The Duke of Cambridge has said he felt “pain like no other pain” after the death of his mother, Princess Diana.
Prince William made the disclosure in a BBC TV documentary about mental health.
He said the “British stiff upper lip thing” had its place when times were hard, but people also needed “to relax a little bit and be able to talk about our emotions because we’re not robots”.
William also spoke of how working as an air ambulance pilot left him feeling that death was “just around the door”.
He said dealing with the loss of his mother – who died in a 1997 car crash – meant he felt he could relate to others who had suffered a bereavement.
He said: “I’ve thought about this a lot, and I’m trying to understand why I feel like I do, but I think when you are bereaved at a very young age, any time really, but particularly at a young age, I can resonate closely to that, you feel pain like no other pain.
“I felt that with a few jobs that I did, there were particular personal resonations with the families that I was dealing with,” he said.
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He described how the emotional aspect of being an East Anglian Air Ambulance pilot was “difficult”, especially having come from the military where feelings tend to be put to one side.
He said the ambulance world was “much more open” and he spoke about experiencing “very raw, emotional day-to-day stuff, where you’re dealing with families who are having the worst news they could ever possibly have on a day-to-day basis.”
“That raw emotion… I could feel it brewing up inside me and I could feel it was going to take its toll and be a real problem. I had to speak about it.”
In the BBC One documentary to be screened on Sunday, William speaks to footballers Peter Crouch and Danny Rose, ex-players Thierry Henry and Jermaine Jenas, and England manager Gareth Southgate.
They all shared various mental health issues and pressures they have faced in their careers.
William and his brother, the Duke of Sussex, have previously spoken about the death of their mother – when they launched a mental health campaign called Heads Together, which encouraged people to talk more openly about their problems.
The Duke and Duchess of Cambridge and the Duke and Duchess of Sussex also teamed up last month to launch a text messaging service for people experiencing a mental health crisis.
William, Kate, Meghan and Harry have backed the initiative, called Shout, with £3m from their Royal Foundation.
The charity running Shout also received a £1.5m grant from BBC Children in Need.
A Royal Team Talk: Tackling Mental Health is broadcast on Sunday, 19 May, at 22:30 on BBC One.
- Over 500 sanitation workers in Nanjing have been asked to wear ‘smart’ watches
- The bracelet tracks their location in real time and records when they clock in
- An earlier version of the bracelet also sends out an alarm if they stopped moving
- The alarm function has been removed after the system sparked public outcry
Officials in east China are forcing its street cleaners to wear GPS-tracking bracelets in order to monitor idle workers.
More than 500 sanitation workers in Nanjing, Jiangsu province have been required to wear the smart bracelets, which would track their location in real time and send out an audio alert if the wearer stopped moving for more than 20 minutes.
The sanitation company removed the alarm feature of the watch after the news last week sparked a public outcry over Big Brother-style surveillance, Chinese media reported.
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A sanitation worker in Nanjing, east China’s Jiangsu province shows reporters the smart bracelet that is used to track his location while on duty
An earlier version of the bracelet sends out an audio alert if sanitation workers stopped moving for more than 20 minutes, sparking public over Big Brother-style surveillance
However, other functions via the bracelet remain, including location tracking and letting the workers clock in for work.
Information from the watch is transmitted to a command centre, which ensures workers stay in their designated work area and are not slacking off, according to a report first published by Jiangsu City Channel last Wednesday.
An unnamed street cleaner told reporters that an alert would be triggered from the bracelet if she stopped moving for more than 20 minutes.
‘It will shout “please continue working! Keep it up!”,’ the woman said. ‘There is a big screen somewhere that shows all our locations. If we still fail to move after the alarm goes off, our managers will come and find us.’
A worker said that he is forced to walk up and down the street even though it’s already clean
‘It will shout “please continue working!”,’ the worker said. ‘There is a big screen that shows our location. If we still fail to move after the alarm goes off, our managers will come and find them’
A clip of the command centre shows a large, wall-mounted screen with dozens of dots indicating the exact location of each sanitation worker in the city
Another worker complained that the wristband forces him to walk up and down the street even though it’s already clean.
A clip of the command centre shows a large, wall-mounted screen with dozens of dots indicating the exact location of each sanitation worker in the city.
Yang Haiping, an employee at the centre said that the smart bracelet programme aims to increase workers’ productivity, reduce management costs and allow total monitoring of its sanitation workers.
There is also an emergency button on the watch in case the worker is ever in danger.
The surveillance system, implemented in September, is only activated during work hours and will not infringe on the workers’ privacy, said Zhang Dongzhong, the company’s vice-president.
There is also an emergency button on the smart watch in case the worker is ever in danger
The system, implemented in September, only works during work hours and will not infringe on the workers’ privacy, according to Zhang Dongzhong, the company’s vice-president
He told Beijing Youth Daily that no one had been punished for information provided by the watches so far.
The report immediately caused a backlash on Chinese social media, with many net users questioning the practicality of the watches and offering their support to the cleaners.
‘As long as the streets are clean and the worker has done their job, I don’t think the constant monitoring is necessary,’ one person wrote on Chinese microblogging site Weibo.
‘It’s not easy being a sanitation worker, they are always overworked. This is just inhumane,’ another user said.
‘Why don’t you put a watch on our government officials? Send out an alert to them if they take a rest for more than 20 minutes?’ one person commented.
Researchers have developed a wearable device for racehorses – similar to fitness trackers used by humans – to provide real-time measures of vital signs.
A team at the University of Bath say the information could help enhance performance, reduce risk of injury and improve welfare through the early detection of disease.
Their platform, named EquiVi, measures heart and respiratory rate, blood oxygen saturation, temperature, blood pressure and heart rate variability.
Trainers and vets can monitor the measurements during a horse’s day-to-day activities such as stabling, exercise and travel.
The device, currently in prototype form, is made up of three sensors positioned on different parts of the horse.
Lucy Nelson, deputy lieutenant of Somerset, described the project as “really exciting”.
“It’s a fantastic tool, it is really revolutionary,” the stable owner said.
“We spend our lives trying to look at horses, trying to understand their language and making sure that the horse is thriving.
“The happier they are, the better they work. There’s no point in trying to train unhappy horses, it just doesn’t work.”
She described the possibilities of being able to use the device to “hone in” on different situations.
This could tell trainers whether a horse would travel best in a forwards or sideways position, on a plane, boat or in a horsebox.
“It will be a real help for racehorse owners, for event horse owners, for vets – there are so many applications it can be used for,” she added.
“It’s revolutionary. I’m so thrilled that Bath has come forward with this extraordinary project.”
Dr Ben Metcalfe, an electrical engineer at the University of Bath, said data generated from a racehorse during an event could help advise the racing industry.
The device could also help pinpoint injuries on horses before they begin to go lame, he said.
“What we want to see is this technology in widespread adoption,” Dr Metcalfe said.
“As we develop more and more sensors we’re really interested in how all these parameters fit together – we look at modelling the health of the entire animal by measuring multiple vital signs at different times and in different ways.”
Flashback to freezing early February, and you can imagine how unenthusiastic I was to embark on an eight-week fitness challenge that promised to upend my entire routine. The Deliveroos and Sunday night sofa sessions with three varieties of Lindt that I was using to self-medicate throughout winter were about to be replaced with daily HIIT classes, alcohol abstinence, limited caffeine and virtuous home-cooked meals. But it was too late to back out – a few weeks prior I’d innocently signed up for the F45 Challenge.
Flashback to freezing early February, and you can imagine how unenthusiastic I was to embark on an eight-week fitness challenge that promised to upend my entire routine. The Deliveroos and Sunday night sofa sessions with three varieties of Lindt that I was using to self-medicate throughout winter were about to be replaced with daily HIIT classes, alcohol abstinence, limited caffeine and virtuous home-cooked meals. But it was too late to back out – a few weeks prior I’d innocently signed up for the F45 Challenge.
For the uninitiated, F45 is a worldwide Australian-born exercise phenomenon that’s spreading like wildfire throughout the UK and Ireland, with studios as far afield as Glasgow, Bath, Bristol, Oxford, all corners of London, and elsewhere, with more set to open this year. (Mark Wahlberg, whose own hardcore workout schedule starts at 2.30am daily, just bought a minority stake in the franchise, so you know it’s serious.) Its USP is its 45-minute circuit classes that combine interval, cardiovascular and strength training to build muscle and fitness. It holds four eight-week challenges a year, which involve training as many times a week as you can manage, while following a meal plan and monitoring your body composition (muscle, fat and more) at the beginning and end. Yeah, it’s a lot.
So why did I sign up? A fitness challenge was high on my goal list for 2019 – I’d never done anything like it and wanted to see how I’d feel, mentally and physically, from sticking to a structured exercise regime. My goal wasn’t to lose weight – if anything, I was keen to put on muscle and spice up my exercise regime while challenging myself. I was stuck in an exercise rut and bored of my unfocused routine – which amounted to a pilates or kettlebells class here, a 10km run there, a few times a week – and didn’t think it would be much of a sacrifice at a time of year when my social life wouldn’t ordinarily be popping off anyway (I was wrong, but more on that later).
Flash forward to now, just a week after finishing the challenge at F45 Farringdon, the endorphins are settling down and the novelty of being able to guiltlessly sip my favourite gin cocktails is starting to wear off, and I’m in a good position to reflect on what I learned. Whether you’re considering doing the next F45 Challenge or another challenge (like Barry’s Bootcamp’s Face Yourself or Hellweek, the CrossFit Games, the or marathon training), or merely looking to hop back on the fitness train for spring, you may find this useful too.
You really do get out what you put in
In a world where everyone’s Instagramming their workouts, and gyms flog their classes with the help of their Herculean superstar trainers’ vast online followings, it’s easy to expect immediate results from the latest fitness trend. I’m as guilty as anyone. But the F45 Challenge hammered home the obvious, unglamorous truth: the more sustained effort you expel, the more likely you are to see the outcome you want. The days when I bench pressed 10kg rather than my safer 8kg were the days I’d leave the studio feeling proudest and most satisfied. “People become braver and push themselves more with weights from week to week,” says Honey Fine, a fitness coach at F45 Farringdon. “They learn that being part of a community allows you to feel comfortable in a safe environment to train, discuss the challenge and their concerns.”
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Equally, there’s no getting around the importance of dusting yourself off and trying again when you hit stumbling blocks. “Getting back into the swing of it after a holiday can be tough for people,” Jake Hazell, F45 Farringdon’s studio manager, tells me, and yep, he’s right. In week three, just as I was hitting my stride, I went on a long weekend to Marrakech and everything went out the window (because YOLO and there’s no way I wanted to be That Girl who ruins their boyfriend’s holiday by eschewing the bread basket and leaving him to drink alone). I ditched the meal plan and broke the plan’s no-alcohol rule, and I drank a few other times later on in the challenge and ended up going more overboard than usual because of the novelty of it. While I don’t regret the fun I had (and wouldn’t have done anything differently on holiday), it was tough getting back into the #fitness mindset and annoying knowing I’d undone my progress. The key, though, is picking up where you left off and letting it go. The challenge is hard enough as it is, without the added mental anguish of regretting some fun experiences that can’t be undone.
A support system is surprisingly important
I’m usually an independent exerciser and have no problem motivating myself to work out – the thought of jogging with a friend to “catch up” brings me out in hives – but I seriously underestimated how vital others’ encouragement would be to get me through such a massive lifestyle change. “Team changing, life changing” is the F45 slogan and they’re not just empty words. Complaining about the meals and difficulty of certain classes with the same people each day was cheering. My now-friend Mervet Kagu, with whom I did virtually every class, also describes “the sense of community and support from fellow challengers and the trainers” as her biggest motivation throughout. As someone who usually avoids all eye contact with others at the gym, I surprisingly didn’t mind having to make small talk with fellow challengers at 7am. I was also added to a WhatsApp group headed by the trainer who’d act as my mentor throughout (shout out to Jonah!), which I was grateful for countless times. Once I’d muted it, which I did within five minutes of being added, it was an invaluable source of challenge intel.
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The first two weeks were the hardest for me – the meal plan means no coffee, alcohol or sugar – and on the first day (my first without coffee for at least a decade) I had the worst headache of my life and felt like I was outside my body, looking down on myself. The immediate impact of the cappuccino withdrawal amazed me, but the WhatsApp group told me I wasn’t alone, and I ended up having one of the best sleeps of my life, so it wasn’t all dire.
On top of the support from the Farringdon studio, there was also the global network of F45 studios to get me through. Whatever fitness challenge you’re doing, I’d recommend following others doing the same challenge on social media. Everyone on the F45 Challenge around the world does the same classes each day, and it was helpful looking at others’ versions of the same meals and the classes beforehand. My Instagram feed looked like the inside of a bodybuilder’s kitchen, with all the chicken breasts and protein shakes on the challenge hashtags I was following, and I’d religiously watch the studio’s Instagram Stories for a glimpse of the workout I had to look forward to.
Variety is underrated
While it’s important to be deliberate and consistent in your training, it’s crucial to have diversity within each session (the same goes for healthy eating). The focus of F45’s classes alternates each day: Mondays, Wednesdays and Fridays are cardio-focused, while Tuesdays and Thursdays are weights-based, and Saturday is a slightly longer class (Hollywood, my favourite) that combines both. Classes are never repeated (and specific exercises are only repeated every now and again) so you never get bored, while recipes on the meal plan aren’t repeated week to week. I realised my diet was extremely lacking in diversity – as a veggie, I leaned heavily towards carbs and wasn’t getting enough protein (I’m now a protein shake addict) – and I was too reliant on caffeine (see: the aforementioned crippling headache). I came away with a cookery book’s worth of recipes that I’ve already been recreating in my post-challenge life.
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You have to make sacrifices if you want to see results
Sad but true. Call me a sheep, but I don’t enjoy socialising sober at night when everyone else is drinking. This meant I had to turn down invitations and plans where I knew alcohol would be involved (read: about 80% of them) to stay on track, because I knew I’d be miserable being the boring “healthy” one and having to explain why I wasn’t eating or drinking as normal. (You may find it easier to strike a balance between socialising and a fitness regime, but an all-or-nothing approach sometimes works better for me.) Thus, my social life suffered – badly. During the week I’d spend every evening at the studio, followed by meal prepping for the next day (three meals and two HOMEMADE snacks). Because my fridge is so small I couldn’t make a week’s worth of meals on Sunday like other people. (This being said, I’d never done a weekly online shop before the challenge and it’s a habit I’ll be sticking to because it is, crushingly, cheaper than nightly runs to Tesco Express. My mum was right.)
Fitness apps may have scored a bad rap recently (with critics claiming they’re too number-heavy) but for me, tracking my habits, mood and workouts in the diary section of the F45 Challenge app became a key source of motivation when I was struggling, and I’d eagerly await the “drop” of the following week’s meal plan on Mondays (how’s that for a sorry glimpse into my life?). I stuck to the meal plan pretty staunchly and trained six times a week on average, giving me a huge sense of achievement and satisfaction that I hadn’t felt for ages. It was great having a fitness and nutrition plan laid out for me – it freed up mental space to think about other things.
Nothing’s more important than your mental health
Too much restriction and life admin, I very quickly realised, is terrible for my mental health. In between the alcohol abstinence and nightly meal-prep, there were times when I felt pretty low. Luckily the encouragement from others and the classes themselves were enough to keep me going, but it’s called a “challenge” for a reason: it’s not sustainable long term. A challenge like this (if you’re a fitness fanatic and can afford the hefty £200 a month) is fun, life-enhancing and the health benefits are amazing – by week eight my skin was blemish-free, I felt stronger and I’d shaved a year off my biological age – but it made me realise how much I value alcohol, meals out, and simply doing nothing (that is, not exercising) for my mental health. That being said, I learned you have to get through the lows to properly value the highs – and I’ve already put the dates for the next Challenge in my diary.
From: Refinery 29 UK
World Health Day: The causes of eating disorders are very complex, characteristically encompassing hereditary, emotional, environmental, and socio-cultural aspects. Here’s how you can deal with a child suffering from an eating disorder.
World Health Day: Parents should nurture trust in their kids suffering from eating disorder
- Create an environment of support for kids with eating disorder
- The causes of eating disorders are very complex
- Having unusual food rituals signal eating disorders in kids
April 7 is observed as World Health Day. On the occasion of this special day, which aims at providing access to healthcare services to everyone, everywhere, we take a look at eating disorders in kids, and how parents can help their kids overcome them.
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Parents often find it difficult to deal with eating disorders in kids. Some of the common eating disorders in kids include like anorexia, bulimia, binge eating or avoidant/restrictive food intake disorder (ARFID). Families tend to feel vulnerable and frustrated when helping kids overcome the eating disorder. Even though parents are held accountable for kids’ health, they are not in full control of the. It is actually up to the kids on how and when the progress towards the path of recovery.
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As a responsible family, it is your responsibility to create an environment of support, sustenance and information for your child. You must allow them to start taking charge for their own well-being.
World Health Day: Eating disorders in kids: causes and symptoms
The causes of eating disorders are very complex, characteristically encompassing hereditary, emotional, environmental, and socio-cultural aspects. Kids are already under pressure if they are suffering from a psychological disorder or if they are constantly being told about dieting and importance of being in shape.
Signs that your child is suffering from an eating disorder include weight gain, inaccurate sense of body image, feeling obsessed with eating food, variations in child’s body weight, dieting at an young age, refusing to eat in front of others, indulging in extreme exercising, having unusual food rituals or displaying strange behaviours, making a trip to the washroom post eating, irritability or variations in mood, weakness and tiredness, thinning of hair, indulging in sports that focus on weight loss, having a family member with an eating illness and cerebral health problems such as anxiety, depression, or OCD to name a few.
World Health Day: Tell your child with confidence that s/he has the capability to recover from eating disorder
Photo Credit: iStock
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How can parents help a child with eating disorder?
It is important for parents to be aware of eating disorders. They should seek out information and get educated about eating disorders. Look for ways of dealing with eating disorders that suit your situation.
1. Prioritise self-care: Children will follow the kind of lifestyle you set in front of your children. You can only efficiently care for your child when your own requirements are being met. Parents should start following a well-balanced lifestyle by consuming nutritious meals. Get proper amount of sleep and exercise regularly. Engage in activities that feel wholesome and joyful to you. If you follow a healthy lifestyle, you child will automatically follow your footsteps.
2. Get early help: When you diagnose an eating disorder early, the child definitely stands a better chance of recovery. Schedule an appointment with your child’s paediatrician to further aid your child’s recovery process, personally attend all appointments with your child. The treatment will take time and effort. Get involved with the care team to get all the assistance your child requires.
3. Practice compassion and kindness: Offer yourself and your child sympathy. Never hold your child to be a culprit for falling prey to such a disorder. Guilt, blame, and disgrace will fail to create the gentle conditions that best serve positive healing.
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4. Nurture trust: Lend your child ample opportunity to have faith and trust in you. Your child is possibly experiencing terrific amount of shame about their eating disorder, which forces them to departure into silence without speaking out their truth. Let your kids understand they can always come and tell you when they purge or are feeling anxiety about eating, and that you are trying to comprehend with their condition.
5. Believe in retrieval: It is important for families to firstly believe that the phase of retrieval is possible. Set for your child a steady confidence that they have the courage and strength to accomplish health, and that blunders are not signals of failure. Particularly in times of setback, it is vital to offer absolute support and highlight your belief that recovery is possible.
On the whole, if your child is purging or is binging on food, the first and foremost treatment involves the family highlighting on standardising their intake of food. So, a child who over-indulgence needs to be thought to consume the next meal at a steady time. The child must be encouraged to eat within every few hours, hungry or not hungry, in order to stop big hunger cues later on, which lead to bingeing. Above all, remember that retrieval from an eating syndrome doesn’t happen just overnight, and it doesn’t happen alone. Eating disorders are curable, and with the right kind of support from your family and child health expert, your child can go on to live a full and healthy lifestyle.
(Dr. Atish Laddad is Founder andDirector at Docterz)
Disclaimer: The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.
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A pet cat is recovering after being shot in the neck with an air gun.
Black-and-white Romeo was found whimpering by his owners on Monday when he managed to make his way back to his home in Croxteth, Liverpool, after being injured in what RSPCA inspectors believe may have been a deliberate attack.
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The air gun pellet, which could be seen lodged in his skin, was removed by vets and two-year-old Romeo is now improving and back to exploring his garden.
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RSPCA Inspector Helen Smith said: “Poor Romeo must have been in such a lot of pain after being shot, and he’s a very lucky boy that the injury wasn’t more serious.
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“Sadly, we do see cases where pet cats are shot and suffer catastrophic injuries, some having to have a leg amputated or even some not making it and dying as a result of their injury.
“It’s possible that Romeo was shot by accident, but also I am concerned that he may have been deliberately targeted.
“Anybody with any information about who may be responsible for injuring Romeo can call our inspector’s appeal line number on 0300 123 8018, where they can leave me a message in complete confidence.”
From: PA Ready News UK
Detainees at UK immigration centres are being hospitalised at the rate of almost one a day, according to new figures that raise fresh concerns over the safety of vulnerable people held inside.
Home Office data, obtained following a freedom of information request, revealed that in 2017, there were 330 visits to hospital by detainees held in immigration removal centres.
The figures were recorded between January and December 2017, shortly after the Home Office introduced its “adults at risk policy”, which was meant to keep vulnerable people out of detention.
The findings follow a scathing report last month by the home affairs select committee that said the Home Office had overseen serious failings in almost every aspect of the immigration detention process.
Sonya Sceats, chief executive of charity Freedom from Torture, which submitted the FoI request, said: “The Home Office figures make it abundantly clear that there are very ill and vulnerable people in these immigration detention centres.
“It is shocking to think that almost every day of the month, there is a hospital admission. From removal centre reports to accounts from torture survivors in treatment with us, we know that self-harm, overdoses and poor provision of medication are commonplace.”
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Sceats outlined one case involving a distressed detainee who made 22 calls on the emergency bell in his cell before staff came to see him and called an ambulance.
“Torture survivors and vulnerable people should never be detained for immigration purposes,” she added.
Another parliamentary report published in February, this time by the joint committee on human rights (JCHR), called for an end to indefinite detention in immigration centres, and said people should ideally be held for no longer than 28 days.
A Home Office spokesperson said: “The health and welfare of those in immigration detention is of the utmost importance. All immigration detention centres have trained medical staff on hand to provide care to those in detention.”
CINCINNATI – A Kentucky high school student lost his lawsuit challenging an order that barred him from school because he refuses to obtain the chickenpox vaccine.
The senior at Assumption Academy in Boone County sued the Northern Kentucky Independent District Board of Health after it banned students without chickenpox immunity from attending school and extracurricular activities during an outbreak.
Jerome Kunkel, 18, was “devastated” by the ruling, said his lawyer, Christopher Wiest of Covington, Kentucky.
Kunkel is not against all vaccines, he told The Enquirer earlier, but he is opposed to those that use aborted fetal cells in their manufacture, including the chickenpox vaccine.
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Jeff Mando of Covington, who represented the health department, said the ruling “upheld the health department’s mission to protect public health and the welfare of folks in Northern Kentucky.”
Wiest said he argued in court that the ban would not be effective in halting the spread of chickenpox, which was found in 32 students, about 13 percent of the student body.
“The chickenpox order makes no sense,” Wiest said. “They all go to daily and weekly mass. The parish receives communion on the tongue. Communion-age kids are going to spread chickenpox. That testimony was unequivocal.”
Wiest said about 30 other students are out of school under the health department’s ban, and they have joined Kunkel’s legal cause. They attend Assumption or Our Lady of the Sacred Heart, an elementary school on the same property as Kunkel’s school.
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Tuesday’s ruling upheld the health department’s authority in Kentucky to implement rules to prevent the spread of contagious diseases.
Mando said early correspondence sent by the health department encouraged students without immunity to avoid interacting in the community to help prevent the disease’s spread.
On Monday during a court hearing, Kunkel asked a judge to let him go back to school and lift a ban that he says the health department imposed in an act of religious retaliation amid an outbreak of chickenpox.
But the lawyer for the health department disputed Kunkel’s claim.
“This is not a case of religious discrimination,” Mando said. “Instead, it presents this question: Do unvaccinated students at Assumption have the right to attend school, play basketball and attend other extracurricular activities in the face of an outbreak of a very serious and infectious disease at the school?”
During a nearly five-hour hearing, Boone County Circuit Judge James R. Schrand heard from medical experts about chickenpox and the vaccine, which came on the U.S. market in 1995. The issue before Schrand, though, was more narrowly focused on the authority that health officials can apply to citizens when trying to contain a disease.
The case arose after chickenpox apparently started sweeping through Assumption Academy and Our Lady of the Sacred Heart School in early February. The health department sent out a warning to parents.
Evidence at Monday’s hearing in Circuit Court showed that only about 18 percent of students at the school have been vaccinated against childhood illnesses such as chickenpox. Kentucky’s statewide vaccination rate for chickenpox is about 90 percent.
In court, Mando pointed out that the state form that the Kunkels signed to get Jerome exempted from vaccines on religious grounds contains the warning, “This person may be subject to exclusion from school, group facilities or other programs if the local and/or state public health authority advises exclusion as a disease control measure.”
In mid-February, the number of suspected chickenpox cases jumped from six to 18. The Assumption Academy boys basketball team was preparing for statewide league playoffs. Local health officials, consulting with state authorities, then banned extracurricular activities to prevent the disease from spreading to other parts of the state.
The ban forbade outside-school activities for 21 days after the last case of chickenpox appeared. Kunkel, the center for the basketball team, and his parents appealed to local and state health authorities that while Jerome had a religious exemption to vaccinations, he was healthy and not contagious.
The health officials said that given the outbreak, there was no telling when Jerome Kunkel might get sick.
The health department issued a statement after the ruling that read, in part:
“The Court’s ruling … underscores the critical need for Public Health Departments to preserve the safety of the entire community, and in particular the safety of those members of our community who are most susceptible to the dire consequences when a serious, infectious disease such as varicella, is left unabated and uncontrolled.”
This article originally appeared on Cincinnati Enquirer: Judge upholds Kentucky school’s ban on unvaccinated student
A top ally to President Trump said on Tuesday that Capitol Hill should expect a fresh health-care plan from the White House soon, just a day after the president himself conceded that no real movement on the issue will happen until after the 2020 election.
Rep. Mark Meadows (R-NC) told The Daily Beast he believes the Trump administration “will have the framework for a comprehensive health-care initiative within months.”
“I can tell you he is working, and his administration are working, as if we will bring it up legislatively this year, but pragmatically understand that a future Congress actually deals with it,” said Meadows.
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The prediction from Meadows foreshadowed the president’s latest position, which he reportedly made clear on Tuesday night. Appearing at a fundraiser for House Republicans, Trump said he would come up with a health-care plan to run on in 2020 and then put to a vote at the dawn of his second term, should the GOP win control of both houses of Congress.
That pledge, and Meadows’ apparent support of it, adds another layer of confusion to a chaotic stretch in which Trump has embraced, backed away from, and embraced again the idea of once more trying to repeal and replace Obamacare.
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Last week, the Trump administration endorsed a court ruling that would, if upheld, strike down the entirety of Obamacare, throwing the future of the law into greater legal uncertainty. At a Senate Republican lunch, Trump urged lawmakers to take another stab at ambitious health-care legislation and publicly tasked three GOP senators the assignment of crafting a “beautiful” new bill.
Days later, Trump had relented in response to behind-the-scenes pressure from Republicans who noted that they do not control the House currently, could not repeal and replace the law when they did, and got clobbered during the 2018 midterms for trying. By Monday evening, the president’s sunny declaration that repeal was moving forward in Congress was replaced with tweets saying that his party was developing a “really great HealthCare Plan”—and that a vote on it would be taken after the election.
In seemingly punting on a health-care battle till after the 2020 elections, Trump relieved most Republicans on Capitol Hill. On Tuesday, Majority Leader Mitch McConnell revealed that he told the president that the Senate would not be taking up repeal-and-replace legislation this session.
Asked if there was any daylight between him and Trump on health care, a grinning McConnell simply told reporters, “not anymore.”
As McConnell framed the president’s health-care fit as water under the bridge, members of his conference criticized the party for passing on a chance to go after a law they loathe and have campaigned against for nearly a decade.
Sen. John Kennedy (R-LA) told a Fox News reporter that some of his colleagues need to see if Amazon is “selling spines at a special discount this week.”
“The only reason I’ve heard not to tackle health care is politics,” Kennedy told The Daily Beast, “and that’s not a good enough reason.”
Other close allies of the president were content to leave responsibility for crafting a health-care plan with Trump, all while not offending him by seeming eager to move on to other topics.
“The president is going to develop something he feels comfortable with, and hopefully most of us can rally around it,” said Sen. Lindsey Graham (R-SC).
Graham, who speaks regularly with Trump, is up for reelection in 2020. He suggested that a Trump health-care proposal could be useful for Republicans on the campaign trail by giving the party a proposal to compete with Democrats’ increasingly ambitious plans to expand Medicare and Medicaid.
“There’s not the votes to get a bill passed,” Graham said, “but I think we need to show the public why Medicare for All is a bad idea and why Obamacare is failing.” He did not offer specifics on what such a plan would look like, but did say it might look like the repeal bill he co-authored with Sen. Bill Cassidy (R-LA) that nearly passed the Senate in 2017.
Those tasked with re-electing the president, meanwhile, couldn’t help but exhale as he appeared to take his foot off the gas.
“My sense is healthcare is a complicated issue as we have found out in the past. There is no bill that Republicans or Democrats have that can be pushed through right away,” said Ed Rollins, a longtime Republican strategist who heads the pro-Trump Great America PAC. “The votes aren’t there. The Democrats control the process [in the House and]…they’re obviously not going to do anything except like Medicare for All.”
Rollins added it “would be very foolish” for Trump and Republican lawmakers to dive back into a healthcare debate that has in recent years proved so politically and electorally toxic to the GOP.
“Don’t waste the effort at this point in time,” he said.
Republican strategists beyond Rollins have increasingly warned that health care reform has become a political quagmire for the party. But for Trump, it remains a lingering, bothersome box unchecked. The first year of the Trump presidency was largely defined by the shambolic, wide-ranging failures of the administration and the GOP to follow through on their long-held promise to finally kill the Affordable Care Act. And it’s one that still causes fits of stress for those who were in the White House as it unfolded.
“The first attempt at healthcare was a debacle,” Cliff Sims, a former White House official and ex-friend of Trump’s, told The Daily Beast on Tuesday.
“The President had heard all of these congressmen go on and on about ‘repeal and replace’ for so long that he assumed they’d be able to just get it done. As is so often the case with Congress, they couldn’t. That led to a different approach on tax reform,” he continued. “We were all joined at the hip with our Hill counterparts. And even with total Republican control, that was still a herculean task. With a divided Congress [today], it’s hard to imagine anything nearly as significant as healthcare reform getting done, especially since neither party has any motivation to work with the other going into what promises to be another polarizing election cycle.”
(Bloomberg) — Even after a plunge last month that wiped $46 billion off Chinese health-care stocks, domestic drugmakers may be far from their floor as a Beijing-led policy shift gathers pace.
China’s plan to drive down generic drug prices through a centralized bulk procurement program is set to redraw the industry by forcing its thousands of small generic drugmakers to streamline and consolidate after decades of enjoying outsized profit margins.
“There won’t be a second act for traditional generic drug makers in China,” said Dai Ming, Shanghai-based fund manager at Hengsheng Asset Management Co. “In the past, there was hope that these companies would benefit from more government investment in health care due to the aging population, but now these health-care stocks will be further hurt by policy and undergo a greater correction.”
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Health-care stocks faced more pressure at the start of 2019. The MSCI China Health Care Index fell 4.2 percent on Wednesday, to the lowest level since March 2017.
In order to survive the shifting landscape and rely less on generics — drugs whose patents have expired — many companies are scrambling to pump money into research and development. Discovering a new medicine allows companies to earn high profits for as long as the new drug is covered by a patent, balancing out the loss of revenue from the fall in generic drug prices.
Chinese companies had been in a sweet spot. Among the top 100 generic drug makers, Chinese firms had a 74 percent gross margin and an 18 percent profit margin in the third quarter, compared with a global average of 55 percent and 9.5 percent, respectively, according to data compiled by Bloomberg.
The privileged position was due to the quirks of China’s regulatory system. While multinational giants had to wait years for approval to import their new drugs, the domestic generic makers could do a thriving business in copying, testing and getting local permission for the medicines.
At the same time, the industry benefited because of the lack of a centralized system for quality control. Multinationals like Pfizer Inc. and AstraZeneca Plc could win more hospital tenders for their off-patent drugs, as they could more easily offer quality assurances for their higher-cost medicines. That kept prices elevated throughout the pharma sector.
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Now, China has embarked on a pilot program in which major cities bulk-buy certain drugs together, forcing companies to bid for contracts and driving prices by an average of 52 percent, one by as much as 90 percent. Last week, Chinese Vice Premier Sun Chunlan said China would be expanding the program to cover more cities and drugs, as medicine prices must fall for health care to be affordable for the people.
Chinese companies that are already heavily invested in R&D stand the best chance of surviving the new landscape. Among mainland shares, Jiangsu Hengrui Medicine Co. has invested the most in research by far — amounting to 16 percent of revenue in the latest quarter. Guangzhou-based Yipinhong Pharmaceutical Co. is in second place with 8.4 percent. Zhejiang Jingxin Pharmaceutical Co., Chengdu Kanghong Pharmaceutical Group Co. and Tianjin Lisheng Pharmaceutical Co. have invested about 8 percent of sales into research.
Among Hong Kong-traded shares, CSPC Pharmaceutical Group Ltd. has 8.14 percent of sales invested in research and Sino Biopharmaceutical Ltd. has 6.23 percent.
At present, Jiangsu Hengrui gets 20 percent of its revenue from novel drugs and 80 percent from generics, a ratio it wants to flip, Lianshan Zhang, president of global R&D, said in an interview last month.
But a successful novel drug can take decades to develop, and the Chinese pharmaceuticals are up against the deep pockets and research talent of the multinationals, who are now enjoying rapid approval from Chinese regulators for their new medicine.
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And since their investment funds come from revenue generated by generics, the plunge in prices may set off a vicious circle, said analysts.
“With generic drug revenue being compressed, there’s a chance that it can’t cover the necessary investment to transition to novel drugs,” said Huarong Securities Co. analyst Zhang Keran. “The market does worry whether or not there will be sustainable cash flow going forward.”
(Adds stock action in fourth paragraph.)
To contact the editors responsible for this story: K. Oanh Ha at [email protected], Jeff Sutherland, Bhuma Shrivastava
©2019 Bloomberg L.P.
One of the biggest financial obstacles for retirees is paying for healthcare, according to a GOBankingRates survey. Healthcare in retirement can be expensive, with the average couple needing an estimated $280,000 after taxes to cover healthcare expenses over the course of their retirement, according to the Fidelity Health Care Cost Estimate.
While there is no way to avoid medical expenses — at least not one that doesn’t involve ignoring your doctors — the variation in healthcare market costs from region to region do mean that where you’re spending your golden years can play a major role in what you can expect to spend. The study looked at those cities where the average annual healthcare costs per capita were under $5,000, then scored that data along with the average out-of-pocket costs and income for those age 65 and older to come up with a final ranking of cities where retirees could potentially pay less for medical care.
15. Colorado Springs, Colo.
Annual Healthcare Spending Per Capita: $4,984
Annual Out-of-Pocket Spending Per Capita: $888
Income of Age 65+ Households: $49,422
Senior residents of Colorado Springs can pencil in almost exactly 10 percent of their annual income for the cost of their health insurance, with incomes just shy of $50,000 a year and healthcare spending just under $5,000 a year. The city very narrowly made this list as its average annual healthcare spending per capita was just $16 shy of the $5,000 cap for inclusion.
14. Memphis, Tenn.
Annual Healthcare Spending Per Capita: $4,644
Annual Out-of-Pocket Spending Per Capita: $864
Income of Age 65+ Households: $35,145
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Seniors in Memphis are earning significantly less than seniors in many of the other cities included here, and with healthcare costs still on the higher end, they can expect to spend over 13 percent of their annual income on medical costs — among the higher rates of the cities included here. The good news for Memphis residents is that — with average costs on the low side — it’s one of the cities where $1 million lasts the longest in retirement.
13. Austin, Texas
Annual Healthcare Spending Per Capita: $4,946
Annual Out-of-Pocket Spending Per Capita: $854
Income of Age 65+ Households: $54,293
The average healthcare spending in Austin is the second highest of the study, behind only Colorado Springs. However, with average incomes for retirement-age households at a healthy $54,000-plus, the percentage of total income devoted to healthcare is about 9.1 percent, among the lowest levels in the study.
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12. Lexington, Ky.
Annual Healthcare Spending Per Capita: $4,465
Annual Out-of-Pocket Spending Per Capita: $902
Income of Age 65+ Households: $49,214
Lexington is notable for having relatively high out-of-pocket healthcare costs compared to other cities on this list. The $902 spent on average represents 20.2 percent of the total annual healthcare bill for the typical resident, the highest percentage of any city in this study. However, Lexington is still one of the cheapest places to retire across middle America despite those higher out-of-pocket costs.
11. Reno, Nev.
Annual Healthcare Spending Per Capita: $4,663
Annual Out-of-Pocket Spending Per Capita: $822
Income of Age 65+ Households: $45,707
The Biggest Little City in the World isn’t just a place to consider for retirement if you’re interested in gambling and taking weekend trips to Lake Tahoe. It’s also home to an annual healthcare bill of $4,663, which constitutes a relatively affordable 10.2 percent of the average income for an age-65-and-older household.
Annual Healthcare Spending Per Capita: $4,528
Annual Out-of-Pocket Spending Per Capita: $827
Income of Age 65+ Households: $44,300
Phoenix is another area where the out-of-pocket costs for medical care are relatively high, with a little over 18 percent of the annual total for healthcare expenditures coming directly from patients. That’s the third-highest level of any city in this study.
Annual Healthcare Spending Per Capita: $4,896
Annual Out-of-Pocket Spending Per Capita: $749
Income of Age 65+ Households: $54,325
With the second-highest average income for senior households in the study, Seattle’s elderly population appears to be doing fine in terms of bringing money in. And although they have the third-highest annual healthcare expenditures of the cities on this list, it still represents just over 9 percent of their total income — the second-lowest proportion of these 15 locations. Still, with high overall costs, Seattle is one city where your retirement nest egg won’t go far.
8. Las Vegas
Annual Healthcare Spending Per Capita: $4,526
Annual Out-of-Pocket Spending Per Capita: $764
Income of Age 65+ Households: $41,969
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Nevada residents likely can’t help but compare costs for Las Vegas vs. Reno, and such a comparison reveals that everything is lower across the board for Vegas. That does mean, though, that although Vegas residents are saving $137 a year on healthcare costs — including spending $58 less out of pocket — they’re also earning $3,738 less over the course of an average year.
7. Portland, Ore.
Annual Healthcare Spending Per Capita: $4,596
Annual Out-of-Pocket Spending Per Capita: $755
Income of Age 65+ Households: $47,775
Portland’s relatively high income for senior households is paired with relatively modest healthcare costs and a relatively low portion of those being out of pocket. All of this is just part of why Portland makes the list of 15 cities you should consider for retirement.
Annual Healthcare Spending Per Capita: $4,484
Annual Out-of-Pocket Spending Per Capita: $701
Income of Age 65+ Households: $32,280
Although annual healthcare costs under $4,500 are notable, it’s unfortunately not making a big enough dent for many elderly Baltimore residents. That’s because — with an average income of just $32,280 a year — healthcare is still taking up an oversized piece of their total budget. The average senior citizen can expect to pay out some 13.9 percent of their income in medical costs by year-end, the second-highest level of any city in this study. So, if the city life is getting you down, you might consider nearby Ocean City, Md. — one of the most affordable places to retire near the beach.
5. Buffalo, N.Y.
Annual Healthcare Spending Per Capita: $4,095
Annual Out-of-Pocket Spending Per Capita: $741
Income of Age 65+ Households: $31,909
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Another city where healthcare costs and incomes are both low, Buffalo residents are spending about 12.8 percent of their income on healthcare on average — lower than some but still higher than many.
4. Spokane, Wash.
Annual Healthcare Spending Per Capita: $4,591
Annual Out-of-Pocket Spending Per Capita: $697
Income of Age 65+ Households: $43,831
Spokane is one city where the out-of-pocket medical costs faced by the average resident are relatively affordable. Just 15.2 percent of total medical costs and 1.6 percent of the average income are going to out-of-pocket medical expenses in a typical year for the average senior citizen in Spokane, both of which are among the lowest levels in the study.
3. Rochester, N.Y.
Annual Healthcare Spending Per Capita: $4,192
Annual Out-of-Pocket Spending Per Capita: $707
Income of Age 65+ Households: $27,998
Annual healthcare costs in Rochester are nearly $1,000 lower than the national average of $5,141, making it one place where you can find relatively affordable healthcare costs. Except that the average retiree household is earning just under $28,000 a year, meaning the proportion of annual income going to healthcare costs — about 15 percent — is the highest in this study.
2. Washington, D.C.
Annual Healthcare Spending Per Capita: $4,663
Annual Out-of-Pocket Spending Per Capita: $662
Income of Age 65+ Households: $59,086
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Although the total healthcare spending isn’t especially low, the high income levels for the average 65-or-older household in our nation’s capital mean that this is the city where the smallest portion of income goes to healthcare costs — just 7.9 percent of that $59,086 a year.
1. Tucson, Ariz.
Annual Healthcare Spending Per Capita: $3,674
Annual Out-of-Pocket Spending Per Capita: $648
Income of Age 65+ Households: $39,448
Although incomes in Tucson are relatively modest for age-65-and-older households, the average annual spending on healthcare per capita is a bit more modest. At $3,674, this is the only city in this study with costs under $4,000 a year — a bar Tucson cleared by over $300 a year.
Click through to
More on Retirement
- How Long $1 Million in Retirement Lasts in Every State
- Retirees Can Easily Save $8,000 More a Year — Here’s How
- This Is What a Comfortable Retirement Will Cost You in Every State
- Watch: How One Couple Retired in Their 30s to Travel in an Airstream RV
Methodology: GOBankingRates determined the 15 best places to retire where healthcare costs less than $5,000 a year by observing 50 cities using a combination of three factors: 1) total spending on healthcare per capita, sourced from the Health Cost Institute; 2) out-of-pocket spending per capita, sourced from the Health Cost Institute; 3) median household income of age-65-and-older households, sourced from U.S. Census Bureau’s 2017 American Community Survey. To qualify among the top 15 cities, total spending on healthcare must be less than $5,000, based on the U.S. average of $5,141. After meeting this criteria, cities were scored based on senior household incomes, total spending and out-of-pocket spending, which were then combined into an overall score.
MADISON, W.Va. (AP) — If you want to understand why U.S. life expectancy is declining, West Virginia is a good place to start.
The state is a bellwether of bad health, portending major problems years before they became severe nationally.
“It seems that the worst outcomes happen here first,” said Dr. Michael Brumage, a West Virginia University public health expert who formerly ran the health department in Charleston. “We’re the canary in the coal mine.”
The drug overdose death rate for all Americans today is where West Virginia’s rate was 10 years ago. The nation’s suicide rate is where West Virginia’s was nearly 20 years ago.
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Obesity was common in West Virginia before it became widespread in the rest of the country. And life expectancy started tumbling in the Mountain State before it began falling across the U.S.
Maggie Hill has lived in the state for all of her 67 years. Sitting in her cabin in the town of Madison recently, she ticked off the many deaths that have befallen her family: An older brother drowned in a flood in 1977. A sister died in a house fire. Two siblings, both smokers, died of lung cancer. Two others were stillborn. Her first husband died of congestive heart failure.
Then there were the suicides. Two of her three sons shot themselves to death, one of them after losing his job. Her second husband died the same way, using a gun in their bedroom closet one Sunday morning while she was still in bed.
“I don’t think people have a lot to live for,” she said. “I really and truly don’t see things getting better.”
After decades of steady increases, U.S. life expectancy has been declining since 2014. A government report released last month said the trend continued last year, driven in part by suicides and drug overdoses — the so-called diseases of despair.
What else is driving the decline? Experts say America’s obesity problem has worsened the diabetes death rate and helped stall progress against the nation’s leading killer, heart disease.
West Virginia eclipses most other states in the percentage of people affected by diabetes, heart disease and obesity. It has had the nation’s highest rate of drug overdose deaths for years running. It also has the highest obesity rate and the highest rates of diabetes and high blood pressure. Adding to those woes is the highest suicide rate among states east of the Mississippi River.
Earlier this fall, U.S. health officials released for the first time life expectancy predictions at a neighborhood level. An Associated Press analysis of the data found wide disparities in cities and towns. Among states, the AP found, Hawaii had the highest life expectancy. West Virginia was the second lowest, behind Mississippi.
Mississippi, Oklahoma and a few other states suffer death and disease rates that are about as bad — or sometimes worse. But those places have unusually large populations of low-income black or Native American people, who suffer a disproportionate share of disability, disease and death.
West Virginia is 94 percent white. That makes it a telling indicator. Nearly 80 percent of the Americans who die each year are white people, and death rates rose in white men and women last year but were flat or falling in blacks and Hispanics.
So white deaths — particularly those of people who are not elderly — are mainly responsible for the nation’s declining life expectancy.
Ten years ago, The Associated Press described Huntington, West Virginia, and its environs as the unhealthiest place in America , based on health survey data from the Centers for Disease Control and Prevention that put it at the bottom of the charts in more than a half-dozen measures, including the highest proportions of people who were obese, had diabetes and had heart disease.
The AP report, and others like it, drew widespread attention that peaked in 2010, when celebrity chef Jamie Oliver staged a reality TV show in Huntington to teach people how to eat better.
The attention was not entirely welcomed. It felt like outsiders coming in to criticize and perpetuate “hillbilly” stereotypes, said Steve Williams, who was elected Huntington’s mayor in 2012.
But Williams said it also was motivating, prompting changes in school food and even improvements to parks and sidewalks.
“We get slammed all the time with obesity,” said Andy Fischer, a financial adviser who organized a 2,500-person community walking program. “We’ve got to get better.”
These days, the Huntington area looks somewhat better in government health surveys. For example, the region’s obesity rate is only a few percentage points above the national median — instead of 10 or 20 points.
That said, it’s clear the Huntington area still has some big problems. It ranks among the worst metro areas in measures like the percentage of adults who smoke, have high blood pressure and have had a stroke.
OPIOIDS AND OBESITY
About the time Huntington was trying to tackle its weight problem, it was rocked by a new crisis — opioid addiction.
West Virginia now has the distinction of having the nation’s highest drug overdose death rate. Last year, for the first time, the state’s body count surpassed 1,000. The epidemic also produced ripple effects such as a spike in the number of children taken into foster care because of dead or addicted parents.
In the last two years, no West Virginia county has seen more overdose deaths than Cabell County, which includes Huntington.
One of the grimmest spots has been Huntington’s West End — some locals call it “the Worst End.” The AP analysis of neighborhood-level death data found the area had a life expectancy at birth of only 62 years, 16 years shorter than national life expectancy.
Huntington’s reputation crystalized on a chaotic Monday in August 2016, when emergency responders saw 28 overdoses over six hours — including two deaths.
The city soon became known as America’s overdose capital. As documentary crews descended, Huntington tried to confront the problem. Among the efforts were quick-response teams charged with finding people days after they were treated for an overdose. The teams include a police officer, a clergy member, a paramedic and a treatment counselor who hand out overdose-reversing naloxone and provide information about treatment. They also direct people to a needle-exchange program run by the Cabell-Huntington Health Department.
One of the key figures in the program is Thommy Hill, a former drug dealer who has become its gatekeeper and central cog. He knows every drug user who visits and constantly tries to persuade them to try treatment — arranging immediate transportation and handing them a backpack full of clothes if they agree.
One morning in late October, bantering with a man who had come in for fresh needles, Hill lit up when the visitor mentioned a past vacation. Hill pitched him a one-week stay at a treatment hospital, joking that “people will wait on you hand and foot.”
A few minutes later, he explained: “It’s all about treating them like people. They don’t get a lot of that.”
Something seems to be working. Non-fatal overdoses in Huntington have fallen and are on track to be 40 percent lower than 2017, city officials said. They are optimistic deaths will be down this year, too.
“If we can turn around overdose numbers here, we can do it anywhere,” Surgeon General Dr. Jerome Adams said in May at a health summit in Huntington.
Politicians including President Donald Trump have decried the opioid epidemic, prioritizing it over other health crises. But obesity still presents a towering threat.
West Virginians exercise less than other Americans. They eat fruits and vegetables less often. Only Mississippi has a larger proportion of adults drinking soda and other sugar-sweetened beverages each day.
In some cases, state policies are not helping.
For example, bariatric surgery can help certain obese people for whom conventional diet and exercise programs have no lasting effect. But West Virginia’s Medicaid program has unusually harsh cost-control barriers that make it difficult for severely obese people to get approved for surgery, according to a recent analysis by George Washington University.
Then there’s the soda tax, which health advocates say can give consumers second thoughts about choosing those drinks. Last year, Gov. Jim Justice proposed raising it from 1 cent per 16.9-ounce bottle to a penny per ounce. It failed in the Republican-controlled Legislature.
SIGNS OF CHANGE
There are some signs of hope in West Virginia. In October, health advocates held a conference on obesity in the South in West Virginia’s capital city. It was a surprisingly upbeat meeting.
The South has long had the highest obesity rates in the country, and nowhere has adult obesity been more common than in West Virginia. But future-focused projects are popping up all over the state, aimed at getting kids to embrace exercise and healthy eating.
“We want to give people hope that we can be knocked off the unhealthiest list” of states, said Kayla Wright, director of an organization called Try This West Virginia that’s funding many of them.
One grant paid for high school students to build a 5K trail and explore creating a teen cross-country running group. Another grant went toward restoring a greenhouse and helping people learn to garden.
Many of the projects are baby steps, but conference participants cited a few places where progress seems broader. Huntington is one, they say.
Another is Mingo County, in the southwest corner of the state, deep in the heart of coal country. Life expectancy there has never been high. Jobs in the lumber and coal industries were notoriously dangerous. Doctors could be hard to find. And there was violence: The deadly Hatfield-McCoy feud played out in those hills, as did bloody labor battles between miners and coal companies.
The largest municipality in the county, Williamson, became known in the last decade as a center for the abuse of prescription opioid painkillers. (Some called the 3,000-person town “Pilliamson.”)
But while the drug crisis was playing out, some local leaders — led by a young doctor named C. Donovan “Dino” Beckett — built a series of programs aimed at creating a culture of health. It started seven years ago with the opening of a free clinic that later became the Williams Health and Wellness Center. That spawned a community garden and a vegetable delivery service, a running club and once-a-month 5K races that draw a few hundred runners. Also in the works, for next year, is a federally funded treatment program for people addicted to drugs.
So far, perhaps the most successful program is one that sends health workers to the homes of diabetics.
Jamie Muncy is one success story.
The 48-year-old lost his job three years ago when the mine he was working in shut down. Last fall, he had just pulled out of a long-term habit of pain pills and other drugs when he bizarrely tore a tendon in his foot while picking up a piece of paper at a post office.
It was so painful he rarely walked, but he continued to eat terribly. Out of a job and with his marriage in ruins, “I had no motivation” to be healthy, he said. “I didn’t care.”
By January, the 5-foot-3 former mine foreman ballooned from 165 pounds to 196. “I was round as I was tall,” he said.
A visit to the Williamson health center revealed he had alarming, diabetes-qualifying blood sugar levels. He’d had mini-strokes in the past, and his physician said a much bigger one was probably on its way if Muncy did not take drastic steps.
The doctor put him on a tight carb-cutting diet, connected him to physical therapy and put him in the home-visit diabetes program.
Now Muncy walks 5 miles a day and is a regular at the farmer’s market. His weight is down to about 145 pounds, he said in a recent interview. He still smokes, though.
AN UNCERTAIN FUTURE
University of Washington researchers recently calculated something called “healthy life expectancy” — the period someone born today could expect to live in relative health. West Virginia, at 62½ years, was the lowest among states.
Clearly, health problems abound.
Black lung disease rates and coal mine injury rates appear to be up.
West Virginia has been at the top of the charts in hepatitis B and C infection rates. Adding to that, the state saw an HIV outbreak last year, and it is still weathering a hepatitis A outbreak — both associated with injection drug users
Maggie Hill, the lifelong West Virginian, has little hope for the future. But she does have Charity.
Charity is a 10-year-old girl Hill adopted about five years ago. Hill’s son had been raising her but lost custody during his ongoing struggle with drug addiction, Hill said.
Hill and Charity live in a small wooded valley with a creek in it — a holler, as they say in West Virginia. Her house is a cabin that from the outside resembles a small, tidy barn. Charity has given her life a purpose, she said.
“I taught her how to survive when I’m gone,” she said. “I have to. She’s going to need to know how to cook. … She needs to know how to keep house. She needs to know how to mow grass, so if she ain’t got a man, she can keep the yard clean. I teach her every bit of this.”
Charity is a good student (“Four A’s and a B on her last report card,” Hill said). And there’s hope that she will do well enough to go to college. Hill is saving for it. “She wants to be a doctor,” Hill said.
If Charity does go to college, some place away from Boone County, Hill says she will move there with her. “If I’m alive,” she said.
AP data journalist Nicky Forster contributed from New York.
The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Source: Associated Press
There are tons of supplements out there, promising to do everything from helping power your rides to helping you drop some pounds. But if there’s one thing that’s been proven time and again, it’s that there is no magic pill for weight loss. And yet, “quick fixes” like detox teas keep popping up everywhere.
One we’ve seen recently? Garcinia cambogia extract-an ingredient most commonly found in weight-loss supplements. So what exactly is the deal with this extract? Will it actually work in conjunction with riding and cross training to help you shed a few pounds? Or is it simply another trend? Here’s everything you need to know.
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What exactly is garcinia cambogia?
Garcinia cambogia-a.k.a. Malabar tamarind-is a fruit commonly grown in India and Southeast Asia, according to the National Center for Complementary and Integrative Health (NCCIH). The rind of the fruit is often used to flavor curries and to preserve food.
That rind, however, also contains a chemical called hydroxycitric acid (HCA), which is where the plant’s weight-loss claims come into play-HCA has been studied for weight loss through appetite suppression, per the NCCIH (which is why supplements that contain garcinia cambogia extract are also thought to help you lose weight).
Can garcinia cambogia help you lose weight?
While, yes, there have been studies on garcinia cambogia and weight loss, they haven’t necessarily been reliable (nor are they recent, for that matter).
In a research review set to be published in 2019, researchers found that only five randomized, controlled studies of garcinia cambogia’s effect on weight loss have been done in the last 50 years, according to Scott Kahan, M.D., M.P.H., director of the National Center for Weight & Wellness, who carried out the study. (There have been more than 14,000 studies on unfounded therapies for weight loss in that time, he says.)
What’s more, in those five studies, participants saw very little weight loss. “The most positive study showed that several months of taking garcinia cambogia may lead to one pound of weight loss, at best,” says Kahan-placebo pills were usually more effective.
Is garcinia cambogia harmful?
According to Kahan’s research, there are very few severe side effects of garcina cambogia- he only found a few examples of diarrhea, brain fog and, in rare cases, liver damage. And according to the NCCIH, garcinia cambogia is pretty safe for short-term use (12 weeks or fewer).
But while garcinia cambogia itself may not be terrible, the ingredients it comes packaged with in some weight-loss supplements can be.
In 2017, for example, the Food and Drug Administration (FDA) issued a warning about the weight-loss supplement Fruta Planta Life, which is marketed as “Garcinia Cambogia Premium” and contains garcinia cambogia extract and sibutramine (Meridia), an appetite suppressant that was removed from the market in 2010 due to safety concerns. Sibutramine had been shown to increase the risk of heart attack and stroke, cause jaundice, and trigger seizures-pretty nasty stuff.
Another thing to note: since garcinia cambogia extract diet pills are supplements, not drugs, the FDA doesn’t regulate their use or review their effectiveness or safety unless their use becomes linked to multiple hospitalizations, says Sue Decotiis, M.D., a medical weight-loss expert. That means that it’s up to manufacturers to decide how much garcinia cambogia extract their pills pack, as well as what other health-impacting ingredients (like sibutramine) are added to the mix.
Here’s the bottom line.
It’s best to skip garcinia cambogia. Possible side effects aside, Kahan says any weight-loss supplement containing garcinia cambogia is a waste of money.
And honestly, that goes for weight-loss supplements in general. “Unlike medical therapies, supplements and various diets and practices are not bound by strict requirements for clinical evaluation and evidence,” says Kahan, adding that “it’s unlikely that all the advertised claims are true.”
Basically, diet supplements-including ones containing garcinia cambogia-aren’t worth the risk or money. If you want to lose weight, speak to your doctor first, and focus on combining a healthy, balanced diet with regular exercise, suggests Kahan.
Tara Sol managed to lose weight and change her life in less than a year, but achieving her healthy state was a surprise to Sol herself. “I’d only ever known being overweight,” Sol tells PEOPLE.
She was raised in a household where her diet was primarily convenience foods, like drive-through pickups or pre-packaged microwavable meals. In her family, their Friday tradition was to go to an all-you-can eat buffet, and food was often used as the way her family bonded.
“I saw food used as comfort within my own sister and parents. We’d just sit in front of the TV and I’d eat a half a bag of chips or a box of cookies, or popcorn,” Sol tells PEOPLE. “Also, it was for sure how my dad showed love or affection. It was getting us a candy barwhen we’d go through the cashier line—he would always do that sort of stuff for us. If I got a good report card, I got to choose my restaurant for dinner.”
Once she became an adult, the 36-year-old mother of six began sneaking food and eating it in secret before she would dine with the rest of her family.
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“I would grab a handful of cookies and eat them and then it would be time for us to have dessert and I would eat it,” Sol says. “Nobody knew I already had the four cookies.”
At her heaviest, Sol weighed 261 lbs. “Walking for five minutes was a challenge,” she says. “I couldn’t even bend over to tie my own shoe. That’s how overweight I was.”
Often, she was bullied for her weight, causing her to be “a very introverted and hidden person.”
“I had this dream where I was just in a fat suit, and I could just unzip my suit and walk out and look at the person, and reveal myself to all of those people that would bully me and say mean things about me,” she says. “I’d say, ‘But look at who I really am.’”
Although she had avoided doctors for most of her life because she “didn’t like having to get put on a scale,” in 2014, as a social worker who was employed by a hospital, she had to visit the doctor for routine blood work and they discovered her blood sugar levels were off the charts. They diagnosed her with pre-diabetes before she had her full testing done that gave her a definitive Type 2 Diabetes diagnosis.
“I was in significant denial about my condition and though I took the medication, I did not change my diet or tell a single person about my diabetes diagnosis,” Sol says. “I even stopped going to my doctor. I was lucky that she happened to refill my prescription for a couple of years.”
Sol’s doctor wrote her a letter informing her that she would stop prescribing her oral medications if she didn’t come in for an office visit. “That finally was my rock bottom.”
So the next day, Sol signed up for Real Appeal, a digital weight loss program that provides you with a personal wellness coach, diet tracking, exercise programs, and online group sessions to help you meet your goals. She was initially drawn to this program because she didn’t have to go to weigh-ins in front of other people.
She visited her doctor and asked her for a three-month extension on her prescription refill, and told her about her new weight loss commitment.
Sol started with small, achievable goals, such as moving her body for 60 minutes each day and cardio workouts she could do in her own home. Within three months of starting the program, Sol’s labs were normal and she no longer had Type 2 Diabetes.
“My doctor actually called the lab to make sure it wasn’t an error,” Sol says. “My labs were just so different in just that three months.”
On the first day of her lifestyle change, Sol also set a goal to walk 1,000 miles in one year—a goal she achieved in just 140 days.
“I was getting little bits of hope,” Sol said. “I was getting these tangible, actual, true things that were validating what I was doing and it fueled my fire and I just also wanted to obviously keep going and getting better and better. I made this commitment to my doctor and I wanted to show her I was keeping my end of the deal.”
In just ten and a half months, Sol reached her goal weight, losing 114 lbs. Today, she’s maintaining a healthy weight of 144 lbs., but she says she’s not “hyper focused on a number on the scale.”
In early 2018, Sol had a skin removal surgery, and now, on top of walking, she enjoys mountain biking, hiking and interval training. She also tracks her calories in MyFitnessPal to maintain her healthy eating habits, and tries to slow down when she’s eating a plate of food.
“I can’t be mindless about what I put in my mouth,” she says, but admits that she still loves food and isn’t afraid to indulge every now and then.
She also says her husband and children have been supportive through the journey, and her healthy eating habits have influenced them.
“I want to be a role model,” she says. “They’ve gotten an understanding of what a healthy lifestyle is by being able to watch my transformation.”
She also adds that her weight loss has allowed her to be a more present mom. For Christmas, her family gives experiences instead of gifts, and she’s been able to participate in fun things like snowshoeing and laser tag, which she couldn’t do before.
“They don’t lose me to the bag of chips while I’m vegging out to the Real Housewives on TV,” Sol says. “They actually get a mom that wants to be more interactive with them. I have energy.”
Aside from her family, Sol says that since losing the weight, her life has changed “in any possible way it could change.”
“That whole concept of ‘if you can’t love yourself, no one else can love you’ is so true,” she says. “[I have] better self esteem, and feel that I am worthy of love and affection and people’s attention. Because I feel so much better about myself and I’ve gotten rid of so much of that hate and shame, it’s definitely just changed my world in that I allow people to be part of my life and my journey now where I never did before.”
Ordering through a food delivery service can be a hit-or-miss situation. It could take hours. The restaurant might get your order wrong. Perhaps the food is cold by the time it makes it to your door. I solemnly swear never to complain again about any of these harmless annoyances, though, because a man reportedly found DIRTY UNDERWEAR inside his Uber Eats bag.
According to WFLA, a man named Leo (who asked that his last name not be printed) recently ordered dinner from a Japanese restaurant nearby to his Florida hotel. When the order arrived, he reportedly met the Uber Eats driver outside of the hotel to pick up the food. Leo told the station: “I grabbed the food and right when I got the food she took off running and I was like, ‘that was kind of odd.'”
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Once back in his hotel room, Leo opened the plastic bag to find his food in a brown paper bag-allegedly sitting beside a pair of “thigh-length underwear, clearly stained with what looked like feces.” Initially, Leo thought it was a fancy napkin when he was pulling out the underwear, Newsweek reports. “Disgusting, unhealthful, it’s potentially deadly,” he said.
Per Newsweek, Leo threw the underwear back in the bag and contacted Uber, the restaurant he ordered from, and the police department. All those he spoke to reportedly expressed sympathy, but said there was little they could do about it.
Delish reached out to Uber for more information regarding the incident and we will update this post as we hear back. In a statement to Newsweek, Uber noted that Leo was given a full refund and “the suspect delivery driver had no prior complaints against her.” A spokesperson for Uber also said, “What’s been reported is very concerning. We are reviewing this order and reaching out to all parties involved to help understand what may have occurred. The courier has been removed from the app pending investigation.”
Leo also requested the Bal Harbor Police Department document the incident on a police report, though a BHPD rep told Newsweek, “No other police action is being taken at this time.”
Now that I’ve thoroughly disgusted you out of ordering delivery tonight, here are all kinds of delicious dinners you can make yourself.
Spot quiz: What is the only subject in school that engages a child’s mind, body, and spirit, promotes their physical and emotional health, helps them to learn better and cultivates the character they need to become productive adults? And what subject is consistently underfunded, understaffed and underscheduled?
If you answered physical education to both questions, you get an A grade.
At a time when American children are increasingly absorbed in their screens and one-third are overweight, the need for robust physical education is acute. Last month, the federal government updated its recommendations for physical activity for the first time in 10 years. The guidelines now include recommendations for children as young as age 3, and advise a minimum of 60 minutes per day of moderate to vigorous activity for ages 6-17. Alas, only one in five teenagers meets this standard.
Inactivity has been called “the new smoking,” and the prevalence of obesity and inactivity may well mean children today will lead shorter lifespans than their parents. Children desperately need to learn the importance of physical fitness, how to achieve it, and how to maintain it. Well-taught physical education keeps students moving and motivated, building their competence and confidence so that they can stay fit over a lifetime.
Funding for PE classes is shockingly low
Alas, just when children need it most, PE has slipped to the bottom of the curricular ladder in all too many school districts. It is profoundly shocking that the median PE budget for American schools is only $764 a year, according to the Society of Health and Physical Educators. In a school of 500 students, that means only $1.50 per child for PE, when total per pupil annual expenditures in our public schools often exceeds $12,000.
This is of special concern in the inner city, where families have few fitness resources outside of school. But it is troubling everywhere, as a perfect storm of circumstances has conspired to minimize activity in children’s lives, not only putting them at risk for life-threatening diseases later on, but depriving them of the mental and cognitive benefits we know exercise provides. Harvard neuropsychiatrist John Ratey has called exercise “Miracle-Gro for the brain,” and hundreds of studies show exercise enhances learning as well as emotional healthand social development.
We are also putting unfit children at financial risk as adults. Researchers at Johns Hopkins University have calculated that an overweight individual’s lifetime medical expenses related to his or her excess weight average $62,331, and lost wages around $93,100, roughly double the costs for a person of healthy weight — and enough money to put a child through college or make a down payment on a house.
Traditionally, schools have been instrumental in supporting children’s health, because they are uniquely positioned to reach the maximum number of children over a 12-year period. They help to ensure students are immunized, provide health screenings, and strive to serve nutritional meals. Physical education is every bit as important as the right shots and eating your vegetables, and yet not one state follows the Centers for Disease Control recommendations for time spent in PE at all grade levels. Some children with the means and desire to play sports get exercise that way, but the reality is that 70 percent of children drop out of organized sports by age 13.
Studies show kids in PE continue healthy habits
By contrast, regular PE class means all children can access the myriad benefits exercise provides until they reach adulthood – and beyond. According to the Physical Activity Council, children who have physical education in school are twice as likely to be active outside PE class and to remain active when they become adults. Correlation does not equate to cause, but it makes sense that children who learn good fitness habits in school will practice them out of school, and that a fit childhood sets a foundation for fitness as an adult.
While I appreciate the competing concerns schools must prioritize today, I believe it is time to make physical education a core subject on equal footing with academic classes. It is well established that children have a right to a quality education, and physical education is a fundamental aspect of that right, giving children the knowledge they need to stay healthy and equipping them for life’s challenges by teaching persistence, resilience, and positive thinking.
Our country boasts one of the highest standards of living in the world. Surely we can find a way to give our kids the gift of physical education and fitness. We did it in the past, when schools rallied behind JFK’s call for a fit nation as “a vital prerequisite to America’s realization of its full potential,” and we can do it again today. Indeed, some schools already have, and we can learn from them. All it takes is the will to make it happen, and Americans have always had plenty of that.
William E. Simon Jr., a former assistant U.S. attorney and the 2002 Republican nominee for governor of California, is co-founder of UCLA Health Sound Body Sound Mind and the author of “Break a Sweat, Change Your Life: The Urgent Need for Physical Education in Schools.”
You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @usatodayopinion and in our daily Opinion newsletter. To respond to a column, submit a comment to [email protected]
This article originally appeared on USA TODAY
If you’re one of the millions of people who vow to begin a new eating regime on January 1, the potential weight-loss plans are endless. And as you scroll through your Instagram feed, you’ll likely to see people touting the “amazing” diet that has shrunk their waistlines, boosted their stamina, and taken years off their appearance.
Two of the trendy diets over the last couple of years include keto and paleo. But before you select your 2019 menu, here’s what you need to know about these somewhat similar plans:
Keto Diet 101
Otherwise known as the diet Halle Berry, Vanessa Hudgens, Alicia Vikander, and even Tim Tebow swear by, the ketogenic diet is a low-carb, high-fat plan that forces the body into a state of ketosis, a metabolic process produced in the liver in which your body burns fat for energy instead of carbohydrates, says Katherine Brooking, MS, RD, co-founder of Appetite for Health. On a standard keto diet, calories should comprised of a minimum of 70% fat, 20% protein, and 10% carbohydrates.
Since the body’s preferred fuel source is sugar (glucose) that comes from carbs (i.e., grains, legumes, fruit), this diet presses the body to use glucose stored in our muscles as glycogen for fuel. “What else happens when we break down muscle glycogen? We lose water weight,” explains Good Housekeeping Institute’s Nutrition Director Jaclyn London, MS, RD, CDN. “Our muscles store about 3 grams of water for every gram of glycogen, meaning we can lose quite a bit of weight right away when we tap into glycogen stores for fuel. That’s why someone who loses weight in ‘just one week!’ from a low-carb plan is likely losing water weight, not necessarily real weight that stays off over time, but the immediacy can feel motivating at first.”
As for the menu, Brooking explains that the keto plan allows dieters to consume fish (salmon, oysters, scallops), meat and poultry (pork, lamb, steak, and yes, bacon!), eggs, nuts, non-starchy vegetables (spinach, broccoli, cauliflower, tomatoes), fats and oils (butter, mayo, avocado oil, ghee) and high-fat dairy (full-fat yogurt, heavy cream, cream cheese, hard and soft cheese). Berries and artificial sweeteners can be eaten sparingly.
“The foods to avoid on keto include most fruits (apples, bananas, peaches, oranges), grains (breads, pastas, cereals, and any foods made with wheat, rice, oats, or corn), legumes (all beans), and anything with added sugar (desserts, honey, cane sugar),” Brooking states. Root veggies (potatoes, carrots, turnips), alcohol, sweetened beverages (juice, soda), sweetened sauces and dips (ketchup, BBQ sauce, some salad dressings), and some oils (canola, soybean, peanut) are on the “no” list – along with any low-fat dairy products.
Paleo Diet 101
“The paleo diet is meant to resemble the supposed diet of our long-ago, hunter-gatherer ancestors,” explains Brooking. “The idea behind it is that our Western pattern of eating is contributing to the rise of chronic illness and obesity.”
Also referred to as the Paleolithic diet and caveman diet, this meal plan – which is reportedly a way of eating for Blake Lively and Jessica Biel – focuses on only the foods that were (allegedly) available way back when: poultry (grass-fed meat, fish, seafood), fresh fruits and veggies, eggs, nuts, seeds, and plant-based oils (such as olive, walnut, flaxseed, macadamia, avocado, coconut).
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The foods not allowed on this plan include legumes (peanuts, beans, lentils, tofu), grains, dairy, refined sugar, salt, artificial sweeteners, anything processed, and alcohol. And there’s no need to count calories or figure out proper percentages. (Do you think the cavewomen were keeping track of their caloric intake?) The diet promotes eating whole foods until you’re satisfied.
The Pros and Cons of Keto
The keto diet has a scientific background – but not for weight loss. “Some evidence has found that a keto diet can be effective for patients with epilepsy,” Brooking says. In fact, the Epilepsy Foundation promotes the ketogenic diet as a way to help control seizures – and it’s usually recommended for children who have failed to respond to prescription treatments.
London adds that she found it hard to believe the keto plan was trending as the latest weight-loss fad since it was prescribed to pediatric patients during the time she worked in a hospital. “It was used as an absolute last resort for families who felt otherwise hopeless in the face of a neurological disease, and under strict medical supervision,” she says.
Eating less carbs can be a good thing. People who follow the typical Western diet tend to consume more than the daily recommended amount of carbohydrates (about half of our calories per day, where at least half of these grains derive from whole grains, according to the 2015-2020 USDA Dietary Guidelines for Americans).
However, nearly erasing carbs from an eating plan may be too drastic. “This would be a hard adjustment for most Americans, making the standard keto plan difficult for many to stick with,” Brooking says.
Along with some unpleasant side effects (like constipation, crabbiness, lightheadedness, nausea, fatigue, and bad breath), Brooking also points to the fat content in this eating regime. “Keto does not emphasize healthy fats, and we know that foods high in saturated (such as butter, cheese, and red meat) can increase the risk of heart disease,” she says.
As for the weight loss, it tends to be short-lived. “The same reasons why we see immediate weight loss on carb-restricted diets is the same reason why we see immediate weight gain after adding a seemingly harmless sandwich back into the mix: The water weight comes back instantly with glycogen storage,” London says.
The Pros and Cons of Paleo
Unlike keto, Brooking gives a thumbs up to the back-to-basics approach in this plan. “The pros of paleo are that it focuses on increasing intake of whole foods, all fruits and vegetables, lean proteins, and healthy fats while decreasing consumption of processed foods, sugar, and salt,” she says.
Proponents of paleo claim that it can reduce inflammation, increase energy, help with weight loss, stabilize blood sugar, and even reduce the risk of chronic diseases, but the majority of science doesn’t agree with all of these assertions. The jury is still out on whether or not the paleo diet can have long-term benefits for people with type 2 diabetesand research published The American Journal of Clinical Nutrition states this dietary plan overall “still lacks evidence.”
“When it comes to scientific backing, there is virtually none to support the paleo diet,” London says. “The average lifespan of a hunter-gatherer was about 30 years (lovely, huh?).”
As with the keto plan, London and Brooking are not in favor of nixing grains, dairy, and legumes from the diet. “Despite what paleo advocates claim, these foods are healthful and are good sources of fiber, vitamins, and minerals,” Brooking says.
And London adds: “My biggest gripe with paleo is that it’s generally nutritious, but the model loses me in the elimination factor. Legumes are truly one of the most nutritious foods you can eat, so if you do want a structured plan, you’re better off with a modified approach to paleo that at minimum incorporates legumes for additional protein, calcium, and fiber. Even better: Mediterranean diets, which will give you back the 100% whole grains and low-fat dairy too.”
The Bottom Line
Both registered dieticians find downsides with the keto and paleo plans and feel that eliminating foods that contain essential nutrients – and, in the case of the keto diet, adding in foods that are high in saturated fat – all in the name of weight loss does not equate to a healthy diet.
“To make real, long-term changes, we can’t rely on restriction,” London says. “We have to approach health and weight loss with an understanding of our own lifestyle, and shift toward healthier eating habits through behavior changes that last a lifetime.”
Since eating preferences and dietary needs vary from person to person, it’s advised to check with your doctor before starting any new weight-loss program.
Article originally appeared on Good Housekeeping
Trying (and failing) to lose weight? Setting a specific goal can breathe life into your fitness regime. Personal Trainer Laura Williams has devised the following 7-day fitness plan, so stick with it and expect to see results in as little as a fortnight.
✔️ Regularity and consistency: These are your best friends when it comes to seeing results. The cumulative effect of exercise cannot be underestimated. Schedule exercise sessions in your diary and stick to them no matter what.
✔️ Keep an eye on your diet: If weight loss is your goal, try not to ‘eat your workout’. Never go hungry but avoid high-calorie food rewards (we’re talking post-workout pastries and muffins) and oversized meals. Good post-workout snacks include pitta and humus, a protein smoothie shake or yoghurt and fresh fruit.
✔️ Consistency is key: You can witch sessions around, but try and stick to following a higher intensity day with a lower intensity workout the next day.
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It’s Monday which means a full-on (but easy-to-follow) workout after the weekend. Start with a 4-minute warm up consisting of:
- Easy jogging-on-the-spot
- Shadow boxing
- Shuttle runs
Next, try the following with 30 second intervals for each move:
- Mountain climbers
- Jumping jacks
- 30 seconds rest
- High knee jogging-on-the-spot
- Squats-with-a-jump (at the top)
- 30 seconds rest
- Fast alternating lunges
- Lateral jumps
- 30 seconds rest
- Fast step-ups left leg
- Fast step-ups right leg
- 30 seconds rest
- Reverse lunge with knee drive left leg
- Reverse lunge with knee drive right leg
- Rest and…repeat!
➡️ Interval walking
This is your active recovery day – the perfect excuse to try this calorie busting walk:
🔹 Start by walking at a moderate pace for five minutes to warm up.
🔹 Then speed up so that you can still hold a conversation, but so that your heart rate is raised and you start to break a sweat.
🔹 Hold this pace for three minutes.
🔹 Slow down to a stroll for one minute and repeat.
🔹 Repeat this four minute cycle a total of five times.
Drinking coffee does not only make you feel good, but it provides a good sense of feeling and helps you navigate the day in a blistering fashion.
However, in case you are a habitual coffee drinker, then you might have realized that this particular love for drinking coffee, after a little few years can add up. The suggested hacks from experts summarized below is solely for the aim of saving you time and money in your drinking choices.
Spend money on certain gadgets.
An Important cost-saver is to learn how to create/make your personal drinks using the most affordable tools available in your home.
The wonders of a French Press is incomparable when brewing fast delicious coffee or few shots of espresso is the aim. All you need is a super fine grounds from quality beans and just fill the jar with enough water (hot) to brew .
If have a milk frothier, that is not very pricey, you can make some cappuccino or lathe from the convenience of your home, thus helping you save a whole lot of money, in accordance to Grind and brew coffee maker.
Sign up to some java Subscription box.
Based upon Your preferences, you will find lots of available coffee subscriptions to pick from . These enables one to order pre-made lathes, grounds or beans and they will be shipped right to your address.
Ordinarily boxes have been shipped from a monthly basis, however the frequency could be adjusted based upon what you require, says Snow Camp Theatre.
Make Bullet-proof Java in your home.
Bullet-proof coffee is made of a beverage composed of distinct oils and java , according to Brian Abernathy, creator and master roaster in Grumpy Goat. It’s now trending at the coffee world because of the assumed health and fitness benefits, therefore that you may likely find it at any restaurants in the area.
Insert salt to remove the bitterness.
Fantastic Information, you do not need to endure through a bad taste coffee if you have made a terrible brew. Rather than throwing it away, you could store it using a salt.
Consider adding a little pinch of sea or Kosher salt rather than sugar. It is going to help decrease the bitterness and draw the inherent candy notes which may be hiding.
Make a cold brew coffee with the following steps.
In case you do not have the patience or perfect gear or coffee maker to create a tasty cold brew coffee, so there are lots of hacks or techniques available at your disposal. 1 way when a grinder is not available, is to use a blender. This can serve as both the grinder and coffee maker container, and it makes a strong brew within 8 – 10 hrs.
Yet the second option is to utilize pods for cold-brewing, a brand-new innovation which allows you to very readily make cold-brew coffee. All you need would be to incorporate a pod, filter paper and a mason jar, and then refrigerate it before going to bed so that your cold brew coffee will be ready by morning.
Make ice cubes for coffee the best way.
Its plain awful to make ice cube for coffee by watering down. However, this innovation have prevented coffee to be discarded sooner than later. Therefore, the secret is to make the ice cubes the right way.
To do this, the coffee and the cubes are done employing the same methods as you drink it, before discharging them in the ice trays. In the event that you use sugar and cream add that prior to freezing. This procedure ensures that the strength and flavor is sustained.
Spices can be used.
Golden latte is a hot topic as of now, because it offers tremendous dietary and health benefits to the drinker. The ingredient “turmeric” is an antioxidant and that helps in reducing inflammation.
Rather than going into the restaurants in the area for an expensive cup of coffee, you’re able to create turmeric rich lathe at the comfort of your home. Only heat and combine two glasses of milk, 1/2 tsp of cinnamon, turmeric grinds, honey, and some pepper. Then enjoy.
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In a research study, those who consumed more organic fruit and vegetables, dairy, meat and other items had 25 percent less cancer detects over all, particularly lymphoma and breast cancer.
Individuals who buy natural food are normally encouraged that it’s better for their health, and they want to pay very much for it. Until recently, proof of the benefits of eating natural have not been properly documented.
A new French research on 70,000 adults for five years, with the majority females, has reported that the most frequent consumers of natural food had 25 percent fewer cancers over all, than those who never ate natural foods. Those who consumed the most natural fruits, veggies, dairy products, meat and other foods had a particularly high drop in the incidence of lymphomas, and a significant decrease in postmenopausal breast cancers.
The magnitude of defense surprised the research study authors. “We did expect to discover a reduction, but the extent of the reduction is rather essential,” said Julia Baudry, the research study’s lead author and a scientist with the Center of Research in Epidemiology and Data Sorbonne Paris Cité of the French National Institute of Health and Medical Research. She noted the study does not prove an organic diet plan causes a decrease in cancers, however highly suggests “that an organic-based diet might contribute to reducing the threat of cancer.”
Nutrition experts from Harvard University who expressed caution over the study, as they failed to check participant’s pesticide residue levels in order to validate direct exposure levels. They called for more long-term research studies to verify the outcomes.
“From a useful perspective, the outcomes are preliminary, and not sufficient to alter dietary recommendations about prevent various cancer,” said Dr. Frank B. Hu, one of the authors of the commentary and the chairman of the department of nutrition at Harvard’s T.H. Chan School of Public Health.
He suggested that it is important for Americans to consume more vegetables and fruits, whether the fruit and vegetables is organic or not, if they want to avoid cancer. The American Cancer Society advises consuming a healthy diet with great deals of fruits and vegetables, entire grains instead of refined grains and minimal amounts of red meat, processed meat and sugarcoated.
Dr. Hu called for federal government bodies like the NIH and the Agriculture Department to fund studies to examine the effects of organic diet, stating there is “strong enough clinical rationale, and a high requirement from the general public health viewpoint.”
The only other big study on organic food consumption and cancer was conducted by the British from 2014. The result found a substantially low risk non-Hodgkin’s lymphoma in ladies who typically or constantly consumed organic food. It likewise discovered a greater rate of breast cancers among organic consumers – and no total decrease in cancer danger.
The authors known as the Million Women study, stated at the time that wealthier, more informed females in the study, who were most likely to buy organic food, also had threat aspects that increase the likelihood of having breast cancer, such as having less kids and greater alcohol usage.
The natural food market has been growing in recent years, both in Europe and the United States. Sales of natural food increased to $45.2 billion last year in the United States, according to the Organic Trade Association’s 2018 survey.
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For food to be accredited organic by the Agriculture Department, produce should be grown without making use of most inorganic fertilizers and pesticides and may not be genetically customized. Meat must be produced from animals fed natural food without hormones or drugs. Such products now occupy just 5.5 percent of all food offered in retail outlets, according to the natural trade group.
An agent of the Alliance for Food and Farming, a group that seeks to ease public issues about pesticides, said customers need to not worry about cancer threats from consuming conventionally-grown vegetables and fruits. “Years of peer-reviewed nutritional studies mainly carried out utilizing traditionally grown fruit and vegetables have actually shown that consuming a diet rich in fruits and vegetables avoids illness, like cancer, and causes a longer life,” its executive director, Teresa Thorne, stated in an emailed statement.
For this research, scientists hired 68,946 volunteers, average age of 44, when the study started. The huge majority, 78 percent, were females.
Individuals provided comprehensive info about how often they took in 16 different types of organic foods. The scientists inquired about a wide variety of foods, including fruits, veggies, dairy and soy items, meat, fish and eggs, in addition to grains and beans, bread and cereals, flour, oils and dressings, white wine, coffee and teas, biscuits and chocolate and sugar, and even dietary supplements. Study volunteers offered three 24-hour records of their consumption, consisting of part sizes, over a two-week period.
The details was much more detailed than that provided by participants in the British Million Women research study, who responded to just a single question about how typically they consumed organic.
Individuals in the French study also supplied information about their basic health status, their occupation, education, income and other information, like whether they smoked. Since individuals who consume natural food tend to be health-conscious and may gain from other healthy habits, and likewise tend to have greater earnings and more years of education than those who don’t eat natural, the scientists made changes to account for differences in these characteristics, as well as such factors as exercise, smoking, use of alcohol, a family history of cancer and weight.
Even after these changes, the most frequent organic food eaters had 76 percent lower lymphomas, 86% less non-Hodgkin’s lymphomas, and a 34% breast cancer reduction that develop after menopause.
Epidemiological studies have actually consistently found a higher occurrence of some lymphomas among people like farmers and farm employees who are exposed to particular pesticides through their work.
One reason a natural diet plan might the risk of reduce breast cancer is that many pesticides disruptor the endocrine that imitate estrogen function, and in breast cancer hormones play a causal role.
Health Insurance 101: Guide to Picking a Health Insurance Plan
The health insurance industry has changed drastically over the past few years. More and more people have started to make use of healthcare policies, and laws that can uplift their well-being. However, the process of picking a health insurance policy, is easy said than done. This is because it is a tacky industry with many complexities and untold pitfalls.
Without the help of proper health insurance policies, you will be left scrambling when disaster hits your home! When it comes to choosing health insurance policy, you should have a clear mind. As potential investors, you must understand the policy fully. This will aid you in making a wise choice, during health insurance enrollment.
Key components of health insurance
First of all, you should know your policy on deductible. By definition, the deductible will state how much of the medical bill should be paid from your pocket, before the health insurance provider takes over. Generally, the deductible would be a very small portion of the entire bill.
Usually, high deductible health plans are cheap. This is because the patient may end up paying anywhere between 5,000 USD to 10,000 USD and most of the medical bill, before the providers lend a hand of help.
Co-pay is another important element of all health insurance schemes. This is a fixed amount of money you pay during the medical assistance. Small bills like the doctor’s fee are covered by the co-pay.
Co-Health insurance is a confused component in most health insurance schemes. It represents split payment. Co-health insurance becomes effective once the deductible is met. You can opt for a 90/10 co-health insurance split (90% represents the amount paid by the health insurance provider and 10% denotes the amount you pay). You can always fine-tune the split, to suit your personalized requirements. As the deductible increases, your monthly premium will decrease. Likewise, higher co-payments and co-health insurance splits will decrease your monthly premiums.
The maximum level represents the total (or maximum) amount paid by customers annually.
If you own a health insurance account, you can reduce the overall impact of the doctor’s bill. This becomes extremely useful when you have high deductible health plan. Meanwhile, verify if the funds roll over every year. When you invest a predestined amount of money in this account, it would be used on your healthcare bills, best espresso machine 2018.
Doran believes that health insurance policies can be fine-tuned to suit your needs. Some plans are much more expensive than the rest. For instance, you can go for plans with higher deductibles and higher premiums too! There are too many choices to pick from.
In Network or Out-of-Network
Health insurance companies establish strong bonds with health care providers. They offer special medical insurance plans at discounted rates. Such plans are also known as in-network policies. Generally, in-network plans are cheap and customized towards certain in-network providers.
Some service providers have set limits on how much is paid by the policy holders, in in-network and out-of-network services. This means you can end up paying 5000 USD for in-network care and 20,000 USD for out-of-network care every year. The cap differs from policy to policy and provider to provider.
When you opt for in-network health insurance plans, make sure it works for you. For instance, verify if your local doctor is a part of the network. Likewise, you can verify if the plan would be useful when you travel around the world. These verifications will help you make a wiser pick.
In some cases, the out-of-network health insurance services, may not have a maximum level cap on the costs. Here is a simple example to demonstrate in-network and out-of-network plans.
For instance, if Jane has a charge of 50,000 USD and BCBS has identified an in-network rate of 40,000 USD with the physician; Jane’s co-health insurance split, would be 80/20. Here, Jane will end up paying 20%. On the other hand, she would have a maximum cap of 5000 USD annually. When it comes to out-of-network health insurance policies, the physician will make Jane pay the 10000 USD difference. This is where the health insurance would prevail from paying a big percentage. Also, Jane wouldn’t have a maximum cap on the money she pays every year.
Finding in or out-of- network health insurance providers
The process of finding in-network and out-of-network health insurance service providers, is tougher than what you can imagine. Technically, the easiest way would be by asking your physician. They will tell you if they are in or out of network. Unfortunately, a lot of doctors are unclear about the network they deal with. And, you cannot rely on the plan document since it would change frequently.
Another easy way out, would be a single call to the health insurance service provider or browse through the healthcare insurance company’s webpage. Remember that, this analysis will help you save several thousand dollars. The only authentic and reliable piece of evidence would be your health insurance plan. After all, the idea of calling health insurance providers is not easy. And, online websites will only tell you who is in and out. Some third party agents like BlueCrossShield have special add-on features like “Provider Finder” to help you check if a doctor is in or out of network.
Heart Attack Situations
The only exception to in-network and out-of-network health insurance service policies is how emergencies are handled. If the health condition is not an emergency, you can always rely on the internet for additional information. You can schedule appointments using online portals. In case you don’t schedule an appointment, you may end up paying a hefty bill to an out-of-network provider. You must check ahead of time if anything is not identified as an emergency.
The need for air ambulances increases during tacky emergency situations. A major challenge faced by people in Montana would be the quest for in-network helicopter companies that don’t ask for a huge pay. And, a lot of health insurance companies in Montana end up paying the going rate but not the charges of air ambulances. The rest of the pay is meant to be borne by the patient.
What happens when a plan has no Benefis?
According to Goodnow, a difference of 10 USD is all that it takes for patients to change their doctor. If you are not prepared to change your doctor, you should pay the out-of-network price. This price can differ drastically. After all there is no such thing as a standard price amongst private hospitals or doctors. Also, Goodnow believes that most health insurance companies steer away from healthcare providers with higher costs. They prefer doctors, who are ready to take what the health insurance company quotes.
Meanwhile, you should remember that you would not quality for a health insurance exchange subsidy, when you reject a health insurance policy, offered by your employer and buy your own health insurance plan. However, you can always discuss with your employer if your healthcare provider can be included to the network.
A lot of people refrain from reading and understanding their health insurance policies, due to its complexity. To learn more about the policy, you should start from the glossary. Also, scan through the summary of benefis. In case your company offers healthcare policies, you should talk to your HR team before proceeding further. Always take as much time as required and understand your health insurance policy before going further.
You will be astounded to note that the contract between health insurance companies and service providers, is a lot more complicated. These contracts can span from 30 to 100 pages. Generally, the contract would state what, when, why and how the payments are made.
Luckily, reputed health insurance service providers offer tutorials about their coverage and special features. If you have a member ID or group number, you can use it to obtain more details. During these calls, you will have the wit to ask several questions. With many questions, you will have the competency to make better financial outcomes and wiser health choices.
Deductible and long term outcomes of Health Insurance Plans
Due to in-network pricing, you may end up spending a little bit of money during a doctor visits and treatments. This is an inevitable situation!
Charity sponsored healthcare
Most patients without health insurance policies, end up visiting non-profit hospitals and clinics. These hospitals will give you a hand of help, irrespective of your financial background.
And, when you rely on ER, the process of getting your way through healthcare will become tough.
When you move out of ER, you will not receive idealistic health insurance services without insurance. Additionally, the safety net offered by charity care will fade away in no time. This can be attributed to the need for health insurance service providers.
Health insurance serves as a cap on your responsibility. If you don’t have a healthcare insurance policy when on an emergency visit, you will end up spending more than the predestined deductible. Meanwhile, if you have Medicaid to help you out, you are certainly better off!
Negotiating your Health Insurance Plan
A lot of people ponder, if they should negotiate the price of their health insurance policy or not. Well, healthcare is not like buying clothes or vehicles. Instead, it is a sensitive business where health insurance companies negotiate with hospitals, doctors and healthcare providers. There is very little a patient can do. If you wish to save money, you must opt for in-network providers.
Luckily, if you feel like you are robbed, you can call over the billing office and verify your medical bills. As you go through every line of item, you will see interesting prices like 22 USD for aspirin, which barely costs a penny. As a patient or potential investor, there is very little you can do. Instead, the health insurance company will act like your immediate buffer. The healthcare providers will help you bag a decent deal! Bear in mind that you will receive the rate they negotiate on behalf of you.
In some situations, you can play around with the deductible. For example, if you need a knee replacement but the deductible is already met, you should either postpone the procedure or wait till the deductible cap resets.
Knowing more information about the health insurance policies
Do you buy milk without knowing its price? Do you buy eggs without knowing its cost-per-dozen? When we serve as consumers, the world treats us completely different. Unfortunately, the healthcare industry treats us as different species. Health insurance providers have converted the medical industry into a pricy shop.
In reality, if a person wished to have a heart transplant on one day and a knee replacement on another day, he/she should call different sites for a price quote. The final quote depends on how complicated the situation can get. A lot of healthcare service providers are striving hard to make it a simple price shop; unfortunately, this is how the healthcare industry serves in USA.
The final price of a healthcare routine depends on several variables. And, patients are free to ask for information at all times. Remember that it would be wise to know more about your deductibles and premiums for a safer investment (especially, if your healthcare provider is a part of out-of-network or the co-pay).
With all this being said, it is evident that you should do lots of homeowner about the health insurance company. You must gather as much information as possible to play safe. Recently, Benefis has come up with new schemes and initiatives that will help you make an upright investment at the right time! These initiatives will save you from unexpected surprises or challenges. According to experienced marketers and health insurance service providers, upright estimates will make sure you know what you ought to deal with. Meanwhile, some health insurance companies take pride in offering support with price comparisons.
BCBS has special mobile services to help you compare and contrast differences between the actual cost and expected benefis from in-network providers. Doran says that with the right kind of information, you can make informed decisions and analyze everything in-front of you. There can be plenty of discrepancy between locations; and it is up to the investor to make a final decision based on the coverage, cost and quality.
Past versus Future – the next big health insurance investment
Past histories don’t have a massive impact on future health insurance policies. A lot of people endure physical problems, without any expectations. No one clearly knows when and how they would fall ill! Health insurance offers peace of mind and extensive amounts of protection.
For instance, how much do you think a car accident would cost you? Or, perhaps you got hit by a bus and is hospitalized with severe injuries! What would you do now?
A lot of people don’t sense a wave of illness or discomfort till they meet up with the need to visit a physician or local hospital. In fact, some people spend several weeks in rehab centers with medical bills that cross several thousand dollars. Unlike conventional bills, medical bills can become expensive and really high in no-time!
Health insurance is a part of preventive care. It is much cheaper than handling medical expenses from your pocket. Benefis employees are asked to undergo a biometric test every year. This test revealed many shocking facts. Employees who believed that they were fine and healthy had chronic illnesses like hypertension and uncontrollable cholesterol levels. Benefis has seen many types of patients. For example, a person with a month-long infection that could have being treated by general physicians opted for an in-patient admission. This ended up costing several tens of thousands of dollars.
Handling the Health insurance Gap
Health insurance service providers are striving hard, to handle this gap as soon as possible. However, the rate at which the coverage is approved and signed depends on the Federal Government. In case authorities approve the Montana waiver quickly, the health insurance gap would be signed up at a faster rate. Very recently, a new kind of program was passed by the Montana Legislature. The scheme was meant for extending health insurance policies to people who exploit Medicare drastically. The most up-to-date request would be the Montana Waiver, which would be passed after the state’s comment period (end of September). People who qualify can opt for open enrollment from October 1.
Medicare health insurance holders, will not be affected by the expansion. And, people who are unable to face unexpected bills, should be prepared to exasperate. Plenty of effort is put to make sure the billing cycle is completed as quickly as possible. As the bill reaches a health insurance company, it may be rejected. Conversely, the appeal would go on for several months. People who make prompt payments will be delighted with sensational discounts.
If you are new to health insurance policies, approach your healthcare provider for more information. They will help you choose an ideal payment method and policy. Additionally, Benefis will aid you in handling bills based on your income. Patients can spread their payments across a predestined and achievable schedule. It will be typical to receive a bill after a year or two. However, at all times it would be wiser to talk with your health insurance provider and clear out doubts! Talk your way through for a safer and smarter deal.
Medical Insurance Quotes Online
When all seems fine goes well, we tend to live a quiet life, not thinking about the possible contingencies that may arise. Therefore, to live better and quieter, it is important to choose from top medical insurance quotes to cover our needs and of those we love.
Selecting best medical insurance quotes
Surely you’ve at least once checked medical insurance plans or hired a health insurance company. No matter your situation, the below 5 tips for selecting the best medical insurance quotes will interest you:
- Look for medical insurance quotes with clear and realistic plan. Find a company with good experience in health care, and able to offer a wide choice of professionals and own hospitals or concerted
- Double check the coverage offered and safe complementary features such as: accidents, compensation for hospitalization or illness, compensation for surgery, travel expenses and transfers, etc.
- Choose medical insurance quotes that have no penalty systems and allow you to go to several specialists in the same month and if necessary testing without extra cost.
- Medical insurance quotes with dentistry solutions. The best policies already offer free consultations, but others take over 50% of the costs for the most common treatments and exclude orthodontics, dentures, implants, etc.
- Search for insurance quotes which includes low grace periods, as some companies offer grace periods during which you do not have access to services such as surgery, childbirth or some expensive medical tests. This is done to avoid hidden fees when you purchase health insurance only to cover timely surgical intervention.
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Medical insurance quotes: Staff and Reimbursement
How do you select the best medical insurance quotes? To make things easier, we share additional recommendations. Yes, before sticking to a specific health insurance plan, take into account the following tips:
Decide on what type of insurance plan you want to hire. In the choice of best medical insurance there are different types of plan you should look out for:
- Medical Staff: The insured can choose which doctor or clinic before going into the agreements with the entity.
- Reimbursement of expenses: The insured may visit the doctor you want (in the country, or worldwide) and the Company reimburses a percentage of the bill that has been paid (between 80 and 100%).
- Mixed: The insured may visit the doctor you want and the insurance company reimburses a percentage of the bill. Additionally, you can choose doctors or clinics medical table without paying.
- Capitation: The insured can go to a single medical specialty.
Also note whether the insurance company specializes in healthcare, before selecting a medical insurance quote. Believe it or not, not all have the requisite knowledge about the sector. Thus, the following points can help you out:
- If they have extensive experience in the sector.
- If they have a wide range of doctors and clinics available to the insured.
- If they have global assistance in an emergency.
- If they have responsiveness to study cases provided for us.
- If they offer customized products, tailored to each person.
Apart from the above, check if the company offers additional services relating to health. As you can tell, selecting between medical insurance quotes is not easy, but you can make it happen.
With clarity and patience, you will be able to spot the ultimate medical insurance quotes. You may be able to save up to 50%: fast and simple.
Private Medical Insurance Plans
Choosing private medical insurance plans is easier said than done. It is a tacky process that requires lots of homework and research. As you browse through the internet you will come across user-friendly policy finders that will help you round-down to a plan that offers complete coverage at an affordable price. Before you handpick a policy, you should keep some basics in mind. And, this article will help you choose the right medical insurance plan and save tens of thousands of dollars.
Checklist #1 – Know your must-haves
First of all, you should identify a list of must haves. Some medical emergencies cannot be anticipated. However, if you ought to get married, it is obvious that you should have maternity coverage. Likewise, if your family have a history of cardiovascular problems, your private medical insurance plans should cover cardiac tests and drugs. According to the Affordable Care Act, the plan you pick must cover at least a dozen services. And more on original donut shop keurig single serve k-cups
Checklist #2 – Affordable
Don’t buy private medical insurance plans that are expensive and irrelevant. A lot of people end up buying insurance policies that are well beyond their abilities. Young policy owners must go for plans that have a high deductible. This way you can save money and pay a lessor premium in the long run.
Checklist #3 – Network
Thirdly, you should investigate more about the network covered by the private medical insurance plans. In case you have specialists and primary healthcare physicians in your mind, check if they are covered by the medical insurance plans. Most policies don’t cover out-of-network healthcare needs.
Checklist #4 – Coverage
When you sign for private medical insurance plans, keep track of the cost you must cover. This is not a complicated treasure hunt or crystal ball gazing. All plans will clearly state how much you should pay from your pocket. There are fee split ups called co-payment and co-insurance to talk about the amount you must pay. Seamlessly, the co-payments may add up during small bills and leave you obligated with expensive ones (several thousands)! When you buy private medical insurance plans, check if essential drugs are covered. Make certain the plan contains a list of medications covered (especially if the drugs are costly).
Checklist #5 – Limits
Watch out on the services and annual limits of the policy. Most private medical insurance plans don’t offer a limit less than 1 USD million. However, the Affordable Care Act states that limits are not required on services; if required you can go for a waiver on the annual margin.
Checklist #6 – Dependents
This plans have special terms and conditions for dependents. In case you have kids (who are below 26 years of age), without any health insurance coverage, the law lets them come within your policy. There are no pre-conditions to exclude kids who are below 19 years from private medical insurance plans.
Checklist #7 – Plenty of Research
Finally, walk through as many plans as possible before finalizing on your private medical insurance plans. Thorough research will help you bag the right plan at the right time!
Family Medical Insurance Plans: How good is yours?
It takes lots of effort and time, even months, for a service provider to convince potential customers to buy some family medical insurance plans. Unfortunately, the process of choosing a medical insurance policy is easy said than done. This is because there are many policies out there with different types of features and options.
Family medical insurance plans: For small families
If your family is very small (less than four members), family medical insurance with floater interests will be ideal. These policies are structured to cover the entire family. The floater plan comprises of a higher premium, when compared against conventional policies. By opting for family medical insurance plans with floater interests, you will inquire a calculated risk in the initial days. These plans have a waiting period of two to four years.
Family medical insurance plans: Insured versus uninsured
A lot of people don’t buy family medical insurance plans if they are covered by the company or employer. Unfortunately, this is a very expensive mistake. An additional health coverage policy is important and useful. Always remember that you will be uninsured when you leave a company or switch jobs. And, buying a fresh policy will not cover your health needs immediately. This is why you should have a stand-alone health insurance policy in your kitty at all times; best coffee and tea products
If you don’t have a conventional job, family medical insurance plans will be of utmost importance to you. For such people, a simple policy that takes cares of hospitalization will not be sufficient. Self-employed individuals must be insured to tackle funds that are lost as a result of hospitalization.
Family medical insurance plans: Policies for elders
If you are living with elders, family medical insurance plans with floater interests will not be a wise pick. Since, the oldest family member determines the premium charge. The more old family members are included, the more the charge increases. So, think twice before you choose a plan for your family.
Family medical insurance plans: Smaller details
A lot of people tend to handpick family medical insurance plans based on the premium charged. However, the plan’s features are also important. You can learn more about a policy by reading through its documents. Take a good look at the plan’s terms & conditions. Make sure the plan guarantees a sum with sub-limits. Plans without any sub-limits will have a bigger premium but they are much safer and better. Meanwhile, take a good look at the co-payment split up. Co-payment is the amount an insurance policy holder promises to repay while settling the bill. Moving on, you must be aware of the plan’s exclusions. Different types of health plans have customized rules regarding exclusions. For example, knee replacement may not be handled in the first two years.
Family medical insurance plans: A huge network
Finally, you should verify if a huge network of hospitals is covered by the family medical insurance plans you buy. Some policies cover more than 3000 hospitals; whereas, certain insurance plans are restricted to few tens of hospitals.Regardless of the count, make sure the family medical insurance plans cover hospitals that are close to your house.
A lot of individuals believe that every individual medical insurance plans, would take care of every other hospitalization expenses. Unfortunately, reality is completely different to this usual belief. Most healthcare insurance schemes, are fine tuned to serve a specific purpose. These policies may not take care of your medical requirements at all times. This is why you should handpick the right kind of policy at the right time! There are many under-publicized healthcare policies in the market. These policies remain unused most of the time. Conversely, you should choose medical insurance plans, that best suit your needs and wants
Here are seven known facts about individual insurance plans for commoners.
Individual Medical Insurance Plans: Fact #1 – Add on expenses
Most medical insurance schemes, are framed to handle the direct cost of hospitalization. Nevertheless, have you ever wondered what happens to the expenses that add on? Or, do you know how refreshments and food can be covered? This is why you should verify, if the policy offers daily hospital cash allowances. This is an integral scheme that would take care of every other medical bill too.
Individual Medical Insurance Plans: Fact #2 – Convalescence
22font-size: 12pt; font-family: ‘times new roman’, times, serif;”>The benefit of convalescence differentiates many individual medical insurance plans from the rest. It would take care of the insurance plan owner’s recovery expenses too. Technically, this feature is also known as recuperating benefit. It is an essential feature that delights the insurance owner with a lump sum. Nevertheless, the actual duration of the hospital stay should be between 5 to 12 days. In some individual medical insurance plans, post-hospitalization is a part of the recuperating period.
Individual Medical Insurance Plans: Fact #3 – Alternate Treatments
Some individual medical insurance plans, are framed to provide financial support for alternative treatments. According to standardInsurance Regulatory & Development Authorities, non-allopathic cures like homeopathy, ayurveda and unani are covered by the insurance schemes. These policies owe to reimburse at least 25% of the actual expense. – More on best fitness monitor
Individual Medical Insurance Plans: Fact #4 – Coverage
Generally, insurance owners believe that the policy is restricted to day-care routines or hospitalization. Nevertheless, standard insurance schemes tend to offer a wider coverage. It takes care of domiciliary treatments too. Before you sign-up for an insurance policy, make sure you read through its terms and conditions. All individual medical insurance plans are worded carefully. Thus, you will not have any issue knowing its coverage.
Individual Medical Insurance Plans: Fact #5 – Transplantation
Emotionally and financially, transplantations can have a massive impact on you! Apart from the recipient’s treatment charges, the donor’s expenses would be added to the hospital bill too. Nevertheless, there are insurance policies to take care of the donor’s expenses too!
Individual Medical Insurance Plans: Fact #6 – Childcare
Insurance plans do have fixed allowances for childcare. In case a child (below 12 years) is hospitalized, all expenses made will be included in the insurance plan. For instance, individual medical insurance plans from service providers like Oriental, are structured to payback sicknesses for a maximum of 10-long days.
Individual Medical Insurance Plans: Fact #7 – Lump Sum Returns
Finally, medical insurance plans tend to offer lump sum reimbursements. These are special policies that cover critical illnesses and medical routines like chemotherapy & dialysis. The high end individual medical insurance plans come with intuitive survival benefits too.
The high cost of Health Insurance in Ohio
An outline on health insurance policy in America, has shown that Ohio is among the states with highest health care expenses. According to report from Cleveland, Ohio is just behind Illinois and Texas in the enrollment for high deductible health plan. With all things being equal, Affordable Care Act has nothing to do with this, but its self is not been reasonable.
The health insurance deductible, has been considered the main offender. It pulls in more people while its health premiums offer minimal protection with respect to high charges. Affordable Care Act on the other hand, offer considerable advantage, with protection fundamentally secured with almost at no cost. While other specialized services test, crisis management, medications and claims have higher costs. Health insurance deductible as high as $10000 per year, is possible and mostly offered by employees.
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In the United States, families that stay away from consideration, fall between thirty percent or more, of those with $1,500 deductibles or more. High deductible health plan, as of late have exploded to several millions across the country. As a result, the insurance corporations have begun discovering novel ways for standard enrollment, while trying to get more cash from customers enrolling or from those not willing to pay for the high deductible health plan. In line with Center for Health Affairs, the community (2011 – 2013), witnessed a dramatic rise in awful coverage, covered by doctor’s facilities from $274m to $631m
Medicaid has been extended in Ohio, with respect to the Affordable care Act. Consequently the United States government insures all with no extra expenses for long term development (3 years), while you pay 10% after that. Other states, within the US have also extended their programs too. Medicaid is a federal government health insurance offered per US states to people below age 65, while Medicare goes to those older than 65. However, only a certain percentage of people qualify for both. Medicare was designed by President Johnson, in 1965 to take care of the elderly,
irrespective of their economic background. The Affordable Care Act, mandates every residents in the US to get insured or pay a fine. Thus many have struggled in between paying fines, prior tests, surgeries and treatments or paying for health insurance deductibles. Free healthcare no longer becomes free, due to additional expenses for your personal total satisfaction. The Affordable Care Act was designed to provide health security to people who want it and not to punish those who don’t. It also offers a medium to check unemployment by debilitating the monetary framework, but many feel otherwise;
Social security is offered to all at some level, though we all ought to have health insurance plans. The appeal of Obamacare might diminish to future leaders, so the reality that awaits it in future is yet to be ascertained. Many have criticized its policy, as been too expensive, while others commend it. For now, the reality for Ohioans is to seek more affordable health insurance plans, while they await to discover the future plan for the Affordable Care Act
Health Insurance Companies Set to Raise Obamacare Premiums
FOR PEOPLE LIKE ME WHO ARE IN THE MIDDLE, THERE IS VERY LIMITED CHOICE, AND NOW THAT LIMITED CHOICE IS GOING TO GET MORE EXPENSIVE
Renewal notices bearing the bad news will go out this fall, just as the presidential election is in the home stretch.
“I don’t know if I could swallow another 30 or 40 percent without severely cutting into other things I’m trying to do, like retirement savings or reducing debt,” said Bob Byrnes, of Blaine, Minnesota, a Twin Cities suburb. His monthly premium of $524 is already about 50 percent more than he was paying in 2015, and he has a higher deductible.
President Barack Obama’s health law provides income-based subsidies for consumers who buy individual policies on HealthCare.gov and state insurance markets. About 10 million people get assistance, helping reduce the uninsured rate to a historically low 9 percent.
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But there’s no subsidy for those making more than $47,520 for an individual and $97,200 for a family of four – cutoffs that represent four times the federal poverty level. Also, subsidies are not available for consumers at any income level who purchase outside of HealthCare.gov or a state marketplace. Those who remain uninsured risk fines.
Premiums are expected to climb next year in many areas because major insurers have taken significant financial losses under the health law. Enrollment has been lower than anticipated, new customers were sicker than expected and a government system to stabilize the markets had problems.
“People receiving subsidies can protect themselves from premium increases, but others who buy their own coverage don’t have that option,” said Larry Levitt, who tracks the health law for the nonpartisan Kaiser Family Foundation. He estimated 5 million to 7 million consumers nationally may be paying full freight.
Byrnes, a manager for a medical courier service, says he supports the law’s goal of expanded coverage, but he hasn’t found his policy particularly affordable.
In the small East Texas city of Lufkin, Kirk Smith buys his policy from the only insurer available, which also happens to be the state’s largest.
Blue Cross Blue Shield of Texas is seeking an average premium increase of nearly 60 percent for 2017, and Smith says his monthly bill of about $350 is already about as much as a car payment. Moreover, he’s had to drive to a neighboring county for medical care because he couldn’t get an appointment close to home.
“I’ve got a problem when you can’t see somebody in the county, and they want an increase?” said Smith, who works for a contractor installing telecommunications equipment. He said the government should subsidize everyone in rural communities with no insurer competition.
Michelle Scarola of Queens, a borough of New York City, said she has received notice that her 2017 premiums will be going up in a range of 8 percent to 25 percent. Scarola, who’s in the midst of a career transition from advertising to interior design, isn’t happy that her insurer dropped the hospital network she’s interested in.
“For people like me who are in the middle, there is very limited choice, and now that limited choice is going to get more expensive,” she said.
Insurance broker Liz Gallops in Raleigh, North Carolina, says she tries to let customers vent about large increases. Some see insurance bills that surpass their mortgage payments. The state’s biggest insurer is proposing average increases of nearly 19 percent.
“I’ve had people yell on the phone,” she said. “I’ve had people curse.”
Back in 2010, the Obama administration used public anger about premium increases as leverage to win passage of the health law. It now says worries about next year’s premiums are premature because final rates have not been approved. Officials say people who don’t receive subsidies still have options.
For example, some people buying directly from an insurer might find that they qualify for subsidies if they go through HealthCare.gov.
Those who make too much for a subsidy still can shop for lower premiums. Under the health law, insurers have to accept consumers with health problems. People are no longer locked into a plan indefinitely.
Another wrinkle is that people who pay their own premiums may be able to later deduct the cost on their income taxes. But the rules are complex, and it’s not the same as getting an upfront subsidy.
It may seem counter intuitive that premium increases for health law policies also hit people who get no financial assistance. It’s happening because the law created one big insurance pool in each state for consumers buying individual coverage, whether or not they go through markets such as HealthCare.gov.
Many people respond to premium hikes by switching to skimpier coverage, yet that leads to bigger medical bills if they need treatment. Some insurance brokers encourage customers to get plans linked to a health savings account. But rising premiums can cut into how much people stash away.
Access to health insurance in Mass. still complicated, inconsistent
The truth about the health insurance system is it’s just very complicated,” “there are people who are truly ineligible for subsidies, people who don’t know the subsidies are available, and people who, even with the subsidies, insurance is too expensive,” Boros said.
A recent survey about health insurance access and costs reveals that while Massachusetts still leads the nation in the percentage of insured residents, health-care costs continue to outpace inflation and income growth, leading roughly one in six respondents to forgo medical care because of potential costs.
In terms of long-term trends, Massachusetts has led in the percentage of those with insurance but has struggled with high cost of health care for many years and families have had to adapt to that for many years,” said Aron Boros, executive director of the Center for Health Information and Analysis, which undertakes the annual survey.
But Mr. Boros said he was surprised to see that the survey revealed that health insurance for many is inconsistent.
“One thing that surprises me is that even though we have an insurance coverage rate of 96 percent, there are still a large number of people (13.6 percent ) who are uninsured at some point in the year,” said Boros. – best coffee grinder
The Center for Health Information and Analysis undertakes an annual survey to gauge health insurance coverage, health care access and use, and health care affordability for state residents. The survey was administered between May and August and involved 5,002 individuals including children, adults between 19 and 64 and adults aged 65 or older.
The survey includes findings that:
– Massachusetts continues to lead the country in the percentage of residents with health insurance in 2015, with 96.4 percent of residents covered by health insurance versus 90.8 percent of residents nationwide.
– 87.3 percent of the uninsured in Massachusetts in 2015 are working age adults and were disproportionately likely to be male, single, Hispanic and with a family income of less than $46,800 a year. Many of these uninsured may be eligible for Medicare or subsidies for health care.
– One in six respondents reported an unmet need for health care because of cost, and one in five reported an unmet need for dental care due to cost. Moreover roughly one in six respondents reported difficulty paying family medical bills in the last year.
– More than half of those who are uninsured cited the cost of coverage as a key factor in their decision, the most cited response.
– 13.6 percent of respondents reported changing to their current form of coverage from being uninsured at some point in the past in 2015.
Mr. Boros said health care and the care system is so complex that it was difficult to give any one explanation to why people remained uninsured when subsidies are available.
The truth about the health insurance system is it’s just very complicated,” “there are people who are truly ineligible for subsidies, people who don’t know the subsidies are available, and people who, even with the subsidies, insurance is too expensive,” Boros said.
Looking closer at the issue in Worcester – where approximately 20 percent of the population is Latino and the median income is $45,994, according to the 2015 Greater Worcester Community Health Assessment – supports this statement.
Ivelisse Delgado, reception/benefits supervisor at the Edward M. Kennedy Community Health Center, said that most of the center’s uninsured patrons haven’t decided to reject health insurance – in fact, they often don’t realize they lack insurance.
Most of them are coming in with inactive insurance,” Ms. Delgado. “They have lost their coverage, and we see more of those people coming in than anything else.”
Ms. Delgado said that most of these patrons have been dropped from Medicaid/MassHealth for failing to renew their insurance, provide proof of income and residency, or other documents necessary to retain coverage. The health center does not keep statistics on the ethnicity of its uninsured patients without insurance. But the center services clients who speak nearly 100 different languages (Spanish is the second most common language after English) and many clients are new to the area and/or new to the country, Ms. Delgado said. Language barriers, a lack of cultural awareness or lack of access to information can also make the renewal of insurance difficult.
So Ms. Delgado oversees the effort to help patients and community members sign up for or re-enroll in health insurance.
Staff educate clients on the benefits of insurance in terms of receiving medical care and avoiding tax penalties. If the client desires, staff will help them evaluate insurance options, select a plan, and fill out the application for coverage.
Ninety-six percent of patients who participate in the process are approved for insurance, Ms. Delgado reported.
The health center also has a federal grant to offer insurance-counseling services throughout the community, giving presentations or offering walk-in services at various locations in the Greater Worcester area.
Through these services, the health center assists 11,000 people a year, and enrolls an average of 8,000 people a year in health insurance, according to Paula Green, vice president for advancement.
As for cost of health care, the health center offers a sliding fee for services dependent on income, so Ms. Delgado said that they are not having patients report that they are forgoing care because of ability to pay.
But other data presented puts the issue of affordability in sharper focus.
The Health Policy Commission’s 2015 cost trends preliminary report, presented last week, raises concerns about a 6.3 percent premium increase scheduled to take effect in January in the state’s merged insurance market. The preliminary report also notes a 5 to 6 percent increase in U.S. health care spending growth in 2015 – a larger growth than in recent years – and that increases in health insurance premiums have outpaced income gains, consuming more than 40 percent of family income growth since 2005.
The presentation was optimistic, however, about low rate of growth in physician and hospital services, a well-functioning Health Connector website “marketplace for insurance,” and stabilizing numbers of enrollees in Medicare.
But it echoed the CHIA report in reporting that 16.9 percent of residents reported an unmet need for health care due to costs. Furthermore, 19 percent of Massachusetts residents paid more than $3,000 out of pocket for health care, 17 percent of residents were paying off old medical bills and, of these, 9 percent owed more than $8,000.
Mr. Boros said that the CHIA survey is trying to better analyze such costs by including, for the first time this year, questions about medical debt and access to care non-physician healthcare providers who generally offer lower cost services.
One of the principals of health care reform is that you always want to have right care at the right time and in the right setting, and you always want to pay the smallest amount for the right care,” Mr. Boros explained.
But he said that a lack of a multi-year data set concerning access to non-physician service providers makes it difficult for CHIA to suggest policy changes and to see if this is a trend.
But David Auerbach, deputy director for research, at the Health Policy Commission, said that Massachusetts is one of the most restrictive states in the types of services a nurse practitioner can provide, primarily because Massachusetts does not allow nurse practitioners to prescribe drugs or work without an affiliated physician. Mr. Auerbach also referred to the commission’s prior work on this issue that concluded these restrictions may represent an unnecessary barrier to cost-effective care, and that nurse practitioners are, nationally, more likely to treat poor, minority or rural populations.
Dr. Dennis Dimitri, president of the Mass. Medical Society, said that pairing physicians with nurse practitioners, nurse assistants and other non-physician care providers enable a collaborative, team approach that can provide a wider range of expertise. Dr. Dimitri described this as part of an “integrated model of care” that aligns care providers to offer patients’ many levels and types of services. But this model also consolidates services among a few provider networks. So asked whether this model – which Dr. Dimitri said was increasing in medical systems – was cost effective, Dr. Dimitri gave a familiar response…
That’s tough to answer,” Dr. Dimitri said. “Economists always warn of reduced competition…but what I described to you can also lead to control of costs. If you have multiple points of care monitoring conditions you can avoid unnecessary emergency department visits, unnecessary re-admissions; it’s preventative, so heart disease or diabetes can be managed and isn’t out of control and then you encourage large efficiency.”
NCQA Releases Health Insurance Plan Ratings for 2015
National Committee for Quality Assurance (NCQA) has released new ratings, for measuring the performance of consumer health insurance plan in key areas.
The new methodology has been in development for over two years, and it provides a more accurate view on the state of various health insurance plan, by evaluating the quality of service rendered by over 1000 health insurance plans. NCQA’s Health Insurance Plan Ratings 2015–2016, covered about 138 million people. They analyzed 1.358 health insurance plans, and ranked 1,016; Medicaid – 149, private – 491 and Medicare – 376.
The new ranking for health insurance plan, gave priority to the satisfaction of the consumer and their health outcomes, and remains in harmony with the CMS Star Ratings of Medicare Advantage plans.
Key deductions from the 2015-2016 health insurance plan ratings:
- Great Lakes and New England health insurance plans, are the best in customer satisfaction and performance. Wisconsin, Vermont, Maine, New Hampshire, Massachusetts, Michigan, Pennsylvania and New York health plans, received the highest percentage of 4.5 to 5.0 out of 5. * Out of 1,016 health insurance plans, 11% got the best ratings – 4.5 to 5.0 out of 5, while 5% received 1.0 to 2.0. Under a graph, most of the plans fall in the middle, thus forming a bell curve.
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NCQA earlier health insurance plan ranking, is in conjunction with Consumer reports and US News. NCQA ratings comprises of:
- Consumer Satisfaction obtained from surveys
- Prevention – the role each health insurance plan play in preventing diseases through regular tests
- Treatment – how the health insurance plan, provide recommended scientific care, for most sickness like heart disease, depression & diabetes.
The outcome of a patient, brings an extra score during scoring for health insurance plan, in each category. In this case, is the disease brought under control or under specific recommended levels?
This emphasis on results means that, together with consumer satisfaction, outcomes are the main driver of ratings results – NCQA said.
The broad categories under which these health plans were grouped, provide consumers a simple guide to knowing their health insurance plan better. Drilling further, any consumer can learn how a particular health issue is being handled, under a health insurance plan.
For instance, the efficiency of postpartum and prenatal care, may be of interest to expectant couples, while some families may want to know more about the 10 procedures of pediatric preventive care and cure.
NCQA says it will maintain consumer Reports-NCQA relationship.
The National Committee for Quality Assurance, is a non-profit, private organization focused on improving the quality of medical care. They rate the health insurance plan, accredit health care organization, and recognizes key are of performance for clinicians.
The impact of Health Insurance on health
The presumption that people with health insurance plans, under the Affordable Care Act, will be healthier may be a farce. It often follows the idea that consumers with a particular illness will get the right drugs at their disposal, if they get health insurance plans.
A recent study by Health Affairs, has thrown more light on the salutary effect of health insurance plans on chronic diseases. The study shows that as more (about half) uninsured (non-elderly) get enrolled for health coverage, close to 1.5 million additional new cases of people with chronic disease, will be recorded while about 659, 000 will get their sickness under control. Referencing other studies, like in the aftermath of Massachusetts’s health care reform, mortality rate for ages 20 – 64 dropped (8 fewer deaths per 100, 000 adults) and many residents in another study for the same period, reported better health and preventive care under health insurance plans. These results have added unto the growing debate on the impact of health insurance plans on health, best fitness monitor
An Oregon research for people selected randomly by lottery, for health insurance plans or coverage, showed a major impact on financial health and mental health by Medic pressure and cholesterol level, experienced no significant change.
Another study shows less child and infant mortality, because of Medicaid expansion to pregnant women in the 80’s and 90’s.
We can infer that, health insurance play an important role in improving health, to a degree depending on how the research is conducted or questions asked.
I suppose one of the major motivations for us in doing this study is there’s been so much debate about the Affordable Care Act and relatively little discussion of health, whereas there’s been quite a bit of discussion about financial outcomes.
said Joshua Salomon – a global health professor, at the Harvard Chan School of Public Health.
They analyzed the health status of participants, by comparing the health of those with health insurance plans and those don’t have it. The participants were extracted from a National survey between 1999 and 2012. The result showed that the likelihood of being diagnosed and getting the chronic disease under control is higher within the insured (with health insurance plans).
The methods and data application involved in this study, is not very much different from what is already being used in other health research, except insurance, which is not a direct contributing factor to health.
Sharon Long, of the Urban Institute health policy center, said that the large survey numbers, can overestimate the importance of having a health insurance plans. In general, researchers do agree on the benefits of health insurance plans.
A health economics professor from Harvard Chan School of Public Health, Katherine Baicker feels that having health insurance plans are better than not been insured.
What seems much less clear to me is how that option compares to other options. None of these studies say which is better: expanding Medicaid, or vouchers for private insurance.
The ideal question now, should be how to restructure health insurance plans, in other to make people get the best from it, and not how big is the effect of health insurance plans on health. Also, there are growing interest involving health insurance coverage and the best way to improve health like poverty eradication. Poverty is mostly associated with poor health.
In response to this, Sharon Long asks whether if pollution (air and water) are addressed, what do we see? Rather than expanding health insurance plans, can there be new strategies?