A National Health Insurance Proposal

Transitioning from HIE-to-HIE

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Staff Reporters

Did you know that according to the New York Times, on November 12, 2008, Senator Max Baucus (D- Montana) would eventually require everyone – not just children – to have health insurance coverage, with federal subsidies for those who could not otherwise afford it, and possible enforcement through the federal tax-system?

The Proposed Health Insurance Exchange

The proposal would create a nationwide “health insurance exchange” [HIE] where people could compare and buy insurance policies, with an option of private insurance and a new public plan similar to Medicare. Insurers could not deny coverage to people who had been sick, and would be limited in their ability to charge higher premiums because of a person’s age or prior illness.

Adults also Insured

Adults aged 55 to 64 would be able to buy Medicare coverage if they do not have access to a public insurance program or a group health plan; Medicaid would be available to everyone below the poverty level. The State Children’s Health Insurance Program [SCHIP] would also be expanded to cover all uninsured youngsters in families with incomes at or below 250 percent of the poverty level; and legal immigrants would no longer be barred from Medicaid and the children’s health program in their first five years in the United States.

Small Business Assistance

The plan would also offer tax credits to small businesses to help them defray the costs of providing health benefits to employees, and would offer tax credits to individuals and families with incomes at or below four times the poverty level who buy coverage on their own.

Assessment

According to the Dictionary of Health Information and Technology, a health information exchange [HIE] may be defined as:

the mobilization of healthcare information electronically across organizations within a region, community or national infrastructure; especially disparate systems with the aim to facilitate access to – and retrieval of – clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.

So, now it seems that we may be progressing from a health information exchange, to a health insurance exchange [www.HealthDictionarySeries.com]

Conclusion

What do you think? As always, your thoughts and comments on this Executive-Post are appreciated.

Speaker:If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Evidence-Based Medicine

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An Emerging Trend Vital to Physicians

[Staff Reporters]

According to Associate Professor Gregory O. Ginn, PhD; MBA, CPA, MEd., of the University of Las Vegas, an emerging trend for all medical providers is evidence-based medicine that offers the promise of improving the quality of clinical services. And, some argue that evidence-based medicine is a trend that will prevail for the foreseeable future.

Definition

According to the Dictionary of Health Insurance and Managed Care, EBM involves the judicious use of the best current evidence in making decisions about the care of the individual patient. Evidence-based medicine (EBM) is meant to integrate clinical expertise with the best available research evidence and patient values. EBM was initially proposed by Dr. David Sackett and colleagues at McMasters University in Ontario, Canada.

Expert Driven Standards of Care

In the past, standards of care were often set by panels of experts. Today, however, there is a greater demand for empirical evidence to establish the efficacy of clinical protocols. Evidence-based medicine can directly affect financial performance because it facilitates the elimination of therapies that cannot be demonstrated to be effective.

Example:

For example, evidence-based medicine can reduce a hospital’s prescription drug costs. Evidence-based medicine may also affect operations management if it shows that multiple approaches to treatment can be efficacious. Of course, in order to accommodate different modalities of treatment, hospitals will need more sophisticated information systems that allow for data integration.

Assessment

Evidence-based medicine may also be used to support another trend, the development of alternative and complementary medicine.

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Conclusion

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