As the political campaigns heat up this summer, health insurance is being discussed more and more. When one looks at the health insurance situation in the country, it is easy to see why this has become a significant issue.

All you need to do is take a quick look at some health insurance statistics to get an idea of why it has been moving more and more to center stage as a political issue. Health care has become a major concern of many Americans. The big problem has been the rising cost. Health care costs are rising at a rate of 6.9% which is double the National inflation rate. Almost $2 Trillion dollars was spent in 2005 on health care, which amounts to almost $6,700 per person. It also accounted for 16% of the Gross Domestic Product (GDP).

It is estimated that by 2015, this will double to $4 trillion dollars and will account for as much as 20% of the GDP. How has this impacted health insurance? The health insurance policy is a basic contract between an individual and an Insurance company. The company receives a premium from a large number of individuals and in return pays the health care costs of those who are sick. In short, the idea is that everyone throws in a little bit of money, and the few that get sick are taken care of by the payments of those who remain healthy.

This system peaked in the 20th Century and at one time, health insurance was something available to most people and at a price they could afford. The Insurance companies invested the premiums wisely and they made a profit. The individual had virtually no worries about health care. They were insured and if they became sick, their medical bills would be paid. The cost of this safety net was reasonable. However, when the health care costs began to raise, this balance changed. The Insurance companies needed to make sure they were solvent enough to meet their obligations, and as health care costs went up, health insurance premiums were forced to follow.

Now, health insurance costs to employers are on the rise. The average is 7.7% increase in the cost of providing health coverage to an employer. Smaller companies have seen rates rise 8.8% while the smallest ones, companies with less than 24 employees, have jumped 10.5%. This has meant that more and more of the cost must be borne by the employee. It now is costing an average of $11,500 per year to provide basic coverage to a family of four. Even a single person must put out around $4,200 a year.

The Health Insurance industry has taken much of the flack for this. They have tried to deal with the problems in many creative ways. Exclusions and limited coverage have become the norm. Also, the basic insurance of our parents and grandparents that cast a complete safety net with few restrictions has become a thing of the past. Yet, still Insurance companies get a bad rap when it is really health care costs that are the culprit.

By: Aazdak Alisimo

Traditional Chinese health beliefs adopt a holistic view emphasizing the importance of environmental factors in increasing risk of disease. According to Quah (1985), these factors influence the balance of body’s harmony, yin and yang. These are two opposite but complementary forces and, together with qi (vital energy), they control the universe and explain the relationship between people and their surroundings. Imbalance in these two forces, or in the qi, results in illness.

In order to restore the balance, traditional remedial practices may be needed. For example, excess `hot’ energy can be counterbalanced by cooling herbal teas, and vice versa. These beliefs are deeply ingrained among the Chinese, and have been found to be unchanged following migration to Singapore.

Lee, et. al. (2004), found that patients with specific chronic diseases, namely arthritis, musculoskeletal diseases and stroke, were more likely to use Traditional Chinese Medicine (TCM). This was strongly determined by the ‘chronic disease triad’, perceived satisfaction with care and cultural health beliefs.

Hence the use of TCM is not associated with the quality of doctor-patient interaction. Astin (1998) also agreed that it was seen as being more compatible with the patients’ values, spiritual and religious philosophy, or beliefs regarding the nature and meaning of health and illness.

In traditional Chinese culture, taking medication is thought to be aversive, hence medications tend to be taken only until symptoms are relieved and then discontinued; if symptoms are not obvious, medications will probably never be taken.

Apart from parental cultural beliefs, minor side effects of certain antibiotics such as stomach upset may contribute to the poor adherence of medication. The use of “leftover”, “shared” antibiotics and over-the-counter purchase of antibiotics by parents are common situations in the community.

They think that their children suffer from the same illnesses judging by the similar symptoms, so they would give the “leftover” or “shared” antibiotics to their children and only bring them to their doctors if there is no improvement (Chang & Tang, 2006). This may cause their conditions to deteriorate and may necessitate aggressive treatments later which may have unnecessary side effects.

However, there are small groups of Chinese who also blamed ill-health or misfortunes on supernatural forces, or on divine retribution, or on the malevolence of a ‘witch’ or ’sorcerer’ (Helman, 1994). Such groups will usually seek cures from their religions.

In Singapore, the Ministry of Health has drawn up the TCM Practitioners’ Ethical Code and Ethical Guidelines to prevent any unscrupulous practitioners from preying on their patients and taking advantage of their beliefs, for example, molesting ignorant patients.

The degree of acculturation has been evidenced in the following case. An old man was brought into our hospital with a week-long history of malaise, nausea and vomiting, and sudden jaundice. He was diagnosed to have an obstructive mass in the liver.

A biopsy revealed hepatocellular carcinoma. The serological test suggested chronic active hepatitis B. When the news broke to his son that his father had cancer, he requested not to disclose that to his father.

When we discussed end of life issues such as hospice care and “do-not-resuscitate” (DNR) orders, the son tried to divert the discussion to other issues such as when his father could go home.

Cultural Issues that may be involved in this case are:

The Chinese tend to protect the elderly from bad news.

Believing in karma – the older folk believe that discussing illnesses or death/dying is bad luck. They think that talking about something bad will cause it to come true.

There is an increased incidence of liver cancer resulting from Hepatitis B due to delayed treatment in the elderly, as it may take a long time for them to accept the initial diagnosis.

Reference:

Astin JA. (1998). Why patients use alternative medicine. J Am Med Assoc 1998; 279: 1548-1553.

Chan, G. C. & Tang, S. F. (2006) Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia. Singapore Medical Journal, 47(4):266

Helman, C. G. (1990) Culture, Health and Illness. Wright, London.

Quah, S. R. (1985) The Health Belief Model and preventive health behaviour in Singapore. Social Science and Medicine, 21, 351-363.

Lee GBW, Charn TC, Chew ZH and Ng TP. (2004). Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Family Practice, 21(6): 654-660.

By: Maurice Wong

Many people think by getting a “good job” they’ll have a “good health benefits package.” That is just not always the case. Sometimes we find our dream jobs – great pay, weekends and holidays off, many opportunities to use our skills and advance – only to find out our dream jobs do not offer employer-sponsored health insurance. So, we start looking for individual insurance policies to purchase, but just do not have the money left over after the bills are paid to pay the higher premiums.

It is a vicious cycle, but it can be stopped thanks to New York State’s Family Health Plus. The Family Health Plus plan was created for adults between the ages of 19 and 64 who can’t find affordable health insurance in New York. Maybe their employers don’t offer group health insurance plans, or maybe they can’t afford to purchase an individual health insurance plan on their own. These are the New Yorkers who are considered to have too much money or assets to qualify for Medicaid; at the same time, they make too little money to afford either out-of-pocket health care costs or individual health insurance plans.

The great thing about New York State’s Family Health Plus plan is that you don’t have to have children in order to be eligible. Single adults as well as married couples without children are eligible for the Family Health Plus plan.

Plus, it costs nothing to apply for and enroll in the Family Health Plus plan, nor will you be required to pay deductibles. You will, however, need to pay co-payments at the time of medical treatment.

The Family Health Plus plan offers coverage for, but not limited to, doctor visits, in and out patient care, emergency room visits, vision care, diabetic services, behavioral health services, and even family planning.

For more information about this affordable health insurance in New York, contact the New York State Department of Health.

By: Elizabeth Newberry