Health
care costs to continue going up, employer study finds
"….Employers
across the United States expect health care costs to rise 14.6 percent in 2003,
about the same as 2002's 14.7 percent increase, the steepest in a dozen years
and seven time the rate of inflation, according to survey results…
…..Nationally,
sharp cost increases are prompting some employers to drop health care coverage
altogether, or switch into consumer-directed health plans."
Dallas
Morning News, December 10, 2002
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Multiple-Product
Discount Cards Fill the Gaps in Employer Benefits
"…Many
employers have found that a desirable way to enhance benefit offerings is to adopt a multiple-product discount card, also called health benefits
card. A discount card program can fill in coverage gaps for employers with limited
benefit offerings by adding coverage such as dental, vision, chiropractic, hearing,
and prescription drugs. Employers can customize the cards to best fit their employee
base and complement their existing benefit offerings.
The various provider
networks on the card encourage utilization, resulting in a healthier work force,
card developers claim.
"Under the discount card concept, we really want members
to go to providers, because that is why provider participate in the networks:
they want patients," explained Vincent DiBenedetto, president of Discount
Development Services…."
Employee
Benefit Plan Review, January 1999
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Say
What? Attracting Medicare Members with Hearing Service Benefits
".Persons with hearing problems now represent nearly 11% of the population of
the United States, and this number is expected to grow with the continued
aging of America. Hearing loss inevitably accompanies aging, making the
Medicare population prime candidates for hearing services including hearing
aids. In fact, hearing loss is the third most prevalent chronic condition for
older Americans. Since Medicare does not provide reimbursement for hearing
aids or the necessary hearing testing, many are turning to non-insurance
savings benefit plans for this type of benefit..."
"...Hearing difficulties are often of slow onset, subtle, unrecognized and/or
denied by the involved person. The lack of motivation for seeking help for hearing
loss is attributed to numerous excuses such as cost of a hearing aid, limited
access to hearing care, concerns about the quality of care and service, cosmetics
of the hearing aid, and personal vanity. Accordingly, hearing aid utilization
is low in spite of the fact that new hearing aid technologies provide improved
hearing and quality of life for those with hearing problems…"
HIU,
September 1999
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SIGHT
for Sore Eyes"…About
160 million Americans-nearly 60% of the population-need
eye-glasses or contact lenses. Approximately 70 million eye exams are
performed each year. The U.S. Department of Health and Human Services says 64%
of the work force over the age of 17 wears some form of corrective lenses. Yet
despite these statistics, the penetration of vision care benefits in the labor
force is less than 35%, and fewer than 25% of the general population have
access to formal vision car programs, according to surveys by such
organizations as Hewitt Associates and A. Foster Higgins."
"….An aging work force, an increasing realization of the importance of vision
and good vision care…are all factors that are promoting the expansion of
vision care benefit coverage in the workplace. In addition, the widespread use
of computers at work is contributing to eye strain and related ailments. Good
vision is imperative to worker productivity and good health…"
HUI,
September 1999
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Integrative
Care: A new approach for healingFor
a basketball power house like Duke University, losing a star player going into
a championship season is a grave matter. So when last year's number one draft
pick, Elton Brand, broke his foot two years ago and it looked as though he would
be out for the season, he and his doctors were ready to try anything that might
help him recover.
Dr.
James Nunley, the Duke orthopedic surgeon who operated on Brand's foot, launched
what he calls "a three-pronged attack" to help the athlete heal. Along
with surgery, he used two non-conventional therapies: ultrasonic stimulation, which
passes sound waves over the fractured bone, and PEMS (pulse electromagnetic stimulation),
which creates a magnetic field around the bone. Although the combination had never
been used for this type of fracture, Dr. Nunley thought it might help speed healing.
Brand recovered nicely, returned four to six weeks earlier than expected, and
helped lead the team to the Final Four Championship Games. Since then, Dr. Nunley
says, he has had good results treating a number of athletes with this protocol.
Medicine
of the future
Some are predicting that as we move into the twenty-first
century, more and more physicians, like Dr. Nunley, will "integrate"
their knowledge of both mainstream and unconventional medicine to find the best
treatment solutions for their patients. This approach to healing, often called
"integrative" or "complementary" medicine, can encompass vitamins,
herbs, foods, acupuncture, and a range of alternative and conventional therapies.
Integrative medicine at Duke actually predates the coining of the term. For almost
75 years, people with heart disease or diabetes have enrolled in the Duke Rice
Diet Program, which prescribes a low-fat, low-sodium, mostly fruit-and-rice diet
that is thought to help manage such conditions. Others struggling to overcome
obesity have participated in two- to 12-week programs in fitness and nutrition
at Duke's Diet and Fitness Center. At Duke's nearby Center for Living, patients
have been coming for more than 20 years to improve their overall well-being and
to learn to live better with such diseases as cancer and arthritis by taking nutrition,
stress management, and exercise classes.
In this rich tradition of holistic health, the university launched its Center
for Integrative Medicine several years ago. Each spring the center sponsors an
annual conference on complementary care called Mind, Body, and Spirit in Medicine.
It has now hosted four such conferences and continues to expand.
Holistic
clinic
Among the latest developments at the center is the opening this
month of a new, outpatient clinic employing a team of MD's trained in conventional
medicine as well as various complementary therapies. Many of those who visit the
clinic have already tried standard treatments and are seeking additional therapies
that might help them cope with such chronic conditions as arthritis, heart disease,
persistent pain, fibromylagia, or cancer.
A patient visiting the clinic initially meets with a staff physician for an in-depth
consultation. Patient and doctor discuss the patient's medical history and make
sure all appropriate conventional treatments have been considered. The discussion
also covers diet, lifestyle, and any supplements, drugs, or alternative therapies
a person might already be using. Spiritual values and personal concerns relating
to the illness are also addressed.
The
consulting doctor then confers with other physicians at the clinic and works closely
with the patient to develop an appropriate treatment plan that he or she can realistically
follow. A patient might, for example, choose to see a doctor trained in acupuncture,
herbal medicine, or massage therapy. He or she might also opt for mind-body approaches,
such as hypnosis, meditation, or psychotherapy.
"The goal of the integrative medicine program at Duke is to expand the frontiers
of how we practice medicine," says Dr. Martin Sullivan, co-director of the
center. He regards the clinic as a fertile learning ground. "Right now, integrative
medicine is a sort of subspecialty, and various clinics and programs are emerging
in different hospitals. As this trend becomes more and more prevalent, a lot of
these ideas will be directly transferred into standard medicine." After a
while, he believes, "the lines separating complementary, alternative, integrative,
and traditional medicine will start to blur."
Integrative
Medicine Clinic/Duke University Medical Center
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CAM
and Cancer: The Key is Communicating
According
to a spate of recent surveys, over the last decade Americans have not only embraced
complementary and alternative medicine (CAM) to promote vitality and good health
but also to fight chronic conditions, such as arthritis and menopause. Now new
research shows that a majority of cancer patients--estimated from 50% to a whopping
83%--are also turning to CAM therapies (herbs, vitamins, soy, acupuncture, relaxation
training, guided imagery) in an effort to round out their conventional cancer
care.
This decision can have real benefits, since CAM therapies are often very effective
in easing symptoms like pain and the nausea associated with chemotherapy. Alternative
therapies can also help build a sense of personal empowerment and well being that
cancer patients often crave. On the other hand, alternative medicine can be problematic,
primarily since more than half of patients using complementary therapies don't
tell their doctors they're doing it. According to the findings of a recent study
in the medical journal Psycho-Oncology, this lack of communication can have serious
ramifications, particularly if you have a serious condition such as cancer.
Three
key issues
The current Psycho-Oncology study identified three specific issues hampering good
doctor-patient communication concerning CAM:
-
Indifference or opposition. Many patients felt that their physicians lacked interest
in CAM, showed little empathy, or were unwilling to discuss it. They reported
a range of responses from hidden disapproval to active opposition (even for supportive
forms of CAM, such as massage, that have little potential for adverse effects).
- Scientific
emphasis. By training, physicians are required to base their medical decisions
on stringent scientific evidence. Because many CAM approaches have not been conclusively
"proven" by Western scientific methods, they are often not on a physician's radar.
Likewise, patients are not accustomed to evaluating health decisions solely on
the basis of statistics and hard evidence, such as percentages of mortality or
longevity.
-
Fear of a negative response. Sometimes patients don't disclose their use of CAM,
or raise the topic for discussion, because they anticipate that their doctors
will be skeptical, tell them to stop, or have another negative response. Others
avoid the issue because they fear making a negative impression.
The
Keys to Openness
According
to Chicago's Dr. David Edelberg, WholeHealthMD's chief medical advisor, "Although
it's essential for patients to be open with their doctor about their CAM use,
they shouldn't necessarily expect approval for a therapy their physician may not
understand." Edelberg further counsels that if you intend to use CAM, "begin
by saying something like: 'Doctor, I want to explore all my alternatives. I certainly
intend to continue the treatment you are providing, but I plan to look at CAM
therapies as well. If you'd like, I'll bring you information about them.' This
way, you're not asking permission, but alerting your doctor to your intentions."
After all, Edelberg adds, "It's your life you're trying to preserve. You
ultimately call the shots."
According
to the Psycho-Oncology study, a good physician-patient interaction should include
the following elements:
-
Active give and take. The doctor should ask about and listen to a patient's description
of CAM choices and use. If side effects or interactions are a concern, the physician
should provide relevant information.
-
Open discussion. Pros and cons, and risks and benefits, should be openly discussed
between doctor and patient.
- Empathy
and support. Regardless of the physician's opinion of specific CAM approaches,
the patients' effort to improve their condition should be compassionately supported.
- Sensitivity
to underlying issues. Knowing why a patient is searching out CAM alternatives
may allow a physician to offer additional help for unmet needs, such as counseling
or social support.
Finding
Common Ground
Most
experts agree that communication characterized by compassion, support, and mutual
respect will go a long way toward increasing patients' satisfaction with their
doctors. And, in the end, fostering openness and trust between patient and physician
can only benefit the healing process.
Just as physicians educate their patients about treatments and risks, patients
can educate their physicians about specific CAM therapies. Start by discussing
forms of CAM that your doctor is probably familiar with. Most physicians, for
instance, now sanction support groups, massage, yoga, and sometimes even acupuncture,
which has been proven to counteract pain and nausea.
"Your physician may not be well-versed in herbal or nutritional therapies, but
when you learn about these on your own and bring in the information, you can discuss
them together," says Dr. Edelberg. "On the other hand," he continues, "if you
say, 'I think I want to travel down to Tijuana for some cancer therapy I saw on
an infomercial,' you'll probably stop the conversation cold. Even so, if you have
established a good open relationship, your doctor should be able to give you insight
on why this may not be a wise choice.
"
According to Edelberg, "The cancer patients who do extraordinarily well are the
feisty ones-the ones who take charge and are proactive, not those who are totally
compliant." Edelberg also suggests that it's this feisty attitude that opens the
communications channels, and that ultimately it's good communications that can
make a significant difference in a patient's quality of life during and following
treatment for cancer.
Whole
Health MD
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