Etudier Aiasi

Blake Vanderhyde asked:


The following is an example of a Health Care Directive (many people still refer to this as a Living Will).   It is broken down into 3 basic parts.  1) Appointment of the Health Care Agent.  2) Health Care Instructions.  3) Making the Document Legal.   Like most legal documents, it can be a bit confusing and overwhelming.  The purpose for making this easily available to the public is simple.  To help people know what to expect before contacting a lawyer and having him or her draft a directive for them.   Nobody likes thinking about their demise or incapacity.  However, dealing with such issues is a necessary part of life. 

 

This example should not be used as a substitute for getting solid legal advice from a licensed attorney.  Every individual is different.  Please consult a lawyer in your area to discuss your specific estate planning needs.

 

 

HEALTH CARE DIRECTIVE

 

I, ___________________________________, understand this document allows me to do One or both of the following:

 

PART I: Name another person (called the health care agent) to make health care decisions for me if I am unable to decide or speak for myself. My health care agent must make health care decisions for me based on the instructions I provide in this document (Part II), if any, the wishes I have made known to him or her, or must act in my best interest if I have not made my health care wishes known.

 

And/or

 

PART II: Give health care instructions to guide others making health care decisions for me. If I have named a health care agent, these instructions are to be used by the agent. These instructions may also be used by my health care providers, others assisting with my health care and my family, in the event I cannot make decisions for myself.

 

 

PART I: APPOINTMENT OF HEALTH CARE AGENT

 

This is who I want to make health care decisions for me if I am unable to decide or speak for myself  (I know I can change my agent or alternate agent at any time and I know I do not have to appoint an agent or an alternate agent)

 

NOTE: If you appoint an agent, you should discuss this health care directive with your agent and give your agent a copy. If you do not wish to appoint an agent, you may leave Part I blank and go to Part II.

 

 

When I am unable to decide or speak for myself, I trust and appoint ___________________ to make health care decisions for me. This person is called my health care agent.  Relationship of my health care agent to me: ___________________

Telephone number of my health care agent: _________________________

Address of my health care agent: _________________________

 

(OPTIONAL) APPOINTMENT OF ALTERNATE HEALTH CARE AGENT: If my health care agent is not reasonably available, I trust and appoint _________________ to be my health care agent instead.  Relationship of my alternate health care agent to me: ___________________________Telephone number of my alternate health care agent: ___________________________ Address of my alternate health care agent: ___________________________

 

THIS IS WHAT I WANT MY HEALTH CARE AGENT TO BE ABLE TO

DO IF I AM UNABLE TO DECIDE OR SPEAK FOR MYSELF (I know I can change these choices)

 

My health care agent is automatically given the powers listed below in (A) through (D).

My health care agent must follow my health care instructions in this document or any other instructions I have given to my agent. If I have not given health care instructions, then my agent must act in my best interest. Whenever I am unable to decide or speak for myself, my health care agent has the power to:

 

(A) Make any health care decision for me. This includes the power to give, refuse, or

withdraw consent to any care, treatment, service, or procedures. This includes deciding whether to stop or not start health care that is keeping me or might keep me alive, and deciding about intrusive mental health treatment.

 

(B) Choose my health care providers.

 

(C) Choose where I live and receive care and support when those choices relate to my

health care needs.

 

(D) Review my medical records and have the same rights that I would have to give my

medical records to other people.

 

If I DO NOT want my health care agent to have a power listed above in (A) through (D) OR if I want to LIMIT any power in (A) through (D), I MUST say that here:

 

______________________________________________________________________

 

My health care agent is NOT automatically given the powers listed below in (1) and (2). If I WANT my agent to have any of the powers in (1) and (2), I must INITIAL the line in front of the power; then my agent WILL HAVE that power.

 

______   (1)  To decide whether to donate any parts of my body, including organs, tissues, and eyes, when I die.

 

______ (2)  To decide what will happen with my body when I die (burial, cremation).

 

If I want to say anything more about my health care agent’s powers or limits on the powers, I can say it here:  ________________________________________________________________________

 

 

 

 

PART II: HEALTH CARE INSTRUCTIONS

 

NOTE: Complete this Part II if you wish to give health care instructions. If you appointed an agent in Part I, completing this Part II is optional but would be very helpful to your agent. However, if you chose not to appoint an agent in Part I, you MUST complete some or all of this Part II if you wish to make a valid health care directive.

 

These are instructions for my health care when I am unable to decide or speak for myself.

These instructions must be followed (so long as they address my needs).

 

THESE ARE MY BELIEFS AND VALUES ABOUT MY HEALTH CARE

(I know I can change these choices or leave any of them blank)

 

I want you to know these things about me to help you make decisions about my health care:

 

My goals for my health care: ________________________________________________________________________________________________________________________________________________

 

 

 

My fears about my health care: ________________________________________________________________________________________________________________________________________________

 

 

My spiritual or religious beliefs and traditions: ________________________________________________________________________________________________________________________________________________

 

 

 

My beliefs about when life would be no longer worth living:

 

________________________________________________________________________________________________________________________________________________

 

My thoughts about how my medical condition might affect my family:

 

________________________________________________________________________________________________________________________________________________

 

THIS IS WHAT I WANT AND DO NOT WANT FOR MY HEALTH CARE

 

(I know I can change these choices or leave any of them blank)  Many medical treatments may be used to try to improve my medical condition or to prolong my life. Examples include artificial breathing by a machine connected to a tube in the lungs, artificial feeding or fluids through tubes, attempts to start a stopped heart, surgeries, dialysis, antibiotics, and blood transfusions. Most medical treatments can be tried for a while and then stopped if they do not help.  I have these views about my health care in these situations:  (Note: You can discuss general feelings, specific treatments, or leave any of them blank)

 

If I had a reasonable chance of recovery, and were temporarily unable to decide or speak

for myself, I would want:

 

________________________________________________________________________________________________________________________________________________

 

 

If I were dying and unable to decide or speak for myself, I would want:

 

________________________________________________________________________________________________________________________________________________

 

 

If I were permanently unconscious and unable to decide or speak for myself, I would want:

 

________________________________________________________________________________________________________________________________________________

 

 

 

 

If I were completely dependent on others for my care and unable to decide or speak for

myself, I would want: …..

 

________________________________________________________________________________________________________________________________________________

 

 

In all circumstances, my doctors will try to keep me comfortable and reduce my pain. This is how I feel about pain relief if it would affect my alertness or if it could shorten my life:

 

________________________________________________________________________________________________________________________________________________

 

 

There are other things that I want or do not want for my health care, if possible:

 

Who I would like to be my doctor:

 

________________________________________________________________________________________________________________________________________________

 

 

 

 

Where I would like to live to receive health care:

 

________________________________________________________________________________________________________________________________________________

 

 

 

Where I would like to die and other wishes I have about dying:

 

________________________________________________________________________________________________________________________________________________

 

My wishes about donating parts of my body when I die:

 

________________________________________________________________________________________________________________________________________________

My wishes about what happens to my body when I die (cremation, burial):

 

________________________________________________________________________________________________________________________________________________

 

 

Any other things:

 

________________________________________________________________________________________________________________________________________________

 

 

PART III: MAKING THE DOCUMENT LEGAL

 

This document must be signed by me. It also must either be verified by a notary public

(Option 1) OR witnessed by two witnesses (Option 2). It must be dated when it is verified or witnessed.I am thinking clearly, I agree with everything that is written in this document, and I have made this document willingly.

 

 

___________________________________

My Signature

  

___________________________________

Date signed:

 

___________________________________ 

Date of birth:

 

___________________________________ 

Address:

 

 

If I cannot sign my name, I can ask someone to sign this document for me.

 

 

_____________________________________________________

Signature of the person who I asked to sign this document for me.

 

________________________________________________________

Printed name of the person who I asked to sign this document for me.

 

 

Option 1: Notary Public

 

In my presence on___________________________________ (date), __________________________________________ (name) acknowledged his/her

signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf. I am not named as a health care agent or alternate health care agent in this document.

 

___________________________________________ 

(Signature of Notary)

 (Notary Stamp)

 

 

Option 2: Two Witnesses

 

Two witnesses must sign. Only one of the two witnesses can be a health care provider or an employee of a health care provider giving direct care to me on the day I sign this document.

 

Witness One:

(i) In my presence on _______________________ (date), ________________ (name) acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.

(ii) I am at least 18 years of age.

(iii) I am not named as a health care agent or an alternate health care agent in this document.

(iv) If I am a health care provider or an employee of a health care provider giving direct

care to the person listed above in (A), I must initial this box: [   ]

I certify that the information in (i) through (iv) is true and correct.

 

______________________________________ 

(Signature of Witness One)

 

Address:  ________________________________________________________________________________________________________________________________________________

 

 

Witness Two:

(i) In my presence on ________________________ (date), _________________ (name) acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.

(ii) I am at least 18 years of age.

(iii) I am not named as a health care agent or an alternate health care agent in this document.

(iv) If I am a health care provider or an employee of a health care provider giving direct

care to the person listed above in (A), I must initial this box: [   ]

I certify that the information in (i) through (iv) is true and correct.

 

________________________________________ 

(Signature of Witness Two)

 

Address:

________________________________________________________________________________________________________________________________________________

 

REMINDER: Keep this document with your personal papers in a safe place (not in a safe deposit box). Give signed copies to your doctors, family, close friends, health care agent, and alternate health care agent. Make sure your doctor is willing to follow your wishes. This document should be part of your medical record at your physician’s office and at the hospital, home care agency, hospice, or nursing facility where you receive your care.

 

Some of this information was taken from Minnesota statute section 145C.16.  This should not be considered legal advice, it is provided as a public service.

Chiva-Som International Health Resort asked:




Chinn Neo - a previous guest at Chiva-Som - is very happy. “[Ken Rosen] treated my husband Robert Lau for his nicotine addiction,” she says. “And after having smoked for the past 20 years, he has stopped! This is AMAZING!!”

Chinn not only now has a healthier husband, she also has no unpleasant smoke odours hanging around the house. True: nicotine is incredibly addictive. But with the help of Traditional Chinese Medicine (TCM) and Emotional Freedom Techniques (EFT), you too can stop smoking.

Ken Rosen is Chiva-Som’s Practitioner of Traditional Chinese Medicine. “At Chiva-Som,” he says, “we offer a complimentary half-hour stop-smoking treatment that follows the NADA (National Acupuncture Detoxification Association) protocol. “The treatment consists of four or five needles placed painlessly at specific points in each ear. After three to ten half-hour sessions, most people quit, and many report back a year later saying they remain smoke free.”

But how does it work? Ken explains: “The ear is a nexus of energy in the body. During the treatment, the body’s nervous energy tries to push the needles out and tunes into itself for healing. When the needles come into equilibrium with the body and mind, the nervous system has been reset in a very profound way. Sort of like restarting a computer.”

Another method to stop smoking is offered by renowned therapist Paul Emery. He uses a powerful combination of EFT and other psychological techniques, NLP for instance. “I can often reduce cigarette cravings in a matter of minutes,” he says. “And I provide guests with a quick tool to use if they need to reduce future cravings or stress.” EFT is based on 5,000 year-old Chinese principles. “It’s a psychological version of acupuncture, but without needles,” Paul reveals. “Instead, I tap specific meridian points. The treatment helps guests to quit smoking physically and psychologically, breaking links with associated activities such coffee breaks and meals.”

TCM and EFT can be used for any addiction, including drugs, food, and work stress. They both have a deeply relaxing effect on the whole person, complementing other therapies at Chiva-Som.

Pennsylvania Health Insurance asked:




Some states in the US require that all citizens of their state be covered for Health Insurance. Ohio is one of the states that allows Ohio citizens to receive Free Ohio Health Insurance. There are 2 free health insurance programs Healthy Start and Healthy Families. However a Ohio resident must qualify first. Ohio Health Insurance Quote



Healthy Start & Healthy Families are Medicaid programs that provide eligible Ohio families with comprehensive health coverage. This means families get coverage for all of the following: doctor visits, prescriptions, hospital care, immunizations, vision & dental care, substance abuse, mental health services and much more! Not only is this a great benefit package, but families who qualify for Healthy Start & Healthy Families will receive covered services at no cost

Who Qualifies:



U.S. citizens of Ohio

Ohio residents

Ohio residents with a social security number

Ohio residents who meet the financial requirements listed below.



Who is covered? Income Eligibility Guidelines Gross Monthly Income Gross Monthly Income Gross Monthly Income Gross Monthly Income Family Size 1 Family Size 2 Family Size 3 Family Size 4 Children (to age 19) 200% FPL $1,734 $2,334 $2,934 $3,534 Pregnant Women 200% FPL $1,734 $2,334 $2,934 $3,534 Families 90% FPL $780 $1,050 $1,320 $1,590

The following services are included in the plan:



Ambulance services

Chiropractic services (children only)

Community alcohol and drug addiction services

Community mental health services

Dental services

Durable medical equipment

Family planning services and supplies

Home and community-based services waivers (restricted enrollment)

Home health services

Hospice

Inpatient hospital services

Lab and X-ray services

Nursing home care

Nurse-midwife, certified family nurse practitioner, and certified pediatric nurse practitioner services

Outpatient services, including Rural Health Clinics and Federally Qualified Health Centers (FQHCs)

Physical therapy, occupational therapy, and speech therapy

Physician services

Podiatry

Prescription drugs

Screening and treatment services to children under age 21 under the HEALTHCHEK (EPSDT) program

Transportation to medical appointments

Vision care, including eyeglasses

Julie Health asked:


Dating back more than 4,000 years, Chinese green tea diet has been long revered as a tasty drink that can ward off diseases and improve one’s well-being. There are only a few herbs that can surpass its impressive history.

Since its first recorded use during the time of Emperor Shen Nung, the link between Chinese green tea diet and good health has never been severed. Today, further studies are made to test the benefits of the remarkable health elixir.

Traditional Health Benefits of the Diet

According to tradition, this diet could cure anything from headaches, body aches, and pains to constipation and depression. Over the centuries, more health claims are made on account of the Chinese green tea diet.

It detoxifies the body. The presence of polyphenols, a naturally occurring antioxidant in this particular tea, is said to combat harmful free radicals and help keep the body free from diseases. In this regard, Chinese green tea helps maintain the overall well-being of the body. It fights against the anti-aging process because the antioxidants can boost immunity, preserve young-looking skin, and brighten the eyes.

Additional health benefits of the green tea is it increases the blood flow throughout the body. Because it contains a little caffeine, ingesting this drink stimulates the heart and allows the blood to flow more freely through the blood vessels. For the same reason that tea stimulates blood flow, it also stimulates mental clarity.

For many years, men of science remained skeptical about the health claims made by Chinese green tea diet enthusiasts because the health benefits are truly vast in number. Their doubt was changed to a more positive reception when subsequent researchers proved its disease-preventing attributes and confirmed most of the health claims.

The Heart

Study after study has shown that drinking green tea and eating polyphenol-rich foods reduces the risk of any heart complications. It helps strengthen the blood vessels that provide oxygen and valuable nutrients to the heart and brain. It has also been researched that men who use the diet have a 75 percent less possibility of having a stroke than those who don’t use the diet.

The green tea diet helps lower total cholesterol levels and improve the ratio between LDL cholesterol and HDL cholesterol. Study shows that men who drink nine or more cups of Chinese green tea daily have lower cholesterol levels than those who drink fewer than two cups. While nine cups may seem a lot, break it up through out the day and you’ll realize it’s not that difficult to drink that many cups. You could have one during and after each meal and during your breaks.

You really need to learn more. The Silent Killer Exposed uncovers and gives you the information you need to maintain a healthy blood system. Visit it here now.

Longevity

The role of the ‘Chinese diet’ in promoting longevity has been investigated upon by many researchers. They found the premise of their study on observing Japanese women who are greater-than-average green tea drinkers; have lower mortality rates compared to others. This led the researchers to believe that the diet has “a protective factor against premature death.”

The polyphenols found in the diet may be held accountable. With its high amount of polyphenols, it seems to have a stimulating effect on the immune system. A stronger immune system as a result of drinking the green tea helps reduce risks of obtaining many illnesses.

If these health benefits of doing the Chinese green tea diet don’t motivate you to start drinking this miracle in a cup, chances are you’ll never become motivated to loose weight. So start today and drink up. The health benefits go well beyond weight loss!

althp health asked:


All we know well that herbal nutrients are required to support healthy metabolism and maintain functions of our body. Available data indicate that many more vitamins and vitamin-like nutrients are yet to be discovered in herbs today. That is why herbal medicines were used for thousand years to fight diseases and improve body functions. Herbal nutrients have been shown to help heal many maladies, improve general health and specific pathological conditions. Herbs can help fight disease and premature aging, maintain sustainable and enjoyable lifestyle.

Alternative health professionals is a NZ based online shop, offering you the largest range of natural health products, including vitamin supplements. We also offer natural beauty products, herbal medicines and remedies.

At Alternative health professionals you will find information on alternative treatments for mind body and soul within our articles section, and in our online store, you will find naturally good products from aromatherapy supplies to herbal balms and lanolin skincare.

Our all natural herbal supplements are obtained from the herbs proven to be the richest natural sources of specific essential nutrients and are provided in the formulation optimal for assimilation by the body. Herbal antioxidants and essential unsaturated oils are not produced by the body but are required for multiple body functions and promote immunity to keep away diseases.

The essential oils used in aromatherapy are extracted from many parts of the aromatic plant: leaves, stems, flowers, seeds, roots, barks, fruits and resins. The oils are a concentrated form of plant energy possessing the qualities of the particular plant, and are usually many times more potent than the comparable dried herbs.

Now a days mostly people face skin problem. All we have different kind of skin so the treatment must be different. We help you to get the best herbal treatment for your skin. When you start shedding the winter layers of clothing upon spring’s arrival, you will possibly find your skin and scalp are dry and flaky, itchy and uncomfortable. Winter weather dries your skin out. You can bring skin back to a youthful glow by cleansing your body internally and exfoliating and moisturizing your skin.

Pennsylvania Health Insurance asked:


www.EasyToInsureME.com is proud to announce they now offer Free Pennsylvania Health Insurance Quotes. Pennsylvania health insurance quotes are available for Blue Cross Blue Shield , Highmark , Independence , Aetna, HealthAmerica , Golden Rule , United Healthcare, and Celtic insurance companies. These health insurance companies are the top Pennsylvania health insurance carriers.

All Pennsylvania residents will be able to visit www.EasyToInsureME.com enter their zip code and compare all of the Pennsylvania health insurance plans side by side in the Easy To Insure ME quote engine. When the Pennsylvania resident has chosen a health insurance plan they can apply online or print an application for immediate health insurance coverage. If the Pennsylvania resident is not ready to buy yet they can choose up to 4 plans to compare and print the Pennsylvania health insurance comparison.

Free Pennsylvania health insurance consultations will be done over the phone between the hours of 9 a.m. to 9 p.m. Feel free to call Chad Levin the owner of Easy To Insure ME at 215 944 3079. Or email them at easytoinsureme@aol.com

Thank you for your trust and confidence Pennsylvania.

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Dr.v.sudhakaram asked:


Health sector Reforms in Andhra Pradesh

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

* greater effectiveness and improved outcomes of existing programs;

* improved efficiency in the allocation of resources;

* greater access and equity; and

* consumer satisfacfion

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

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

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

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

(III) Changes in financing methods

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

(IV) Reforms related to human resources

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

(V) Involving community in health service delivery and Provision

Women Health Volunteers Scheme

(VI) Reforms to quality of care

Performance indicators for grading the PHCs Performance rating of secondary hospitals

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

Women Health Volunteers Scheme

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

 

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

       

 

Pennsylvania Health Insurance asked:


Pennsylvania Health Insurance : Uninsured Helping Pennsylvanians since 2005 : EasyToInsureME



Some states in the US require that all citizens of their state be covered for Health Insurance. Pennsylvania is one of the states that allows PA citizens to receive  Free Pennsylvania Health Insurance. There are 2 free health insurance programs CHIP for children and AdultBasic for adults. However a Pennsylvania resident must qualify first.

Do you Qualify for CHIP see income charts and apply now at EasyToInsureMe.com

Do you Qualify for AdutlBasic see income charts and apply now at EasyToInsureMe.com

SO, HOW DO I SIGN UP for CHIP?

You’re ready to apply - great! Before you do, you will need the following information handy to apply:



Income amounts for your entire household before taxes - this includes income from employment and all other forms of income (for example - social security, pension, workers compensation, unemployment, child support, etc)

Social Security Numbers and birthdates for all applicants

Day care expenses for your household (if any)

Work transportation expenses for your household (if any)

Private health insurance information (if you have or had private health insurance in the last six months)

Car insurance card information (if you have car insurance)



SO, HOW DO I SIGN UP for AdultBasic?

Recognizing the need to provide quality healthcare coverage that is accessible and affordable to the Commonwealths uninsured adult population, adultBasic was launched in 2002 to cover the basic healthcare needs of Pennsylvanians age 19-64 who have no health insurance and who meet certain eligibility requirements.

We are proud to have already covered over 90,000 Pennsylvanians with adultBasic. You may be eligible to take advantage of the benefits that adultBasic has to offer. Find out if you qualify by accessing the links below. You’ll be glad you did.







Current Enrollment 55,256

What is adultBasic?

Am I eligible for the program?

What are the benefits?

How do I apply for coverage?

Is it true adultBasic has a waiting list? YES

Where can I find additional resources?

HBF Health Funds asked:


Funny thing pain, if you’ve never had a severe pain then the suggestion of taking simple analgesia and resting the affected area all seems quite reasonable. I was reminded of this when I read recently of a doctor’s advice to someone who was suffering from sciatica. Having personally experienced sciatica, it’s a condition I would not recommend to anyone who wishes to walk, sit, laugh, sleep, or to just simply pull up your trousers. It’s a bit like a dentist drilling your teeth without an anaesthetic, but it affects your whole leg. In other words the pain is consuming, exhausting and without respite. Clinical studies do show that in the majority of cases the pain will eventually subside and surgery may not be necessary, but in the meantime the patient has to deal with the pain or deal with the medication required to dull the pain. Remember, pain-killers are not selective to the area affected. They affect the whole of the nervous system and elsewhere so there may be significant side-effects from these medications.

Dealing with severe pain can be a complex issue, but I suggest that you have to treat this sort of pain fairly aggressively as acute severe pain is relatively easier to treat than chronic severe pain. In the early stages of an injury or insult to an area of the body, most of the pathological processes are happening at the site of the injury or insult. Throughout time the brain begins to modulate this pain and so no only do you have the injured area to deal with, but you also have complex neural pathways within the brain to deal with as well. This often means a far more complex management plan and a far more protracted recovery time. Specialists are very skilled at dealing with these issues but they do rely heavily on the stories their patients give them. That means being honest in answering their questions and not being heroic with a grin and bear it grimace! Often the use of a pain scale is helpful with zero being no pain at all and a 10 being the worse pain you have ever experienced.

Another health issue we commonly down play is influenza. Over the years I have frequently heard people say that they would not have the flu vaccine because either they never get the flu or that they had it last week for a couple of days and then it was all over! Influenza is a serious debilitating disease that will usually last from 10 days to two weeks and often leave you flat on your back exhausted. It’s not a happy 10 days either as patients do not have the energy to read a magazine or even watch a DVD. You will literally feel ancient with every movement being a real challenge and that doesn’t include the aching all over or the fevers and sleepless nights. The influenza virus is also extremely contagious and most people are unaware that if you spread it to someone who is more frail than yourself that you may actually be putting their life at risk.

With the ‘flu the big challenge is to vaccinate as many people in the community as possible, including children, those employed and unemployed, the elderly and the infirm, to reduce the chance of an epidemic occurring. Recent research has also showed that vaccinating pregnant women in the last trimester of their pregnancy will help protect their new born infants born during the ‘flu season.

Medicine has evolved over the last 40 years, but the change has been fairly slow with doctors by nature being very cautious and conservative people. But we can’t leave the doctors to take all the initiatives. As patients we need to be good listeners in our approach to health by heeding all the great health messages that keep being given to us about vaccinations, smoking, alcohol, exercise and healthy eating. We also need to be good communicators and tell our doctors how we are feeling with conditions such as pain. If the team treating you doesn’t have the best information then it may be that you will not end up getting the best treatment!

 

Pennsylvania Health Insurance asked:


Group Health Insurance Benefits:

How To Keep Health Insurance Coverage 100%

Only 5% of employers in the U.S. still offer 100% coverage for their employees’ health insurance benefits. Other employers are choosing high copay plans or high deductible plans. Most others are passing their increase in health care costs on to their employees.

Fact: Health Care Premiums are rising faster than workers wages

Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) and the overall inflation rate (2.6 percent), according to the 2007 Employer Health Benefits Survey conducted by the Kaiser Family Foundation and the Health Research and Educational Trust.

The 6.1 percent average increase this year was the slowest rate of premium growth since 1999, when premiums rose 5.3 percent. Since 2001, premiums for family coverage have increased 78 percent, while wages have increased 19 percent and inflation has increased 17 percent.

The average premium for family coverage in 2007 is $12,106. On average, workers now pay $3,281 out of their paychecks to cover their share of the cost of a family policy. While premiums continue to rise faster than wages, this year’s gap of 2.4 percentage points is much smaller than the 10.9 percentage point gap recorded four years ago, when premiums rose 13.9 percent and

wages grew just 3 percent. (Agent Sales Journal Nov. 2007)

Lets Keep it 100% coverage and reduce the premiums

This is a strategy from Easy To Insure Me .com

We will use 2 equations for a 15-employee group: Current and Future Solution

Equation 1 Current

15 employees

(Yearly Premium) $100,000=Health Care

Equation 2 Future Solution

(Yearly Premium) $60,000 + $15,000 (employees x deductibles) = $75,000 maximum exposure

100% coverage and the employer pays for the deductible

while still saving 20% to 40%

**We say maximum exposure because not all employees will satisfy the deductible

Call 215 944 3079 and ask for Chad Levin for more information