A Pediatric Dentist Can Help Your Children Care for Their Teeth With Ease

When you bring your children to a pediatric dentist for the first time, an experienced doctor will do what’s necessary to make your children comfortable. Depending on the age of your children, a doctor may engage in conversation or even a bit of play. Bottom line, the goal is for your children to feel relaxed from the beginning and for the doctor to create a good rapport with your kids. In addition, there are other benefits of bringing your children to this kind of doctor. Not only will this type of skilled doctor help them have a positive view of the dental experience, but also help them better care for their teeth.

Kid-friendly office

One of the biggest ways taking your children to a pediatric dentist can help your children care for their teeth is the fact that the office is specially designed for kids. Oftentimes, an office that caters to adults does not have an area for toys and the staff communicates in a more adult manner. On the other hand, a kid-friendly office is usually filled with brighter colors and a waiting room where kids can play and have fun. Also, this office may have television screens mounted on the ceiling so kids can watch movies while they’re lying back getting their teeth worked on.

Sensitive staff

In addition, the staff talks in a more playful tone that connects with kids and makes them feel at ease. For example, there are some technicians or hygienists that are genuinely good with kids. They know how to relate to them and make them more accepting of certain services and procedures. The same can be said for the pediatric dentist. He or she will go out of their way to make your child laugh and feel less anxious. In fact, sometimes the doctor won’t even perform any procedures on your children until he feels the children are well adjusted and have formed a sense of trust with him or her and the staff.

Oral hygiene tips

Once the children are ready to have procedures, the doctor may begin with a simple cleaning. This way, the children are getting able to get used to seeing strange tools coming near their mouths as well as the sounds some of these tools make. Getting a cleaning at a pediatric dentist is a lot less stressful than having to get other dental work, such as a filling. That’s why when children visit this type of doctor on a regular basis, they are not only becoming more comfortable but also learning to form better habits. As a result, they’ll have fewer cavities or no cavities at all, which can prevent them from having to get more in-depth or painful dental work later.

The Differences Between Drug Addiction and Drug Abuse

A drug problem is an everyday struggle of not only the user, although some users haven’t realized yet that it is a problem, but the users family, friends, or special loved one. You may not instantly determine or realize that someone you care about is having problem with drugs.

People involved with drug problems or know someone who has at times thinks that drug addiction and drug abuse are basically the same thing, and should just be used interchangeably. But actually they are both different terms with different meanings. Complexity revolving drug abuse and definition has become increasingly clear and several efforts have been done to look of the right meaning both terms.

Drug Addiction:

The World Health Organization committee (WHO) had collected numerous of definitions concerning drug abuse and addiction and had suggested a generic term “drug dependence”. This addiction is defined as a disorder wherein the drug user’s behavior is being strongly influenced and dominated by the drug. It is a condition of recurring intoxication that happens when there is constant consumption of drug. It has characteristics of intense need or desire of continuous use, tendency of increasing dosage, unfavorable effects on both individual and society, and dependence on effects.

Drug Abuse:

Drug abuse is defined as the misuse of the drug or substance according the culturally acceptable standard. It is simply an abuse usage of substance which may involve excessive and habitual use in order to attain a certain effect. These so-called substances may be illegal, can be taken from streets and syndicates against the law, or can be legal as well in a form of prescription that are used in a pleasurable manner rather than medical.

Causes of Drug Addiction and Drug Abuse:

As both terms have different definition, their causes are different as well. Drug abuse is more complicated than drug addiction, although drug addiction has more forceful motivational condition. With drug addiction, it comprises the drug’s effect on the brain wherein it can become a strong motivational factor to use the drug again. On the other hand, drug abuse as a misuse of a substance, may or may not go together with a strong motivational factor to continue the use of the drug. In many cases, therefore, drug abuse does not necessarily make drug addiction, but drug addiction can constitute drug abuse.

Patterns of Behavior:

Drug addiction and Drug abuse have basically the same effects. Both have unwanted or unfavorable consequences both to society and the individual. Some symptoms and patterns of behavior of drug addiction and abuse comprise an abnormally slow in speech, reaction or movement, cycles of restlessness, inability of sleep or intensified energy, sudden gain or loss of weight, series of excessive sleep, sudden constant wearing of long-sleeved tops even under high temperature just to hide scars of injection points, loss of physical control, sudden impulse and confidence in doing risky activities, and withdrawal symptoms when trying to stop drug use.

Knowing the fact that drug users are prone to deny their drug-related symptoms and behavior, the family, friends, and loved ones must be sensitive and be more aware of these signs.

Being with a Drug Abuse or Addiction Problem:

At times it is not easily recognizable that someone so important to you is struggling with drug problem. It could be that it has started very early but not noticeable since the progression is slow, and that person might have been good in hiding the level of drug use from you. Or since that drug has been used early on and slowly, you might have easily adapted to the users behavior to the point that it seems normal still. It can be that the realization that someone so important to you is a victim of drugs is painful. You should never feel embarrassed. There are so many people who are in the same position as you. Drug abuse and addiction have affected millions of families all over the world.

There are available help and support everywhere. You can start by looking for support groups locally. Support groups can be in your very own religious area, private or government institutions, and small communities. By just listening to others who share the same experiences and dilemmas can be a very good way of support and give comfort. Other sources to find support and help would include a therapist, spiritual leader, a trusted friend or family member.

Centers For Medicare and Medicaid Services – Home Health Quality Measures Explained

The Centers for Medicare & Medicaid Services (CMS) is part of the federal government’s Department of Health and Human Services. Because many Medicare and Medicaid recipients are elderly, much of the funding goes to nursing homes or eldercare services. Health agencies that receive certifications from Medicare undergo an assessment every three years. CMS assesses these home health agencies via quality measures and publishes each agency’s results.

CMS & Home Health

CMS provides scoring for all Medicare-certified home health agencies via Health Compare. The quality measures take into account: (1) the patient’s improvement in performing a variety of activities of daily living (ADLs), and (2) whether the patient’s health improves or stabilizes over time.

It is important to note that the quality measures should only be used as a general guide. Many home health care recipients are elderly, and each patient’s needs are different. Some patients are recovering from surgery or a medical emergency. Others have chronic and worsening medical conditions. Therefore, the lack of improvement in some home health care recipients is not due to poor standards or substandard care, but rather due to declining health. In addition, Medicare’s quality measures for home health are fairly recent and are still being refined. Currently, the quality measures provide a baseline to help consumers see how a local agency compares to both state and national averages.

CMS Quality Measures

CMS quality measures are used in Medicare-certified home health care agencies in order to come up with the final scoring. Medicare details the following quality measures:

* Three measures related to improvement in getting around:
– Percentage of patients who get better at walking or moving around
– Percentage of patients who get better at getting in and out of bed
– Percentage of patients who have less pain when moving around

* Four measures related to meeting the patient’s activities of daily living:
– Percentage of patients whose bladder control improves
– Percentage of patients who get better at bathing
– Percentage of patients who get better at taking their medicines correctly (by mouth)
– Percentage of patients who are short of breath less often

* Two measures about how health care ends:
– Percentage of patients who stay at home after an episode of home health care ends
– Percentage of patients whose wounds improved or healed after an operation

* Three measures related to patient medical emergencies:
– Percentage of patients who had to be admitted to the hospital
– Percentage of patients who need urgent, unplanned medical care
– Percentage of patients who need unplanned medical care related to a wound that is new, is worse, or has become infected

Eldercare Tips – How to Hire Help Your Parents Won’t Hate Through an Agency

How can you find capable and honest people whose quirks won’t drive your parents nuts? How much will they be paid? For how many hours at a stretch? How many stretches per week or month? Will these people be employees of yours/your parents? Of an agency? Or independent contractors? Do you know how the IRS determines these things and what paperwork and record keeping are required? Have you thought about worker’s comp and withholding? Suppose the applicants don’t speak much English?

Finding Candidates
There are two common ways to find help. Your parents can hire workers through an agency or can hire privately using referrals from friends, neighbors, physicians, local groups, or advertisements. Do you and your parents know the pros and cons of each option?

Agency hires
What are the pros and cons?

If your parents hire through an agency, the helper is the employee of that agency. It will find candidates, select a helper, pay that person, withhold taxes, provide W-2 forms to the helper, and bill you/your parents at its hourly rate. Although your parents will not have to recruit, screen, or haggle over wages, they will have limited choice in whom the agency sends – but somebody will show up, including substitutes when your parents’ worker is ill or on vacation. Clients may ask about the agency’s hiring and screening policies but are expected to rely on the agency’s selection.

If your parents have a problem with the worker, they can call the agency and a supervisor will talk to the worker for them. This is a strong argument in favor of agency hires, as long as your parents are willing to ask for help. How likely are your parents to report dissatisfaction while problems are small and easily fixed? Will they have the moxie to call the supervisor? Will they let you know?

Your parents will probably be charged between $20.00 and $40.00 per hour and will have to agree to a minimum number of hours per visit, usually four. The worker receives about half of the agreed-on fee. If the worker is dissatisfied with the fee schedule or benefits, that dissatisfaction is with the agency, not with your parents. Most agencies have policies prohibiting clients from supplementing salaries or giving gifts to their helpers. This is to protect clients from pressure by rather poorly paid helpers. If a helper suggests ways to skirt this policy and bestow tokens or riches, the agency should be told immediately. This could lead to financial abuse. Will your parents tell you or the agency promptly if this happens?

Types of agencies:
If your parents need simple housekeeping, they should work with a housekeeping agency. If they need in-home help including personal assistance, they should use agencies that specialize in in-home helpers and non-medical personal care providers. If they need assistance with health problems, they’ll need to look into more skilled home health aides.

The first option, housekeeping agencies, provides people who clean homes. But even this apparently simple option should be influenced by the results of the check sheets.

• Some house cleaners sent by housekeeping agencies bring their own cleaning supplies. That’s a help if it saves you or your parents a shopping trip, especially one that involves hauling heavy containers. But it’s a problem if your parents want specific cleaning products used and not others.
• House cleaners from agencies probably are on a fairly tight schedule, will come in, clean, and move on to the next house and may work in pairs or teams. This is great if your parents want the house cleaned quickly because it reduces the time somebody is in their home. But it can be a problem for a parent who doesn’t like people in the house because it increases the number of people there at one time. And with a team cleaning, several rooms may be in upheaval at the same time.
• Agency house cleaners may also chat with each other, and not necessarily in English. This can be a problem if your parents don’t want the noise involved with several people cleaning and talking. If they want to work along with or supervise the helpers, they may hit trouble both because of the helpers’ time constraints and also because they may not speak much English. And, if your parents want sociability as well, they may want to avoid this option. These workers get paid for cleaning, not talking, and need to move quickly and get on to their next job.

The second option, agencies that provide personal assistance and light housekeeping, offers more services and more sociability. Even if your parents don’t need much assistance beyond light housekeeping at this point, choosing an agency that provides in-home health aides may make sense. As your parents’ needs increase, they won’t have to start fresh with a new agency. These agencies provide employees who can offer broader services including transportation, sociability, assistance with activities of daily living (ADLs), and other support. In essence, your parents make a list of things they’d like help with, how many hours a day/week they’d like assistance, and the agency does its best to match the request with their available staff. The agency bills an agreed hourly rate based on the level of difficulty of the services provided. It has policies about weekend, holiday, and overtime charges.

To get the best match through an agency that provides help beyond housekeeping, you and your parents should give the intake worker at the agency a detailed list of what your parents want help with and how they want to be helped. These checklists should be reviewed right away with any helper who shows up at the house to prevent the well meaning 19-year-old aide from driving your parents crazy by gabbing all day long about a fruitless search for a soul mate. Review the checklists and work regularly with the aide, and pass the feedback along to the aide’s supervisor at the agency. Attention to little details at the outset will make eldercare services more tolerable to your parents now and in the future.

Top Ways to Prevent Chronic Disease

Even if you have a family history of chronic diseases, you can take steps to prevent these conditions and maintain your health for many years. Studies show the best ways to prevent chronic diseases include:

Eating Healthy Foods
No diet has to be perfect, but you should strive to eat nutritious, lean foods as much as possible. A healthy diet should always include foods like:

  • Vegetables and fruits
  • Lean meats like poultry
  • Fish
  • Nuts
  • Beans
  • Whole grains
  • Healthy fats like olive oil or avocados

By filling your plate with these items, you’ll rarely have space left to eat sugary or fatty foods that can increase your risk of a chronic disease.

Staying Active
You don’t have to run marathons to see the health benefits of exercise. Simply walking for about 150 minutes each week can help your body stay healthy. Even if you walk in short 10 minute intervals, you will see healthy benefits.

For extra health benefits, incorporate resistance training to build strong muscles and bones.

Maintaining Low Blood Pressure
High blood pressure (hypertension) can hurt your heart and your kidneys. While a healthy diet and exercise should keep your blood pressure healthy, be sure to check your blood pressure at least once a year and take blood pressure medicines as your doctor recommends.

Sleeping Well
Sleep may play a larger role in your health than you think. People who are sleep deprived tend to have higher levels of stress, higher blood pressure, higher blood sugar and poor metabolism. Proper sleep helps your body work well.

Keep a Healthy Weight
If you are already at a healthy weight, work to maintain that weight through proper diet and exercise. If you are carrying a few extra pounds, work with your physician to find ways to lose weight that work for you. Everyone is different, and no single weight loss plan works for everyone. Keep trying to find the plan that’s right for you and your lifestyle.

Don’t Smoke
Smoking has countless negative effects on your health, increasing your risk for heart attack, stroke, lung cancer and more. If you need help quitting smoking, speak to your physician. Your physician can help you find smoking cessation support and give you access to prescription medicines that might help you quit.

Remember, your doctor is your partner in healthy living. If you have any questions about preventing or managing chronic disease, always ask your physician for help.

The Weakness of Contemporary Cultural Medicine

The term Cultural Medicine is used to refer to changes to a medical system provided specifically to reach out to and serve a diverse culture. The title is applied differently than Integrative Medicine. Integrative Medicine acknowledges that there are different preventive and reactive ways to address issues of preventive health, health maintenance, disease, injury and medical care (IntgMed), many of them cross-cultural. Cultural Medicine is applied to all that is not specifically IntgMed. Rather, it is that which supports underlying layers of infrastructure required to deliver ever-expanding, culture-specific positions, products and services, rather than focused, inclusive services.

An example of inclusive delivery is recognition that the national language is English. A focused, nationally oriented, fully integrative system of medicine would acknowledge the beneficial elements of all IntgMed, but it would be delivered in English (except non-translatable elements). This approach encourages all citizens to learn and excel in English and markedly limits the cost of IntgMed products/services components delivery. If for example, government-paid and/or delivered services focus on delivering a more culture-neutral, English-based IntgMed service only, costs would be markedly reduced and all citizen-consumers would be encouraged to become more English-language proficient. As an aside, pharmaceutical products, medical technologies, acupuncture needles, physical therapeutic manipulations and exercises, and other key elements of IntgMed do not recognize the human body as gender, ethnicity or culture-specific – they simply perform functions. Such subdivisions are behaviors of service providers.

One of the primary sets of questions ignored by state and U.S. governmental agencies are:

  1. Who is most qualified to determine if a proposal or intervention should be that in which we should invest given all other needs, ideas, and proposals?
  2. Who should be responsible for payment for this proposal/intervention if we proceed with it?
  3. Define success. What does it look like?
  4. When (initial and follow-up) and how shall we measure the effectiveness of the subsequent program, service, or intervention?
  5. Is it not appropriate for payers (e.g., public taxpayers) to receive easily accessible, unbiased reporting of interim services delivery progress and performance measurements?”, and
  6. What will we do if measured results are not as expected and desired (e.g., inadequate Return on Investment)?

If you took your car in for service, paid for the services, and only fifty percent of the claimed fixes were effective, would you be satisfied? No, you would not be satisfied. If the same automotive repair company employed you, yet still provided you and your peers with the above-described poor service, would you then be satisfied and recommend to your friends that they should be satisfied in similar circumstances? You should respond, “No.” You should not be favorably biased toward the repair company simply because it employs you. However, government initiatives usually provide many millions, if not billions of dollars to the recipients of their investments, including the creation of well-paying jobs. And, unlike as would be the case in private industry, recipients of these public windfall monies and opportunities are loath to give up your tax money, and are often willing to publicly denigrate you for demanding that they be held accountable (e.g., fix the entire car as promised versus aren’t you satisfied with partial function?)

There are numerous governmental pseudo-medical/medical programs that are abysmal failures, that continue to expand. In spite of their prolonged failures at missions to curtail drug abuse, misuse, pharmaceutical products-related deaths, decrease STD/STI incidence, minimize gender-critical maladies, and social disruptions due to related issues, the programs and funding persist. With grand budgets and swollen senses of importance and entitlement, no one receives good answers to above listed six questions from these program representatives. Such are the effects and weaknesses of contemporary Cultural Medicine. Everyone in the culture, position-empowered or not, rich and poor, citizens or not, payers or not, aware of and sensitive to current budget constraints or not, believes that they should receive timely, broad-based, sometimes very expensive, individualized care and financing of their programs. And, numerous cultural subgroups (geographic, ethnic, gender-specific, age-specific, financial, religious, secular, other) with sufficient financing and/or sophisticated representation, lobby for special consideration. To suggest that they do not have the right to do so would be politically incorrect and insensitive, right?

Contact your local, regional, state and national government representatives to determine how they are addressing the weakness of contemporary Cultural Medicine in your neighborhood.

Eldercare Tips – 17 Questions to Answer Before Your Parents Will Accept Help Shopping For Groceries

For eldercare services to be tolerable to the elders, you need to explain to the in-home helpers exactly what your parents want help with. It’s not enough to say “hire someone to clean the house.” Does this mean the person cooks meals? Does laundry? Makes beds? Waters the lawn?

It seems simple enough. Your father said he can’t drive anymore so he needs someone to help him with shopping. Unfortunately, it’s easy to misinterpret what’s really needed. Does your father need someone to take a grocery list, go shopping and drop groceries off in the kitchen? Or does he need someone to stop by, pick him up, wait outside while he shops, bring him back, and drop him off? Does he need someone to go in the store and shop with him? For him? Help unpack and put the groceries away?

People make assumptions about what to do and how to help-and don’t get enough detailed information for the assistance to be acceptable to person needing assistance. To avoid these mistakes, and the complaints and cycle of hiring and firing in-home aides, get a complete picture of what your parents want help with. Begin the conversation by focusing first on a single, simple issue like shopping.

Because an apparently simple task like shopping is actually a series of smaller tasks, we have broken each topic into its components. Explore these details with your parents to learn what they really mean when they say “I think I want help shopping for groceries.” The detail may seem excessive to you, but it will make your parents feel understood and allow you to train the helper in acceptable assistance so his/her tenure will exceed a nanosecond.

• Shopping for groceries
Some people enjoy grocery shopping and would miss the activity. They may like the social connection of seeing and talking to other people in the store; they may enjoy slowly wandering down the aisles looking at and feeling the fresh fruits and vegetables, or they may want to keep control over decisions about what is purchased and how much money is spent. For these reasons, grocery shopping can plug into issues of authority and companionship.

Be sure you don’t hire a mismatch, e.g., someone who comes in and does a fabulous job selecting, buying, and organizing the groceries thereby annoying your parents who love to shop and see this as one of the last vestiges of control over daily life. Talk to your parents about the tasks involved in grocery shopping.

Do you want help:
• Deciding how much to spend?
• Making grocery lists?
• Getting to and from the store?
• Selecting the groceries?
• Navigating the aisles?
• Reaching items on very high and/or low shelves?
• Putting the groceries into the cart, onto the checkout counter?
• Paying?
• Carrying the groceries to the car and into the house?
• Unpacking the groceries?
• Doing the whole thing?

Grocery related issues – Do you want:
• Someone to follow along patiently while you shop?
• Someone to chat with while you are shopping?
• Someone to talk to the store clerks for you if you need help finding an item?
• Someone to handle the payment at check out?
• To do shopping on a regular schedule…when?
• To buy only specific brands or specific product sizes?

You may not have realized how much was involved in shopping for somebody else. Busy people just zip in, buy what they need and zip out. But, for people whose world has gotten smaller, these little things matter a great deal. No matter how experienced the provider of eldercare services is, he/she cannot anticipate each client’s preferences and may not ask in sufficient detail to get adequate information. Use these questions to help your parents get clear on exactly what they want help with and how they want to be helped, and to train the helper so he/she can provide elder care services they will accept.

How Do Strong Social and Community Ties Impact Your Health?

I called my friend, also named Lisa, who lives in Houston, Texas. Hurricane Harvey’s devastation had not only hit Houston, the fourth largest city in the United States, but many communities in the Gulf Coast region. According to my friend, who lives on the north side of Houston where they got no flooding except for those who were near a river or large body of water, the worst of the rain is over. People are leaving shelters scattered thought-out Harris County, where Houston is located.

Out of the 6.5 million people in the greater Houston area only about 1.5 million lost power and most all the water is drinkable. No need for ice, a valuable commodity, for many of us here in Charleston who experienced the wrath of Hurricane Hugo. Unlike Houston, Hurricane Hugo, also a category 4 storm, was a direct hit and as a result we not only got the flooding but also high winds. But no one can deny that the Houston area experienced the worst flooding in its history, with some areas getting as much as 50 inches of rain. And because Hurricane Harvey’s devastation was so widespread, it will take years for the region to recover from this natural disaster.

My friend, Lisa, who is originally from Charleston, knows about hurricanes and the emotional roller coaster they bring; the anxiety before the storm of not knowing exactly what is going to happen, the storm itself, the flooding and aftermath once the storm has passed. No doubt, you too, no matter where you call home, are aware of the horrific situation the residents of the Gulf Coast region, north of Brownsville, Texas, are now experiencing. Lives have been lost, people displaced and the uncertainty of what’s ahead. It is one thing to watch the news again and again and be reminded of the destruction and the anguish. But to just absorb the information without acting when we can help can be paralyzing and emotionally harmful.

Animals as well need help and assistance. Donate to the Houston Humane Society, which is helping animals affected by the storm. The Hurricane Harvey Relief Fund, administered by the Greater Houston Community Foundation, is another charity. You may also want to check out Charity Navigator to further ensure your donations are helping those in need.

By helping those in need, you too can benefit. Studies have shown that people with strong social and community ties tend to live longer, are less likely to report being depressed, and have a stronger a sense of belonging, purpose and self worth.

Healthcare Plans For Families

Family healthcare plans start with your researching all the types of insurance that fit you particular family needs. From the day a baby is born until old age, family health care is very important. Now is the time to start looking and find insurance coverage for your family if you are currently uninsured.

Five reasons to look for family insurance now.

A lot of companies are no longer offering health benefits to their employees. Don’t take a job just for the benefits it may offer, make a living doing what you truly like and find insurance for yourself and your family on your own.

You never know when an accident could happen and you need a trip to the emergency room for stitches or a broken bone. You can get the medical help you need without worrying about large bills if you have health coverage.

Your credit score may drop if you have problems paying medical expenses. You can avoid that predicament if you have health insurance. Your credit will also be safeguarded for your health and economic future.

With health insurance, you will feel more confident that you can save money without having to worry about emergencies, and how much the medical bill will be.

Options to pay your premiums on a quarterly or yearly basis can result in significant savings in the long run. If your employer offers you insurance, but not your family, this supplement works well for a personal plan while giving the rest of your family a plan for them to ensure their health. Its important for children to have medical screenings as they grow into adults.

What will be the cost of health insurance for you whole family?

You won’t find an answer for this question right off the bat. What you will require to do is seek the coverage plan that suits where you hail, your life style and your medication or physician needs.
Based on the plan that you choose, along with the deductible and the yearly plan you want to set into motion for your managed care you will find a set price on health insurance. Without comparing deductibles, insurance providers, and doctor’s lists, you won’t find a real price from any type of insurance provider.

Think about it along the lines of purchasing car insurance, you have to specify what coverage you want in order to get it on your policy. The same rule applies for the health insurance for your family. Specify what you want so that your medical plan can be catered to your needs.

Health Savings Accounts – An American Innovation in Health Insurance

INTRODUCTION – The term “health insurance” is commonly used in the United States to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a non-insurance social welfare program funded by the government. Synonyms for this usage include “health coverage,” “health care coverage” and “health benefits” and “medical insurance.” In a more technical sense, the term is used to describe any form of insurance that provides protection against injury or illness.

In America, the health insurance industry has changed rapidly during the last few decades. In the 1970’s most people who had health insurance had indemnity insurance. Indemnity insurance is often called fee-forservice. It is the traditional health insurance in which the medical provider (usually a doctor or hospital) is paid a fee for each service provided to the patient covered under the policy. An important category associated with the indemnity plans is that of consumer driven health care (CDHC). Consumer-directed health plans allow individuals and families to have greater control over their health care, including when and how they access care, what types of care they receive and how much they spend on health care services.

These plans are however associated with higher deductibles that the insured have to pay from their pocket before they can claim insurance money. Consumer driven health care plans include Health Reimbursement Plans (HRAs), Flexible Spending Accounts (FSAs), high deductible health plans (HDHps), Archer Medical Savings Accounts (MSAs) and Health Savings Accounts (HSAs). Of these, the Health Savings Accounts are the most recent and they have witnessed rapid growth during the last decade.

WHAT IS A HEALTH SAVINGS ACCOUNT?

A Health Savings Account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States. The funds contributed to the account are not subject to federal income tax at the time of deposit. These may be used to pay for qualified medical expenses at any time without federal tax liability.

Another feature is that the funds contributed to Health Savings Account roll over and accumulate year over year if not spent. These can be withdrawn by the employees at the time of retirement without any tax liabilities. Withdrawals for qualified expenses and interest earned are also not subject to federal income taxes. According to the U.S. Treasury Office, ‘A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care.

HSA’s enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.’ Thus the Health Savings Account is an effort to increase the efficiency of the American health care system and to encourage people to be more responsible and prudent towards their health care needs. It falls in the category of consumer driven health care plans.

Origin of Health Savings Account

The Health Savings Account was established under the Medicare Prescription Drug, Improvement, and Modernization Act passed by the U.S. Congress in June 2003, by the Senate in July 2003 and signed by President Bush on December 8, 2003.

Eligibility –

The following individuals are eligible to open a Health Savings Account –

– Those who are covered by a High Deductible Health Plan (HDHP).
– Those not covered by other health insurance plans.
– Those not enrolled in Medicare4.

Also there are no income limits on who may contribute to an HAS and there is no requirement of having earned income to contribute to an HAS. However HAS’s can’t be set up by those who are dependent on someone else’s tax return. Also HSA’s cannot be set up independently by children.

What is a High Deductible Health plan (HDHP)?

Enrollment in a High Deductible Health Plan (HDHP) is a necessary qualification for anyone wishing to open a Health Savings Account. In fact the HDHPs got a boost by the Medicare Modernization Act which introduced the HSAs. A High Deductible Health Plan is a health insurance plan which has a certain deductible threshold. This limit must be crossed before the insured person can claim insurance money. It does not cover first dollar medical expenses. So an individual has to himself pay the initial expenses that are called out-of-pocket costs.

In a number of HDHPs costs of immunization and preventive health care are excluded from the deductible which means that the individual is reimbursed for them. HDHPs can be taken both by individuals (self employed as well as employed) and employers. In 2008, HDHPs are being offered by insurance companies in America with deductibles ranging from a minimum of $1,100 for Self and $2,200 for Self and Family coverage. The maximum amount out-of-pocket limits for HDHPs is $5,600 for self and $11,200 for Self and Family enrollment. These deductible limits are called IRS limits as they are set by the Internal Revenue Service (IRS). In HDHPs the relation between the deductibles and the premium paid by the insured is inversely proportional i.e. higher the deductible, lower the premium and vice versa. The major purported advantages of HDHPs are that they will a) lower health care costs by causing patients to be more cost-conscious, and b) make insurance premiums more affordable for the uninsured. The logic is that when the patients are fully covered (i.e. have health plans with low deductibles), they tend to be less health conscious and also less cost conscious when going for treatment.

Opening a Health Savings Account

An individual can sign up for HSAs with banks, credit unions, insurance companies and other approved companies. However not all insurance companies offer HSA qualified health insurance plans so it is important to use an insurance company that offers this type of qualified insurance plan. The employer may also set up a plan for the employees. However, the account is always owned by the individual. Direct online enrollment in HSA qualified health insurance is available in all states except Hawaii, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, Vermont and Washington.

Contributions to the Health Savings Account

Contributions to HSAs can be made by an individual who owns the account, by an employer or by any other person. When made by the employer, the contribution is not included in the income of the employee. When made by an employee, it is treated as exempted from federal tax. For 2008, the maximum amount that can be contributed (and deducted) to an HSA from all sources is:
$2,900 (self-only coverage)
$5,800 (family coverage)

These limits are set by the U.S. Congress through statutes and they are indexed annually for inflation. For individuals above 55 years of age, there is a special catch up provision that allows them to deposit additional $800 for 2008 and $900 for 2009. The actual maximum amount an individual can contribute also depends on the number of months he is covered by an HDHP (pro-rated basis) as of the first day of a month. For eg If you have family HDHP coverage from January 1,2008 until June 30, 2008, then cease having HDHP coverage, you are allowed an HSA contribution of 6/12 of $5,800, or $2,900 for 2008. If you have family HDHP coverage from January 1,2008 until June 30, 2008, and have self-only HDHP coverage from July 1, 2008 to December 31, 2008, you are allowed an HSA contribution of 6/12 x $5,800 plus 6/12 of $2,900, or $4,350 for 2008. If an individual opens an HDHP on the first day of a month, then he can contribute to HSA on the first day itself. However, if he/she opens an account on any other day than the first, then he can contribute to the HSA from the next month onwards. Contributions can be made as late as April 15 of the following year. Contributions to the HSA in excess of the contribution limits must be withdrawn by the individual or be subject to an excise tax. The individual must pay income tax on the excess withdrawn amount.

Contributions by the Employer

The employer can make contributions to the employee’s HAS account under a salary reduction plan known as Section 125 plan. It is also called a cafeteria plan. The contributions made under the cafeteria plan are made on a pre-tax basis i.e. they are excluded from the employee’s income. The employer must make the contribution on a comparable basis. Comparable contributions are contributions to all HSAs of an employer which are 1) the same amount or 2) the same percentage of the annual deductible. However, part time employees who work for less than 30 hours a week can be treated separately. The employer can also categorize employees into those who opt for self coverage only and those who opt for a family coverage. The employer can automatically make contributions to the HSAs on the behalf of the employee unless the employee specifically chooses not to have such contributions by the employer.

Withdrawals from the HSAs

The HSA is owned by the employee and he/she can make qualified expenses from it whenever required. He/She also decides how much to contribute to it, how much to withdraw for qualified expenses, which company will hold the account and what type of investments will be made to grow the account. Another feature is that the funds remain in the account and role over from year to year. There are no use it or lose it rules. The HSA participants do not have to obtain advance approval from their HSA trustee or their medical insurer to withdraw funds, and the funds are not subject to income taxation if made for ‘qualified medical expenses’. Qualified medical expenses include costs for services and items covered by the health plan but subject to cost sharing such as a deductible and coinsurance, or co-payments, as well as many other expenses not covered under medical plans, such as dental, vision and chiropractic care; durable medical equipment such as eyeglasses and hearing aids; and transportation expenses related to medical care. Nonprescription, over-the-counter medications are also eligible. However, qualified medical expense must be incurred on or after the HSA was established.

Tax free distributions can be taken from the HSA for the qualified medical expenses of the person covered by the HDHP, the spouse (even if not covered) of the individual and any dependent (even if not covered) of the individual.12 The HSA account can also be used to pay previous year’s qualified expenses subject to the condition that those expenses were incurred after the HSA was set up. The individual must preserve the receipts for expenses met from the HSA as they may be needed to prove that the withdrawals from the HSA were made for qualified medical expenses and not otherwise used. Also the individual may have to produce the receipts before the insurance company to prove that the deductible limit was met. If a withdrawal is made for unqualified medical expenses, then the amount withdrawn is considered taxable (it is added to the individuals income) and is also subject to an additional 10 percent penalty. Normally the money also cannot be used for paying medical insurance premiums. However, in certain circumstances, exceptions are allowed.

These are –

1) to pay for any health plan coverage while receiving federal or state unemployment benefits.
2) COBRA continuation coverage after leaving employment with a company that offers health insurance coverage.
3) Qualified long-term care insurance.
4) Medicare premiums and out-of-pocket expenses, including deductibles, co-pays, and coinsurance for: Part A (hospital and inpatient services), Part B (physician and outpatient services), Part C (Medicare HMO and PPO plans) and Part D (prescription drugs).

However, if an individual dies, becomes disabled or reaches the age of 65, then withdrawals from the Health Savings Account are considered exempted from income tax and additional 10 percent penalty irrespective of the purpose for which those withdrawals are made. There are different methods through which funds can be withdrawn from the HSAs. Some HSAs provide account holders with debit cards, some with cheques and some have options for a reimbursement process similar to medical insurance.

Growth of HSAs

Ever since the Health Savings Accounts came into being in January 2004, there has been a phenomenal growth in their numbers. From around 1 million enrollees in March 2005, the number has grown to 6.1 million enrollees in January 2008.14 This represents an increase of 1.6 million since January 2007, 2.9 million since January 2006 and 5.1 million since March 2005. This growth has been visible across all segments. However, the growth in large groups and small groups has been much higher than in the individual category. According to the projections made by the U.S. Treasury Department, the number of HSA policy holders will increase to 14 million by 2010. These 14 million policies will provide cover to 25 to 30 million U.S. citizens.

In the Individual Market, 1.5 million people were covered by HSA/HDHPs purchased as on January 2008. Based on the number of covered lives, 27 percent of newly purchased individual policies (defined as those purchased during the most recent full month or quarter) were enrolled in HSA/HDHP coverage. In the small group market, enrollment stood at 1.8 million as of January 2008. In this group 31 percent of all new enrollments were in the HSA/HDHP category. The large group category had the largest enrollment with 2.8 million enrollees as of January 2008. In this category, six percent of all new enrollments were in the HSA/HDHP category.

Benefits of HSAs

The proponents of HSAs envisage a number of benefits from them. First and foremost it is believed that as they have a high deductible threshold, the insured will be more health conscious. Also they will be more cost conscious. The high deductibles will encourage people to be more careful about their health and health care expenses and will make them shop for bargains and be more vigilant against excesses in the health care industry. This, it is believed, will reduce the growing cost of health care and increase the efficiency of the health care system in the United States. HSA-eligible plans typically provide enrolled decision support tools that include, to some extent, information on the cost of health care services and the quality of health care providers. Experts suggest that reliable information about the cost of particular health care services and the quality of specific health care providers would help enrolls become more actively engaged in making health care purchasing decisions. These tools may be provided by health insurance carriers to all health insurance plan enrolls, but are likely to be more important to enrolls of HSA-eligible plans who have a greater financial incentive to make informed decisions about the quality and costs of health care providers and services.

It is believed that lower premiums associated with HSAs/HDHPs will enable more people to enroll for medical insurance. This will mean that lower income groups who do not have access to medicare will be able to open HSAs. No doubt higher deductibles are associated with HSA eligible HDHPs, but it is estimated that tax savings under HSAs and lower premiums will make them less expensive than other insurance plans. The funds put in the HSA can be rolled over from year to year. There are no use it or lose it rules. This leads to a growth in savings of the account holder. The funds can be accumulated tax free for future medical expenses if the holder so desires. Also the savings in the HSA can be grown through investments.

The nature of such investments is decided by the insured. The earnings on savings in the HSA are also exempt from income tax. The holder can withdraw his savings in the HSA after turning 65 years old without paying any taxes or penalties. The account holder has complete control over his/her account. He/She is the owner of the account right from its inception. A person can withdraw money as and when required without any gatekeeper. Also the owner decides how much to put in his/her account, how much to spend and how much to save for the future. The HSAs are portable in nature. This means that if the holder changes his/her job, becomes unemployed or moves to another location, he/she can still retain the account.

Also if the account holder so desires he can transfer his Health Saving Account from one managing agency to another. Thus portability is an advantage of HSAs. Another advantage is that most HSA plans provide first-dollar coverage for preventive care. This is true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. It was also true of over half (59%) of the plans which were purchased by individuals.

All of the plans offering first-dollar preventive care benefits included annual physicals, immunizations, well-baby and well-child care, mammograms and Pap tests; 90% included prostate cancer screenings and 80% included colon cancer screenings. Some analysts believe that HSAs are more beneficial for the young and healthy as they do not have to pay frequent out of pocket costs. On the other hand, they have to pay lower premiums for HDHPs which help them meet unforeseen contingencies.

Health Savings Accounts are also advantageous for the employers. The benefits of choosing a health Savings Account over a traditional health insurance plan can directly affect the bottom line of an employer’s benefit budget. For instance Health Savings Accounts are dependent on a high deductible insurance policy, which lowers the premiums of the employee’s plan. Also all contributions to the Health Savings Account are pre-tax, thus lowering the gross payroll and reducing the amount of taxes the employer must pay.

Criticism of HSAs

The opponents of Health Savings Accounts contend that they would do more harm than good to America’s health insurance system. Some consumer organizations, such as Consumers Union, and many medical organizations, such as the American Public Health Association, have rejected HSAs because, in their opinion, they benefit only healthy, younger people and make the health care system more expensive for everyone else. According to Stanford economist Victor Fuchs, “The main effect of putting more of it on the consumer is to reduce the social re-distributive element of insurance.

Some others believe that HSAs remove healthy people from the insurance pool and it makes premiums rise for everyone left. HSAs encourage people to look out for themselves more and spread the risk around less. Another concern is that the money people save in HSAs will be inadequate. Some people believe that HSAs do not allow for enough savings to cover costs. Even the person who contributes the maximum and never takes any money out would not be able to cover health care costs in retirement if inflation continues in the health care industry.

Opponents of HSAs, also include distinguished figures like state Insurance Commissioner John Garamendi, who called them a “dangerous prescription” that will destabilize the health insurance marketplace and make things even worse for the uninsured. Another criticism is that they benefit the rich more than the poor. Those who earn more will be able to get bigger tax breaks than those who earn less. Critics point out that higher deductibles along with insurance premiums will take away a large share of the earnings of the low income groups. Also lower income groups will not benefit substantially from tax breaks as they are already paying little or no taxes. On the other hand tax breaks on savings in HSAs and on further income from those HSA savings will cost billions of dollars of tax money to the exchequer.

The Treasury Department has estimated HSAs would cost the government $156 billion over a decade. Critics say that this could rise substantially. Several surveys have been conducted regarding the efficacy of the HSAs and some have found that the account holders are not particularly satisfied with the HSA scheme and many are even ignorant about the working of the HSAs. One such survey conducted in 2007 of American employees by the human resources consulting firm Towers Perrin showed satisfaction with account based health plans (ABHPs) was low. People were not happy with them in general compared with people with more traditional health care. Respondents said they were not comfortable with the risk and did not understand how it works.

According to the Commonwealth Fund, early experience with HAS eligible high-deductible health plans reveals low satisfaction, high out of- pocket costs, and cost-related access problems. Another survey conducted with the Employee Benefits Research Institute found that people enrolled in HSA-eligible high-deductible health plans were much less satisfied with many aspects of their health care than adults in more comprehensive plans People in these plans allocate substantial amounts of income to their health care, especially those who have poorer health or lower incomes. The survey also found that adults in high-deductible health plans are far more likely to delay or avoid getting needed care, or to skip medications, because of the cost. Problems are particularly pronounced among those with poorer health or lower incomes.

Political leaders have also been vocal about their criticism of the HSAs. Congressman John Conyers, Jr. issued the following statement criticizing the HSAs “The President’s health care plan is not about covering the uninsured, making health insurance affordable, or even driving down the cost of health care. Its real purpose is to make it easier for businesses to dump their health insurance burden onto workers, give tax breaks to the wealthy, and boost the profits of banks and financial brokers. The health care policies concocted at the behest of special interests do nothing to help the average American. In many cases, they can make health care even more inaccessible.” In fact a report of the U.S. governments Accountability office, published on April 1, 2008 says that the rate of enrollment in the HSAs is greater for higher income individuals than for lower income ones.

A study titled “Health Savings Accounts and High Deductible Health Plans: Are They an Option for Low-Income Families? By Catherine Hoffman and Jennifer Tolbert which was sponsored by the Kaiser Family Foundation reported the following key findings regarding the HSAs:

a) Premiums for HSA qualified health plans may be lower than for traditional insurance, but these plans shift more of the financial risk to individuals and families through higher deductibles.
b) Premiums and out-of-pocket costs for HSA qualified health plans would consume a substantial portion of a low-income family’s budget.
c) Most low-income individuals and families do not face high enough tax liability to benefit in a significant way from tax deductions associated with HSAs.
d) People with chronic conditions, disabilities, and others with high cost medical needs may face even greater out-of-pocket costs under HSA qualified health plans.
e) Cost-sharing reduces the use of health care, especially primary and preventive services, and low-income individuals and those who are sicker are particularly sensitive to cost-sharing increases.
f) Health savings accounts and high deductible plans are unlikely to substantially increase health insurance coverage among the uninsured.

Choosing a Health Plan

Despite the advantages offered by the HSA, it may not be suitable for everyone. While choosing an insurance plan, an individual must consider the following factors:

1. The premiums to be paid.
2. Coverage/benefits available under the scheme.
3. Various exclusions and limitations.
4. Portability.
5. Out-of-pocket costs like coinsurance, co-pays, and deductibles.
6. Access to doctors, hospitals, and other providers.
7. How much and sometimes how one pays for care.
8. Any existing health issue or physical disability.
9. Type of tax savings available.

The plan you choose should according to your requirements and financial ability.