The Affordable Care Act (official name of health reforms in United States) has some good and bad news, as with any other reform. It is important for every Americans to know important features of health reforms, which Obama administration has implemented, for proper planning of their health care needs.

Americans have to buy health insurance or pay penalty:

Currently approximately 60% Americans have health insurance. But from 2014 every American has to have health insurance or pay penalty, with exceptions of low income individuals who are eligible for “medicaids”, “medicare” and other public funded healthcare programs. Individuals may have to pay approximately $5,000 per year and families may have to pay $15,000 per year on health insurance premium.

Government will provide subsidized policies (to reduce premiums) to individuals with income range of $15,000 to $43,000 per year and families with income of up to $90,000, (e.g. for a family of four subsidized health insurance plans will cost between $1,300 per year up to $8,400 per year).

How much penalty an individual and family has to pay for not having health insurance?

The penalty for individuals not having health insurance is $95 dollars or 1% of income, whichever is greater. But from 2016 the penalty will be $695 dollars or 2.5 percent of income, whichever is greater. But as a family the penalty may be as high as $2,085 or 2.5 percent of family income by 2016.

What is the best part of the health reform?

The best part of health reforms (opinion of the writer) is that, insurers won’t be able to deny health insurance to applicants based on any ground, for example an earlier diagnosis of cancer (e.g. breast cancer), which insurers are doing frequently at the moment. Currently many insurers do not insure an individual if he/she is suffering from serious and chronic illness, which they will not be able to deny due to health reforms. At present insurers frequently rescrubbed policies (discontinue policy before it closes) due to diagnosis of serious disease such as cancer, which they will not be able to do so. Insurers will also not able to drop policy holders (health insurance), unless there is a clear case of fraud such as failure to disclose a preexisting cancer, or make false claims.

NB: The above information is for US citizens only,
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Tablets are easy to find at the local coffee shop but are still scarce at hospitals.

iStockphoto.com

Tablets are easy to find at the local coffee shop but are still scarce at hospitals.

Hospitals are often eager to embrace the latest medical technology, but the road to deploying tablet computers has been a little bumpy.

iPads have been available since April 2010, but less than 1 percent of hospitals have fully functional tablet systems, according to Jonathan Mack. He's director of clinical research and development at the West Wireless Health Institute, a San Diego-based nonprofit focused on lowering the cost of health care through new technology.

"We're really lagging behind in the U.S. in using electronic medical records on mobile devices like iPads," Mack says.

The federal government is giving hospitals financial incentives to implement electronic medical records, but the most popular systems don't yet make apps that allow doctors to use the records on a tablet the way they would on a desktop or laptop. To use a mobile device effectively requires a complete redesign of the way information is presented, Mack says.

 

And that would require hospitals to "cough up a lot more money," he says. "When you look at a health system that has bought into an EMR, they're not ready to turn the boat around and start over."

But some clinicians at UC San Diego Health System have been using the iPad since it first came out. Kate Franko, a physician assistant who is part of the hospital's transplant team, has been one of the pioneers.

On a brisk day in December, Franko stood by the bedside of patient Jose Reyna, a 24-year-old student who had received a new kidney just days earlier after three years of dialysis.

Franko scrolled through Reyna's medical records on her iPad 2, checking his vitals and medical notes. She also pulled up a graph of his blood test results over the past week to help him see how his new kidney was doing. A chest X-ray displayed on the iPad showed a build-up of fluid in his lungs. "You can see it's a little white in these corners. It's what we call patchy," she told him.

For Reyna, who is a tech guy with a smartphone sitting by his bedside, the in-hospital iPad was a very cool experience. He says the hospital in Desert Hot Springs, where he's from, still uses pen and paper.

The iPad "lets me know how I'm doing from the first time I got here," Reyna says.

But there are also several important downsides that so far have kept UC San Diego from deploying more of the devices. Right now, their electronic record system has a read-only app for the iPad, meaning it can't be used for entering all new information.

To get around the problem, clinicians log on through another program called Citrix. But because the product is built on a Windows platform and meant for a desktop, it can be clunky on an iPad and difficult to navigate. There are concerns about patient privacy, and spotty wireless coverage at the hospital also means doctors are logged off frequently as they move around.

In addition, the iPad doesn't fit in the pocket of a standard white lab coat. Franko bought a messenger bag that she uses to carry the device, but it's not all that convenient.

Franko also worries the extra technology causes clinicians to be distracted. "It's hard when you have an iPad in your hands, sometimes there are moments when you want to check your email and possibly update your Facebook, and it does take willpower to not be distracted," she explains.

It's still unclear whether tablets actually make medical care more efficient. In the meantime, even pioneers like Franko are hedging their bets. In addition to her iPad and two iPhones, she also carries a good old-fashioned pager, just in case.

Permanent cessation of menstrual bleeding in women is called menopause, which is due to loss of function of ovarian follicles. Consecutive 12 months amenorrhea (absence of menstruation is called amenorrhea) should be present to diagnose menopause. Normally menopause occurs in between 45 and 55 years of age. In the United States the average age of menopause is 51 years. Women who smoke, menopause can appear two years ahead of normal time.

Peri-menopause is the term used to refer the period preceding menopause. During peri-menopause the menstrual cycle becomes irregular along with waning of fertility. The period of peri-menopause lasts for two to eight years with an average of four years. During peri-menopause, menstruation should be absent for at least a year to call that menopause has begun. The period after menopause is called post menopause and during this period a woman may suffer typical health problems.

Diagnosis of menopause:

Women after 40 years of age with irregular menstrual bleeding can be diagnosed as peri menopause and during this period the irregularity of menstruation increases, e.g. amenorrhea may be become more frequent. Once peri-menopause sets in, continuous absence of menstrual bleeding for successive 12 months is called menopause. Essentially menopause is diagnosed clinically and no test is done or required for diagnosis of menopause.

Transition from peri-menopause to menopause:

The transition from peri-menopause to menopause may be a problem for women taking oral contraceptive hormone therapy to alleviate symptoms of peri-menopause. It may be difficult to determine whether to switch over to hormone replacement therapy (HRT) or not and if yes, when and how. Hence this should be individualized. The doses of estrogen and progestogen in HRT are lower than oral contraceptives and can not prevent pregnancy. Those willing to use barrier method of contraception should do so and advised to do so. During use of barrier method, if natural menstrual bleeding occurs oral contraceptives should be resumed. This should be repeated every year till permanent cessation of menstrual bleeding or menopause.

Image: Ambro / FreeDigitalPhotos.net

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A Transportation Security Administration volunteer demonstrates a full-body scanner at Chicago's O'Hare International Airport in March 2010.

Scott Olson/Getty Images

A Transportation Security Administration volunteer demonstrates a full-body scanner at Chicago's O'Hare International Airport in March 2010.

If you're heading for the airport humming I'll Be Home For Christmas, all of us at Shots hope your trip goes without a hitch.

With all the comings and goings of the holiday season on our minds, we recently asked Americans a few questions and air travel and health.

And the latest NPR-Thomson Reuters Health Poll finds that when it comes to flying, the vast majority of American don't have a care about health once they're in the air. Only 8 percent said they had any health worries about traveling by plane; 92 percent don't think twice.

 

What's the biggest personal risk from being airborne? Twenty-one percent cited the ultimate health risk: a crash. Sixteen percent said it was catching a cold or the flu. About 7 percent said it was anxiety.

Only 5 percent said developing a blood clot, which has been recognized as a problem for sedentary travelers on long-haul flights.

We wondered if anyone thought flying had ever led them to become ill, and 11 percent said they thought it had.

Now what about the security screening that goes on before the plane takes off? More than 1 in 5 respondents (23 percent) said they would refuse to be examined in one of the whole-body scanners now in many airports. A third of people under 35 said they would decline the scans.

About 23 percent of poll respondents said they were concerned about radiation exposure from the scans. Invasion of privacy bothered 17 percent, and 13 percent object to the scans because they consider them to be an unreasonable search.

The risk from radiation exposure from the security checks is scant, said Dr. Ray Fabius, chief medical officer for the health care unit of Thomson Reuters. "The much more serious health concerns associated with flying are exposure to communicable illnesses and blood clots during long air excursions," he said. "By avoiding traveling when sick and exercising in your seat, these risks can be minimized."

The telephone poll of more than 3,000 adults across the country was conducted during the first half of November. The margin for error is plus or minus 1.8 percentage points. Click here to read the questions and complete results. You can find the previous polls here, or by clicking on the NPR-Thomson Reuters Health Poll tag below.

Permanent cessation of menstrual bleeding in women is called menopause, which is due to loss of function of ovarian follicles. Consecutive 12 months amenorrhea (absence of menstruation is called amenorrhea) should be present to diagnose menopause. Normally menopause occurs in between 45 and 55 years of age. In the United States the average age of menopause is 51 years. Women who smoke, menopause can appear two years ahead of normal time.

Peri-menopause is the term used to refer the period preceding menopause. During peri-menopause the menstrual cycle becomes irregular along with waning of fertility. The period of peri-menopause lasts for two to eight years with an average of four years. During peri-menopause, menstruation should be absent for at least a year to call that menopause has begun. The period after menopause is called post menopause and during this period a woman may suffer typical health problems.

Diagnosis of menopause:

Women after 40 years of age with irregular menstrual bleeding can be diagnosed as peri menopause and during this period the irregularity of menstruation increases, e.g. amenorrhea may be become more frequent. Once peri-menopause sets in, continuous absence of menstrual bleeding for successive 12 months is called menopause. Essentially menopause is diagnosed clinically and no test is done or required for diagnosis of menopause.

Transition from peri-menopause to menopause:

The transition from peri-menopause to menopause may be a problem for women taking oral contraceptive hormone therapy to alleviate symptoms of peri-menopause. It may be difficult to determine whether to switch over to hormone replacement therapy (HRT) or not and if yes, when and how. Hence this should be individualized. The doses of estrogen and progestogen in HRT are lower than oral contraceptives and can not prevent pregnancy. Those willing to use barrier method of contraception should do so and advised to do so. During use of barrier method, if natural menstrual bleeding occurs oral contraceptives should be resumed. This should be repeated every year till permanent cessation of menstrual bleeding or menopause.

Image: Ambro / FreeDigitalPhotos.net

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Should You Use Centchroman as Contraceptive?

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It may or may not be a punt, but the Obama administration wants to let states play a bigger role in deciding what constitutes an "essential health benefits" package when it comes to health insurance.

The Department of Health and Human Services issued what it called a "bulletin" outlining a policy it hopes to impose. In other words, it's not even yet a formal regulation.

The idea is to give states "more flexibility and freedom" to implement the part of the health law that includes the essential health benefits requirement. Under the proposal, rather than having the federal government set a package of benefits for plans sold to individuals and small businesses, states could match the benefits of specified plans currently available to their residents.

States would choose a "benchmark" plan from one of these groups:

• The three largest small group plans in the state by enrollment.
• The three largest health plans available to state employees.
• The three largest health plans available to federal workers.
• The largest HMO offered in the state's commercial market.

 

"This is the latest step we're taking, in partnership with the states, to ensure that all Americans have access to quality, affordable coverage," HHS Secretary Kathleen Sebelius told reporters on a conference call.

The concern with the requirement for essential health benefits comes down to this: One goal of the federal Affordable Care Act is to ensure that insurance be comprehensive enough that people get care they need, but that coverage must remain affordable.

"And we've acknowledged many times, coverage that works in Florida may not work in Nebraska," Sebelius said.

But the proposal, which is open to public comment until the end of January, is already drawing criticism from those who think it goes too far and those who think it doesn't go far enough.

Debra Ness, President of the National Partnership for Women and Families, called the proposal "deeply disappointing" and said it "jeopardizes the promise of health reform for millions of women and families." The partnership is worried that by "failing to provide specific standards on what the maternity coverage required under the law must include, HHS allows plans to continue offering substandard coverage that fails to meet women's needs."

Meanwhile, Utah Sen. Orrin Hatch, the ranking Republican on the Senate Finance Committee and an opponent of the health law, said the proposal will cause premiums to rise.

"The framework proposed by the administration takes away the right of individuals to choose the health care plan that best fits their needs," Hatch said.

Once you decide to enter into sexual relationships, your whole life changes.  You open the door to a form of deep intimacy that gives you the opportunity to know another person on a different level than you’ve experienced before.  But such a relationship is equal parts risk and reward.  Although you can experience the true love that writers, artists, and musicians have spent centuries trying to adequately express, you will almost certainly have to deal with a loss of that love at some point, complete with a broken heart.  But aside from the emotional issues at play, there are also physical drawbacks to consider.

For one thing, you need to take precautions to stop unwanted pregnancy and/or the spread of sexually transmitted diseases like genital herpes, gonorrhea, syphilis, and HIV (just to name a few).  Some of them are merely annoying, but others can be life-threatening.  For example, nearly one in six adults has genital herpes (which never goes away) and they can pass along the disease even when they have no visible signs of an outbreak.  And although there are now many medical treatments available to manage HIV, it is still considered a deadly disease, especially once it develops into AIDS.  And these are just a few of the many STDs you could catch from having unprotected sex.

Of course, even with protection you might suffer mishaps.  There’s a reason why the effectiveness for most forms of birth control is listed at 99% instead of 100% (and that’s only when used according to directions).  For one thing, there is the small problem of human error.  Raise your hand if you didn’t know that antibiotics can mess with the effectiveness of oral contraceptives (the birth control pill).  It’s surprising how many women find this out the hard way simply because their doctors assume they already know and fail to mention it.  And then there are times when a woman misses a pill and poof!  Suddenly she’s pregnant.  Oops.  Abstinence is, in truth, the only form of birth control that is 100% guaranteed to work (apparently they decided not to factor in Immaculate Conception, although plenty of girls have tried that excuse).

Keep in mind though that most forms of birth control, while fairly effective at stopping pregnancy, are no deterrent to the spread of disease.  And unless you trust that your partners are 1) disease-free, and 2) not having sexual relations with others, you don’t really know what they might be passing along.  In fact, without testing, you don’t know what you might be passing on before symptoms show up.  And while you can certainly ask your partners to provide medical documentation before you get busy, you have no way of knowing if it is currently accurate.

So your best bet is to use condoms all the time, at least until you enter into a long-term, monogamous relationship.  And since even that may not be enough, start going in for annual exams with a gynecologist or urologist and getting regular STD tests (pap, Western Blot Reagents exams, and so on) to ensure that you are in optimal health, or begin treatment if you aren’t.

Carol Montrose is a contributing writer for Western Blot Reagents which offers STD and other related health testing.

Image: healingdream / FreeDigitalPhotos.net

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