using specific workplace health policies and management tools.
  • Maintaining work ability thus also employability throughout working life.
  • Reducing health care costs caused by employees’ and employers’ injuries, diseases, illnesses and premature retirement resulting from or influenced by occupational, environmental, life style and social health determinants
  • Using resources effectively, protecting the natural environment and creating a health supportive environment.
  • Improving social communication and literacy on health, environment and ethics.

This article series describes the author’s observations of various roles undertaken by the occupational health nurse. Whilst recognizing the wide variation that exists in occupational health nursing practice between different industrial and blue collar environments this series reflects the standards that have already been achieved where occupational health nursing is at its most advanced. However it has to be recognized that the level of education, professional skills and the exiting national legislation determines what role can be actually undertaken by occupational health nurses. Even more important is to remember that no one professional out of the exiting workplace health professions is now capable to meeting all health needs of the working population. A multi-disciplinary approach is needed to effectively manage the growing workplace health and safety demands in business today.

The workplace health services use the skills of many professionals such as specialist occupational physicians, safety engineers, occupational hygienists, occupational health nurses, ergonomists, physiotherapists, occupational therapists, laboratory technicians, psychologists and other specialists. The role and tasks actually performed for the companies by representatives of different health and safety professions vary greatly depending upon legislative needs, scope of the workplace health concept perceived by directors, enforcement practice, the level of their education, position in the occupational health infrastructure, actions undertaken by insurance institutions and many other factors. Occupational health nurses are the largest single group of health professionals involved in delivering health services at the workplace and have the most important role to play in the workplace health management. They are at the frontline in helping to protect and promote the health of the nations working population.

The role of the occupational health nurse in workplace health management is a new and exciting concept that is designed to improve the management of health and health related problems in the workplace. Specialist occupational health nurses can play a major role in protecting and improving the health of the working population as part of this strategy. Occupational health nurses can also make a major contribution to the sustainable development, improved competitiveness, job security and increased profitability of businesses and communities by addressing those factors which are related to the health of the working population. By helping to reduce ill health occupational health nurses can contribute to the increased profitability and performance of organizations and reduce health care costs. Occupational health nurses can also help to reduce the externalization of costs onto the taxpayer, by preventing disability and social exclusion, and by improving rehabilitation services at work. By protecting and promoting the health of the working population, and by promoting social inclusion, occupational health nurses can also make a significant contribution towards building a caring social ethos within the UK. This article provides guidance to employers and employees on establishing workplace health management systems within their own organizations. On how to determine and develop the role and functions of the occupational health nursing specialist within each enterprise and where to go for additional help and advice in relation to occupational health nursing.

Changing nature of working life and the new challenges

The world of work has undergone enormous change in the last hundred years. To a large extent the very heavy, dirty and dangerous industries have gone, and the burden of disease, which came with them, in most European countries, has declined. However, the new working environments and conditions of work that have replaced them have given rise to new and different concerns about the health of the working population. Exposure to physical, chemical, biological and psychosocial risk factors at work are now much more clearly linked to health outcomes in the mind of the general public. Expectations of society in regard to health at work have also changed, with increasing demands for better standards of protection at work and for the improvement of the quality of working life. Employers are also recognizing that health-related issues, such as sickness absence, litigation and compensation costs, increasing insurance premiums, are expensive; ignoring them can lead to serious economic consequences. The best employers’ emphasize the important message that good health is good business, and that much can be achieved in this field simply by introducing good management practices.

The Need for Workplace Management

There are approximately 400 million people who work in the EU Member States. The majority of whom spend more than one half of their waking life at work. However, fatal accidents at work are still common. The standardized incident rates per 100,000 workers in the European Union show that the fatal accident rate varies between 1.6 in the UK to 13.9 in Spain, with Austria, Greece, France, Italy and Portugal all above 5.0%. In the entire European region there are approximately 200 to 7500 non-fatal accidents per 100,000 employees per year, of which around 10% are severe leading to over 60 days absence from work, and up to 5%, per year, lead to permanent disability. It has been estimated that the total cost to society of work related injuries and ill health in the European Union is between 185 billion and 270 billion ECU per year, which represents between 2.6% to 3.8% of Gross National Product (GNP) in member states. The cost of workplace accidents and ill health, in both financial and human terms, remains an enormous, largely unrecognized burden in UK. The majority of those accidents and diseases could have been prevented if appropriate action had been taken at the workplace. Many responsible employers have consistently demonstrated that by paying attention to these issues this type of harm and the subsequent costs can be avoided, to the benefit of everyone concerned. Increasing concern is the growing awareness of occupational stress. Up to 42% of workers in a recent survey complained about the high pace of work. Job insecurity, fear of unemployment, lack of a regular salary and the potential loss of work ability are all additional sources of stress, even for those in employment.

The wide ranging social and health effects of occupational stress on the health of the working population are well documented, for example 23% of workers surveyed claimed that they had been absent from work for work related health reasons in the previous twelve months. The resulting cost of sickness absence in United Kingdom is considered to be substantial. In the UK 177 million working days were lost in 1994 as a result of sickness absence; this has been assessed at over 11 billion in lost productivity. HSE statistics are encouraging given in 2009; only 29.3 million days were lost overall, 24.6 million due to work-related ill health and 4.7 million due to workplace injury. Much of this burden of ill health and the resulting sickness absence is caused, or is made worse by working conditions. Even where ill health is not directly caused by work, but by other non-occupational factors such as smoking, lifestyle, diet etc. Interventions designed to improve the health of the working population, delivered at the workplace, may help to reduce still further the burden of ill health. At present the socioeconomic impact of environmental pollution caused by industrial processes on the working population is uncertain, but it is likely to contribute further to the burden of ill health in some communities.

Workplace Health Management

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Workplace Health Management (WHM) There are four key components of workplace health management:

  • Occupational Health and Safety
  • Workplace Health Promotion
  • Social and lifestyle determinants of health
  • Environmental Health Management

In the past policy was frequently driven solely by compliance with legislation. In the new approach to workplace health management, policy development is driven by both legislative requirements and by health targets set on a voluntary basis by the working community within each industry. In order to be effective Workplace Health Management needs to be based on knowledge, experience and practice accumulated in three disciplines: occupational health, workplace health promotion and environmental health. It is important to see WHM as a process not only for continuous improvement and health gain within the company, but also as framework for involvement between various agencies in the community. It offers a platform for co-operation between the local authorities and business leaders on community development through the improvement of public and environmental health.

The Healthy Workplace setting – a cornerstone of the Community Action Plan.

The Luxembourg Declaration of the European Union Network for Workplace Health Promotion defined WHP as the combined effort of employers, employees and society to improve the health and well-being of people at work

This can be achieved through a combination of:

  • Improving the work organization and the working environment
  • Promoting active participation of employees in health activities
  • Encouraging personal development

Workplace health promotion is seen in the EU network Luxembourg Declaration as a modern corporate strategy which aims at preventing ill-health at work and enhancing health promoting potential and well-being in the workforce. Documented benefits for workplace programs include decreased absenteeism, reduced cardiovascular risk, reduced health care claims, decreased staff turnover, decreased musculoskeletal injuries, increased productivity, increased organizational effectiveness and the potential of a return on investment.

However, many of these improvements require the sustained involvement of employees, employers and society in the activities required to make a difference. This is achieved through the empowerment of employees enabling them to make decisions about their own health. Occupational Health Advisors (OHA) are well placed to carry out needs assessment for health promotion initiatives with the working populations they serve, to prioritize these initiatives alongside other occupational health and safety initiatives which may be underway, and to coordinate the activities at the enterprise level to ensure that initiatives which are planned are delivered. In the past occupational health services have been involved in the assessment of fitness to work and in assessing levels of disability for insurance purposes for many years.

The concept of maintaining working ability, in the otherwise healthy working population, has been developed by some innovative occupational health services. In some cases these efforts have been developed in response to the growing challenge caused by the aging workforce and the ever-increasing cost of social security. OHA’s have often been at the forefront of these developments.

There is a need to develop further the focus of all occupational health services to include efforts to maintain work ability and to prevent non-occupational workplace preventable conditions by interventions at the workplace. This will require some occupational health services to become more pro-actively involved in workplace health promotion, without reducing the attention paid to preventing occupational accidents and diseases. OHA’s, with their close contact with employees, sometimes over many years, are in a good position to plan, deliver and evaluate health promotion and maintenance of work ability interventions at the workplace.

Health promotion at work has grown in importance over the last decade as employers and employees recognize the respective benefits. Working people spend about half of their non-sleeping day at work and this provides an ideal opportunity for employees to share and receive various health messages and for employers to create healthy working environments. The scope of health promotion depends upon the needs of each group.

Some of the most common health promotion activities are smoking reducing activities, healthy nutrition or physical exercise programs, prevention and abatement of drug and alcohol abuse.

However, health promotion may also be directed towards other social, cultural and environmental health determinants, if the people within the company consider that these factors are important for the improvement of their health, well-being and quality of life. In this case factors such as improving work organization, motivation, reducing stress and burnout, introducing flexible working hours, personal development plans and career enhancement may also help to contribute to overall health and well-being of the working community.

The Healthy Community setting In addition to occupational health and workplace health promotion there is also another important aspect to Workplace Health Management. It is related to the impact that each company may have on the surrounding ambient environment, and through pollutants or products or services provided to others, its impact on distant environments. Remember how far the effects of the Chernobyl Nuclear accident in 1986 affected whole neighbouring countries.

Although the environmental health impact of companies is controlled by different legislation to that which applies to Health and Safety at work, there is a strong relationship between safeguarding the working environment, improving work organization and working culture within the company, and its approach to environmental health management.

Many leading companies already combine occupational health and safety with environmental health management to optimally use the available human resources within the company and to avoid duplication of effort. Occupational health nurses can make a contribution towards environmental health management, particularly in those companies that do not employ environmental health specialists.

Occupational Health

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It is not possible to describe a highly complex and dynamic process such as occupational health nursing simply in terms of core activities or tasks. Occupational Health Nurse (OHA) are constantly learning new skills, adapting current practices to meet new needs and developing new approaches to solving problems and therefore their practice is not static but is constantly improving based upon a core range of skills.

However, within this limitation it is possible to describe those core areas of knowledge and competence that occupational health nurses use. The following list is not intended to be exhaustive, but rather to give an indication of the wide range of competencies that occupational health nurses demonstrate in practice.

The Clinician

Primary prevention

The OHA is skilled in primary prevention of injury or disease. The nurse may identify the need for, assess and plan interventions to, for example modify working environments, systems of work or change working practices in order to reduce the risk of hazardous exposure. Occupational health nurses are skilled in considering factors, such as human behavior and habits in relation to actual working practices. The nurse can also collaborate in the identification, conception and correction of work factors, choice of individual protective equipment, prevention of industrial injuries and diseases, as well as providing advice in matters concerning protection of the environment. Because of the occupational health nurses close association with the workers, and knowledge and experience in the working environment, they are in a good position to identify early changes in working practices, identify workers concerns over health and safety, and by presenting these to management in an independent objective manner can be the catalyst for changes in the workplace that lead to primary prevention.

Emergency care

The OHA is a Registered Nurse with a great deal of clinical experience and expertise in dealing with sick or injured people. The nurse may, where such duties form part of their job, provide initial emergency care of workers injured at work prior to transfer of the injured worker to hospital or the arrival of the emergency services. In many instances, where hazardous conditions exist at work, or where the workplace is far removed from other health care facilities, this role will form a major part of an occupational health nurse’s job. Occupational health nurses employed in mines, on oil rigs, in the desert regions or in areas where the health care systems are not yet fully developed will be familiar with a wide range of emergency care techniques and may have developed additional skills in order to fulfill this role. For others, who are working in situations where the emergency services are on hand, they may simply provide an additional level of support beyond that provided by the industrial first aider.

Nursing diagnosis

Occupational health nurses are skilled in assessing client’s health care needs, establish a nursing diagnosis and formulating appropriate nursing care plans, in conjunction with the patient or client groups, to meet those needs. Nurses can then implement and evaluate nursing interventions designed to achieve the care objectives. The nurse has a prominent role in assessing the needs of individuals and groups, and has the ability to analyze, interpret, plan and implement strategies to achieve specific goals. By using the nursing process the nurse contributes to workplace health management and by so doing helps to improve the health of the working population at the shop floor level. Nursing diagnosis is a holistic concept that does not focus solely on the treatment of a specific disease, but rather considers the whole person and their health care needs in the broadest context. It is a health based model rather than a disease based model and nurses have the skills to apply this approach with the working populations they serve.

General Health advice and health assessment

The OHA will be able to give advice on a wide range of health issues, and particularly on their relationship to working ability, health and safety at work or where modifications to the job or working environment can be made to take account of the changing health status of employees.

In many respects employers are not solely concerned with only those conditions that are directly caused by work, but do want their occupational health staff to help address any health related problems that may arise that might influence the employees attendance or performance at work, and many employees appreciate this level of help being provided to them at the workplace because it is so convenient for them. In particular the development of health care services to men at work, younger populations and those from ethnic groups can be most effective in reaching these sometimes difficult to reach populations.

Research and the use of evidence based practice

In addition to utilizing information and knowledge produced by research in various fields to support activities that relate to the occupational health component of their role, occupational health nurses will also utilize fully research information available from many fields to help support the general health of the working population.

Specialist

Occupational health policy, and practice development, implementation and evaluation

The specialist occupational health nurse may be involved, with senior management in the company, in developing the workplace health policy and strategy including aspects of occupational health, workplace health promotion and environmental health management. The OH nurse is in a good position to advise management on the implementation, monitoring and evaluation of workplace health management strategies and to participate fully in each of these stages. Possibility to perform that role will depend upon level of nurse education, skills and experience.

Occupational health assessment

OHA’s can play an essential role in health assessment for fitness to work, pre-employment or pre-placement examinations, periodic health examinations and individual health assessments for lifestyle risk factors.

Collaboration with occupational physician may be necessary in many instances, depending upon exiting legislation and accepted practice. The nurse can also play an important role in the workplace where informal requests for information, advice on health care matters and health related problems come to light. The nurse is able to observe the individual or group of workers in relation to exposure to a particular hazard and initiate appropriate targeted health assessment where necessary. These activities are often, but not exclusively, undertaken in conjunction with the medical adviser so that where problems are identified a safe system for onward referral exists.

Health surveillance

Where workers are exposed to a degree of residual risk of exposure and health surveillance is required by law the OHA will be involved in undertaking routine health surveillance procedures, periodic health assessment and in evaluating the results from such screening processes. The nurse will need a high degree of clinical skill when undertaking health surveillance and maintain a high degree of alertness to any abnormal findings. Early referral to an occupational health physician or other appropriate specialist will be the responsibility of the occupational health nurse where any abnormality is detected. The nurse will be involved in supporting the worker throughout any further examination or investigation, and may help to monitor their health on return to work. Once alerted to the possibility of an adverse health effect the occupational health nurse is in a good position to co-ordinate efforts to re-evaluate working practices in order to help protect others who may be similarly affected.