georgeob1 wrote:-- excepting only that ours is voluntary.
It's not voluntary in the Commonwealth of Massachusetts.
Lucky tax payers in Massachusetts just received in the mail their 2007 Mass Resident Income Tax Form 1 which contains Schedule HC. The latter comes with 6 pages of instruction and the Form itself comes with 3 pages to be filled out.
In case, you haven't guessed HC stands for HEALTH CARE, and in case you don't know, in Massachusetts
it's the LAW that all residents must be covered by health insurance, effective 1-2008.
So, FORM HC is a check on whether Mass taxpayers
are obeying the law by having the required Health Insurance.
USAFHokie80 wrote:I've brought it up before, only to be dismissed out-of-hand for whatever reason, but I wanted to bring it up again...
Yes, on Tuesday, October 29, 2002, I suppose.
No-one said, as far as I remember, that the Canadian (or any other) health system is the best.
But at least all are secured.
NHS patients told to treat themselves
By James Kirkup, Political Correspondent
Telegraph.co.uk
Last Updated: 2:23am GMT 04/01/2008
Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a Government plan to save billions of pounds from the NHS budget.
Instead of going to hospital or consulting a doctor, patients will be encouraged to carry out "self care" as the Department of Health (DoH) tries to meet Treasury targets to curb spending.
The guidelines could mean people with chronic conditions:
Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home
Reporting medical information to doctors remotely by telephone or computer
Administering their own drugs and other treatment to "manage pain" and assessing the significance of changes in their condition
Using relaxation techniques to relieve stress and avoid "panic" visits to emergency wards.
Gordon Brown hinted at the new policy in a message to NHS staff yesterday, promising a service that "gives all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition".
The Prime Minister claimed the self-care agenda was about increasing patient choice and "personalised" services.
But an internal Government document seen by The Daily Telegraph makes clear that the policy is a money-saving measure, a key plank of DoH plans to cut costs.
Critics claimed the plan would provide doctors with an excuse for ignoring the elderly or those with debilitating, but not life-threatening long-term conditions, and would not work without significant investment in community health services.
The Arthritis Research Campaign said it risked providing health managers with "an excuse for neglecting elderly patients".
Jane Tadman, a spokesman for the charity, said: "Arthritis is already too low down the priority list and the fact that this is being mooted as a money-saving measure is very worrying.
"Some GPs don't take arthritis seriously enough, and the result of this could be to give them another excuse to tell arthritis patients just to go away and take their tablets."
The Patients' Association welcomed more moves to empower patients, but warned against using self-care systems to save money.
"We are all for better-informed patients," said Katherine Murphy, a spokesman. "But it is a concern that financial pressures will take precedence over clinical needs."
Peter Weissberg, the medical director of the British Heart Foundation, said: "People affected by heart disease need specialist care. Whilst we support changes that empower people to look after their own health, we would be very concerned if they led to any reduction in the availability or quality of expert care for those who need it."
After years of record spending, the health service is facing a sharp slow-down as Mr Brown tries to curb soaring government borrowing.
In the Comprehensive Spending Review last year, it was announced that the health budget will grow by four per cent a year over the next three years, down from the seven per cent annual growth rate between 2002 and 2007.
The Treasury also demanded that the DoH achieves three per cent "efficiency savings" over the next three years, equivalent to £8.2 billion.
The department's "Value for Money Delivery Agreement" - an internal document drawn up with the Treasury and circulated to NHS trusts over the Christmas holiday - sets out how the NHS will meet the savings target.
In a section on chronic conditions, it says the key to greater efficiency in the management of patients with long-term illnesses is a reduction in the need for "expensive" interventions by the NHS.
"Reductions in the use of NHS (GP consultations, outpatient appointments, inpatient admissions, length of stay, emergency care and prescribing) can be achieved through increased support for self care (for example through education and skills training, information prescriptions, or self care devices)," it says.
The DoH has told the Treasury that NHS officials are drawing up "good practice guidance on care planning including support for self care". The advice is expected to be published next month.
The emphasis on self care was inspired by the success of the Expert Patients Programme, an NHS pilot scheme that offers a six-week training course for people with chronic or long-term conditions.
About 30,000 people have completed the course and reduced their hospital attendances by up to 16 per cent, a result NHS managers hope to repeat across the service.
Health budgets face pressure from the cost of caring for people with chronic conditions, including 8.5 million with arthritis, 3.4 million with asthma, 1.5 million diabetics and 500,000 with heart failure.
Opposition politicians questioned whether the Government could save money without reducing services. But an Asthma UK spokesman said: "Our focus is on the clinical benefits of self-management.
"If the Government implements procedures to ensure more self management and save money, we would support that."
The above was an anti-government interpretation of the PM's new year message.
Commitment to change
Quote:The health secretary, Alan Johnson, tells John Carvel that, like his predecessor, he thinks competition is good for the NHS, and explains why he is contemplating a constitution for the health service
John Carvel The Guardian, Wednesday January 9 2008
[...]
Gordon Brown sparked controversy in a new year message to NHS staff that suggested patients would be given responsibilities as well as rights. This was interpreted in sections of the media as a warning that treatment might be denied to people who led unhealthy lifestyles, including smokers and obese people.No, says Johnson: "This will not be about denying healthcare to anybody." The government is giving increased priority to public health, he says. Plans to screen patients to detect and treat the onset of disease were set out by the prime minister in a keynote speech on Monday. Doctors might tell a patient to lose weight or stop smoking before an operation. But that was a clinical matter in which politicians should never interfere.
So what are the new responsibilities that may be imposed on patients? Johnson sees them as a qualification of people's rights. If patients are to be guaranteed an operation within 18 weeks of referral by a GP, they should show up for hospital appointments. If they do not, they could not expect the NHS to deliver the 18 weeks. If they become violent in the A&E department, they might forfeit a right to be treated within four hours.
Walter Hinteler wrote:USAFHokie80 wrote:I've brought it up before, only to be dismissed out-of-hand for whatever reason, but I wanted to bring it up again...
Yes, on Tuesday, October 29, 2002, I suppose.
No-one said, as far as I remember, that the Canadian (or any other) health system is the best.
But at least all are secured.
I'm not sure what your reference to that date is supposed to imply. The article was written then... ?
and no one said "this is the best" but everyone keeps up with the general tone of canada's system being far better than ours and that we should strive to be like it...
USAFHokie80 wrote:
I'm not sure what your reference to that date is supposed to imply. The article was written then... ?
and no one said "this is the best" but everyone keeps up with the general tone of canada's system being far better than ours and that we should strive to be like it...
According to your own quote the article is from that date.
Well, a system which insures everyone seems to be better than one which leaves 40 million unsecured, I think.
But certainly others may prefer such.
Dentists Flee U.K. Health System, Patients Pay More
Jan. 16 (Bloomberg) -- A rebellion by U.K. dentists against the latest government contract has led more than 7 million Britons to avoid state-subsidized dental care in the past two years.
A Citizens Advice Bureau survey released today reports that 4.7 million people were forced to use private care since April 2006 at twice the cost of a state-funded dentist because so many practitioners refused to see National Health Service patients.
Another 36 percent of people, or 2.7 million, who responded to the poll by London-based Citizens Advice have gone without any treatment for almost two years. Under the NHS, every resident is eligible for care by a local dental practice.
Since the government changed its contract with 21,000 NHS dentists in April 2006, one in 10 dentists stopped offering state-funded services, saying the contract required them to increase their workloads while limiting their earnings. The U.K.'s private dental market grew 63 percent to 3 billion pounds ($5.9 billion) from 2002 to 2006, overtaking the 2.4 billion pounds budgeted by the government.
``Dentists are exiting the NHS either completely or they're spending a much smaller proportion of their time doing NHS work,'' said Sharon Grant, chairman of the public advocacy Commission for Patient and Public Involvement in Healthcare. The Birmingham, England-based group published a survey in October with similar findings.
The shortage of dentists willing to take NHS payments has resulted in an increase in the use of private dental insurance. The number of subscribers to dental plans, which cost 15 to 20 pounds a month for basic care, rose 31 percent to 2.9 million in 2006, according to London-based market research firm Laing & Buisson.
Skipping Care
Two in three Britons see NHS dentists, 25 percent use private ones and the rest, about 10 percent, skip dental care, according to an October survey of more than 5,000 patients and 750 dentists published by the commission.
``Improving access to NHS dentistry is now a national priority for the health service,'' Health Minister Ann Keen said in an e-mailed statement.
The 2006 contract groups charges for 400 dental procedures into three bands and requires practitioners to meet quotas to maintain their earnings. Patients have paid for a portion of their dental care since 1951, three years after the NHS was founded.
Four years ago, NHS patients paid dentist Ian Gordon about 37 pounds per filling. Now, he's required to fill as many teeth as needed at one time for 44 pounds.
Hitting the Target
``In the past, you looked at patients, at what they needed,'' said Gordon, who just sold his NHS practices in and around Middlesbrough, England to a large chain and plans to open one that will only accept private patients. ``Now you have to look at hitting the target. Working to a target culture isn't the best thing for patient care.''
When Lorna O'Neill, 25, moved to Manchester from Liverpool to be closer to her job at a public relations firm last spring, she called three or four dentists near her new home. None was taking new NHS patients. She gave up and saw a private dentist, using a dental plan provided and paid for by her employer.
The country has about 42 dentists for every 100,000 residents, according to the Department of Health. Germany has 78 per 100,000, while the U.S. has 59, according to the World Health Organization.
Ballooning Budgets
The U.K. government, like counterparts in the U.S. and Europe, faces pressure to slow the growth of health-care spending as the cost of treatment rises and people live longer. While the NHS' total budget grew 41 percent to 78.4 billion pounds from 2002 to 2006 in England, government spending on dentistry increased 38 percent.
The squeeze prompted private-equity firms such as Duke Street Capital Ltd. and Hutton Collins & Co. and corporate dentistry chains to buy up practices and has fueled demand for dental plans and insurance.
``We have not seen the end of this boom yet,'' said Pam Whelan, corporate dental sales manager at 1.8 million-member Denplan, based in Winchester, England.
The 2006 NHS contract was aimed at encouraging preventive measures and reducing dentists' incentives for so-called drill and fill care in an assembly-line fashion to boost earnings. A parliamentary committee plans to probe the contract's impact in an inquiry next month.
About 58 percent of dentists who responded to the October survey said the quality of care has declined.
``If a patient comes in and needs a lot of work, there's no additional reward for that,'' Gordon said. ``You get no gain for prevention. Who in their right mind is going to treat six crowns for the price of one?''
Leaving the Country
Patients' frustration has reached the point where thousands seek dental care outside the U.K. Dublin-based Reva Health Network, a Web-based referral service, estimates 35,000 Britons a year travel to countries including Poland, Hungary, Thailand and Turkey for dental treatment that would cost more or require too long a wait at home.
Airline stewardess Noreen Fitzpatrick had dental work done during a stopover in South Africa after NHS dentists in Rickmansworth, a suburb north of London, told her they weren't accepting new patients.
``I called the dentists and they were full,'' Fitzpatrick, 44, said.
The government plans to increase the dentistry budget by 11 percent in the 12 months starting in April. Some practices stopped seeing NHS patients and sent their workers on forced vacations toward the end of the last fiscal year as government money ran low.
Last March, retirees Joan and Les Smith received a telephone call from their dentist in Rickmansworth.
``They phoned up and said they couldn't do us on the National Health because they'd run out of funds,'' Joan Smith, 73, said. ``We had to wait.''
And the USA a visit at the dentist's is free as well, you say?
Dentists in the US is not free. Even with dental insurance, they usually max out at $1,000 or $1,500/year. Those of us on Medicare can purchase dental insurance that costs about $10/month premium, but we lose our choice of dentists. My wife and I decided last year to remain self-insured for dental care, and ended up paying $30,000 plus in dental bills for my wife and I, and for our son who lives at home. We were able to write off our medical expenses on our 2007 income tax, and also was able to make early withdrawals of our IRA by paying one-third the capital gains tax.
Since most in the US have mortgage payments, they can itemize their deductions on the income tax, but we normally take the Standard Deduction on our tax returns because we have no mortgage. 2007 was a tough year for us on total expenditures.
Miller wrote:georgeob1 wrote:-- excepting only that ours is voluntary.
It's not voluntary in the Commonwealth of Massachusetts.
Lucky tax payers in Massachusetts just received in the mail their 2007 Mass Resident Income Tax Form 1 which contains Schedule HC. The latter comes with 6 pages of instruction and the Form itself comes with 3 pages to be filled out.
In case, you haven't guessed HC stands for HEALTH CARE, and in case you don't know, in Massachusetts
it's the LAW that all residents must be covered by health insurance, effective 1-2008.
So, FORM HC is a check on whether Mass taxpayers
are obeying the law by having the required Health Insurance.
Well, I never really thought of Massachusetts (at least the part from Fall River to Boston) as actually part of the country.
dental care in canada is NOT included in the universal health insurance plan .
many dentists , however , are suggesting that dental care for children - up to 18 years - should be included in a separate plan . they state that good early dental care would save the economy a great deal of money by getting the young people off on the right foot .
neglecting good dental care can cause many other medical problems later in life . so prevention - as usual - is the best way to handle dental care .
we have our own private dental-insurance plan split 50/50 with my former employer . we certainly do not regret paying for it over many years , even though in the earlier years the premiums were higher than what our own outlay would have been .
as we are getting older , our dental care requirements have increased and it's comforting to us that we get our teeth cleaned and checked every four months and that any major problems are taken care of early - BEFORE any teeth have to be pulled .
hbg
Thomas wrote:georgeob1 wrote:Frankly taking your descriptions at face value, the systems in Germany and the US are similar indeed-- excepting only that ours is voluntary.
That's true in part, but only in part. From the patients' perspective, the systems are indeed quite similar. From the providers" perspective, though, they are quite different: The American system is voluntary on the provider's side, wheras the German system is not.
This means German providers have to insure anyone who applies for a policy, and have to insure everyone for the same flat percentage of their gross income. (Insurers can set that percentage; it's one of the things they compete on.) These restrictions are enough to break the vicious cycle of adverse selection between patients and providers that prevents entirely free healthcare markets from performing efficiently.
All that said, I do think something like the German system would be a good compromise between "Medicare for all" and a purely free market. That's why I'm so pleased with the leading Democratic candidates, who seem to be shooting for just such a compromise.
What about unemployed people who may have no gross income? Who pays for their coverage, and is it the same as what is available to others? How is family coverage organized - particularly with respect to non-employed mothers (there actually still are some)? The system you described involves a significant transfer of wealth from those with high income to those with lower incomes - not necessarily a bad thing, but one with great potential for mischief. People with high gross incomes may have a high incentive to sign up for the cheapest (and least) coverage due to the high marginal cost and, in effect self-insure for other things. Is private medical care, paid directly by the consumer available?
The U.S. system provides a strong economic incentive for employers to provide medical coverage - the costs to the employer are a deductable business expense (escaping a 35% corporate tax) , and the benefit to the employee is itself untaxed. It works very well for those who are employed. (An interesting fact is that a very large fraction of the "uninsured" in this country are employed people in their 20's and 30's who voluntarily forego available medical benefits, merely to escape the 15% - 25% of the cost of coverage that employers deduct from their paychecks.)
georgeob1 wrote:What about unemployed people who may have no gross income? Who pays for their coverage, and is it the same as what is available to others?
They are insured like anyone else and get of course the same as others.
Either the 'job agency' or the 'family office' (that's the former 'wellfare ofice') pays the employer's part of the fee.
georgeob1 wrote:How is family coverage organized - particularly with respect to non-employed mothers (there actually still are some)?
The one (or two or all) in a family who earn money comntribute to the insurance company. Those (spose, children) who don't get a wage are free (children up to 27, when e.g.still at university).
georgeob1 wrote:The system you described involves a significant transfer of wealth from those with high income to those with lower incomes - not necessarily a bad thing, but one with great potential for mischief. People with high gross incomes may have a high incentive to sign up for the cheapest (and least) coverage due to the high marginal cost and, in effect self-insure for other things. Is private medical care, paid directly by the consumer available?
The lowest (for those with no income or e.g. only small rent etc) monthly fee is about 110 Euros, the highest possible about 650 Euros. [All above 5,300 Euros monthly income is "free".]
That may be (slightly) different from company to company, but those figures include the fee [between 0.85 % and 1.% of income] for the compulsory long term care insurance.
Walter Hinteler wrote:And the USA a visit at the dentist's is free as well, you say?
If you have dental insurance, you pay a percent of the bill. If you don't have dental insurance, you pay the whole thing. a dental implant right now is $4000+/tooth.
cicerone imposter wrote:Dentists in the US is not free. Even with dental insurance, they usually max out at $1,000 or $1,500/year. Those of us on Medicare can purchase dental insurance that costs about $10/month premium, but we lose our choice of dentists. My wife and I decided last year to remain self-insured for dental care, and ended up paying $30,000 plus in dental bills for my wife and I, and for our son who lives at home. We were able to write off our medical expenses on our 2007 income tax, and also was able to make early withdrawals of our IRA by paying one-third the capital gains tax.
Since most in the US have mortgage payments, they can itemize their deductions on the income tax, but we normally take the Standard Deduction on our tax returns because we have no mortgage. 2007 was a tough year for us on total expenditures.
$30,000 in one year is a big expense. Could you have spread the cost over several years? Like if you want 4 dental implants ( $24000) space the implants over 16 months for each one if you can.
georgeob1 wrote:Miller wrote:georgeob1 wrote:-- excepting only that ours is voluntary.
It's not voluntary in the Commonwealth of Massachusetts.
Lucky tax payers in Massachusetts just received in the mail their 2007 Mass Resident Income Tax Form 1 which contains Schedule HC. The latter comes with 6 pages of instruction and the Form itself comes with 3 pages to be filled out.
In case, you haven't guessed HC stands for HEALTH CARE, and in case you don't know, in Massachusetts
it's the LAW that all residents must be covered by health insurance, effective 1-2008.
So, FORM HC is a check on whether Mass taxpayers
are obeying the law by having the required Health Insurance.
Well, I never really thought of Massachusetts (at least the part from Fall River to Boston) as actually part of the country.
Oh you thought Massachusetts was part of Canada? :wink:
Miller wrote:Walter Hinteler wrote:And the USA a visit at the dentist's is free as well, you say?
If you have dental insurance, you pay a percent of the bill. If you don't have dental insurance, you pay the whole thing. a dental implant right now is $4000+/tooth.
Dental insurance is of course part of the health insurance here - though transplants are not covered (but you get additional private supplementary insurance to cover such).
from hokie's post :
Quote:The 'greedy doctors' myth
After spending a decade in university, going $100,000 in debt and taking on life-or-death responsibility, doctors are wondering why they make the same salary as auto plant workers. Dave Rogers reports.
Dave Rogers
The Ottawa Citizen
Tuesday, October 29, 2002 CREDIT: Tim Fraser, The Ottawa Citizen
dave rogers and tim fraser decided not to tell the full story of ontario's doctor shortage .
from 1995 to
2002 (note the year !) ontario had a conservative government under premier mike harris .
harris promised a COMMON SENSE REVOLUTION - lower taxes and a TAXPAYER DIVIDEND of $200 (WOW !) .
what he did NOT tell the citizens was that the government would SEVERELY restrict the access to medical schools - the government arbitrarily cut the number of places in the medical schools quite drastically . that was one way of cutting government expenditures !
now , six years later , ontario has the dilemma of not having graduated enough medical students from universities !
while the places in medical schools have been restored , it'll take some more years to get the new graduates to the frontline - as practicing physicians .
there is certainly NO shortage now of students applying to be admitted to medical school , but ontaio's citizens will have to suffer for a while longer from the harris COMMON SENSE REVOLUTION !
(of course , he has in the meantime found a number of seats on the boards of corporations - the common sense revolution seems to have stopped at his doorstep !).
hbg
Walter Hinteler wrote:And the USA a visit at the dentist's is free as well, you say?
Do you really think dental care in the UK is "free"?
