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Index » Regional/Local » USA/Canada » Health Care Page: Previous  1, 2, 3 ... 262, 263, 264, 265  Next
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BlueHeronDruid

BlueHeronDruid Avatar

Location: planting flowers


Posted: Oct 30, 2008 - 10:24pm

 Alchemist wrote:
My wife is a physician, and I hear no end of the ever increasing paperwork and government mandates that interfere with her ability to help patients.  She says if she had known back in college how bad things would get she would have chosen a different field (and this is from a tireless patient advocate).  She read Hillary's entire health care reform screed and noted not a single clinician (a doctor who sees patients) contributed!  

The government has screwed up medicine, and it will only get worse if they seize more control.

 
This is why my physician (and friend) practices without a net. No insurance accepted. Meaning: she can spend time and attention with her patients (who can afford to pay up front) and have only an office assistant. Her practice is growing - but not among Medicare recipients, as you'd imagine. One schedules appts. with her by the quarter-hour or more. Our insurance pays a bit towards this. But her attention is priceless. 

OlderThanDirt

OlderThanDirt Avatar

Location: In Transit
Gender: Male


Posted: Oct 30, 2008 - 10:17pm

 Alchemist wrote:
My wife is a physician, and I hear no end of the ever increasing paperwork and government mandates that interfere with her ability to help patients.  She says if she had known back in college how bad things would get she would have chosen a different field (and this is from a tireless patient advocate).  She read Hillary's entire health care reform screed and noted not a single clinician (a doctor who sees patients) contributed!  

The government has screwed up medicine, and it will only get worse if they seize more control.

 

It kinda makes you long for the good old days, like 1941.  My mom told me my birth cost my parents $14.

(and that was one of the more expensive vets.
{#Lol}
Alchemist

Alchemist Avatar

Location: San Jose, CA
Gender: Male


Posted: Oct 30, 2008 - 10:06pm

My wife is a physician, and I hear no end of the ever increasing paperwork and government mandates that interfere with her ability to help patients.  She says if she had known back in college how bad things would get she would have chosen a different field (and this is from a tireless patient advocate).  She read Hillary's entire health care reform screed and noted not a single clinician (a doctor who sees patients) contributed!  

The government has screwed up medicine, and it will only get worse if they seize more control.
OlderThanDirt

OlderThanDirt Avatar

Location: In Transit
Gender: Male


Posted: Oct 30, 2008 - 10:00pm

 bokey wrote:

  My dad  pays a little under $300 a month for medicare and Aetna as a supplemental, but he was an uber geek for  defense contractors during the glory days of retirement funds and has some crazy benefits, the likes of which no American will ever see again.I don't know what the same coverage would cost some guy trying to scrape up the payments out of what is left of his IRA.
 
That's comparable (times 2) to what we pay, and for what it's worth to us, I guess it's warranted.  I think I said this before, so stop me if you've heard it - my last procedure at Stanford was an outpatient thing.  Into the OR at 8am, on my way home at 1pm.  I still don't know how they justified charging almost $47k for that, but it only cost me something like $213.  And because of it, I get to live for a few more years.  I guess I shouldn't complain.


bokey

bokey Avatar

Gender: Male


Posted: Oct 30, 2008 - 9:49pm

 OlderThanDirt wrote:

There are many doctors in our area who will not take new Medicare patients, even those with private, supplemental "Medigap" policies.   L's doctor left the group with which she had practiced for several years to start her own "boutique" practice.   L discovered that finding a new doctor that would take her was not easy, and practically impossible without the supplement.   Our cost for the supplement plus Medicare part B is about $650 per month.   Makes me wonder what all those MC deductions from our salaries are being used for.
 
  My dad  pays a little under $300 a month for medicare and Aetna as a supplemental, but he was an uber geek for  defense contractors during the glory days of retirement funds and has some crazy benefits, the likes of which no American will ever see again. I don't know what the same coverage would cost some guy trying to scrape up the payments out of what is left of his IRA.

OlderThanDirt

OlderThanDirt Avatar

Location: In Transit
Gender: Male


Posted: Oct 30, 2008 - 9:43pm

 ScottFromWyoming wrote:




Wouldn't surprise me.  {#Lol}
ScottFromWyoming

ScottFromWyoming Avatar

Location: Powell
Gender: Male


Posted: Oct 30, 2008 - 9:39pm

OlderThanDirt wrote:

There are many doctors in our area who will not take new Medicare patients, even those with private, supplemental "Medigap" policies. L's doctor left the group with which she had practiced for several years to start her own "boutique" practice. L discovered that finding a new doctor that would take her was not easy, and practically impossible without the supplement. Our cost for the supplement plus Medicare part B is about $650 per month. Makes me wonder what all those MC deductions from our salaries are being used for.




OlderThanDirt

OlderThanDirt Avatar

Location: In Transit
Gender: Male


Posted: Oct 30, 2008 - 9:18pm

 bokey wrote:

 It's abused by doctors and is difficult for the elderly to understand.

 It's far from perfect, but is a heck of a lot better then the VA ,IRS or SSA in my experience.
 
There are many doctors in our area who will not take new Medicare patients, even those with private, supplemental "Medigap" policies.  L's doctor left the group with which she had practiced for several years to start her own "boutique" practice.  L discovered that finding a new doctor that would take her was not easy, and practically impossible without the supplement.  Our cost for the supplement plus Medicare part B is about $650 per month.  Makes me wonder what all those MC deductions from our salaries are being used for.

bokey

bokey Avatar

Gender: Male


Posted: Oct 30, 2008 - 9:00pm

 rosedraws wrote:

This is so well said.

My questions:

- Isn't Medicare a totally successful program?

- Is it really not feasible to run a National Health Care that way?

- What are the current costs to the government, brought on by the uninsured?
 
 It's abused by doctors and is difficult for the elderly to understand.

 It's far from perfect, but is a heck of a lot better then the VA , IRS or SSA in my experience.

rosedraws

rosedraws Avatar

Location: close to the edge
Gender: Female


Posted: Oct 30, 2008 - 8:52pm

ScottN wrote:

United Health Care, located here in the Minneapolis/St.Paul metro. pays it CEO about $100 Million/year. Yes, I have my zeroes correctly counted. Start there. I am a capitalist; a small business owner. I believe in a free market, generally. I believe the source of the problem here lies in the inherent contradiction of having a vendor whose interest is in minimizing costs and maximizing income and profits be the source of care. No system works everywhere, and the free market has not worked here. We have public schools, libraries, roads, bridges, and on. Health care should be available to all. Gov't can legislate proscriptions and rules to avoid abuse. The idea that a free market, and competition that comes with it, will inevitably benefit the consumer has been completely co-opted in the case of health care....and we are all paying.

This is so well said.

My questions:

- Isn't Medicare a totally successful program?

- Is it really not feasible to run a National Health Care that way?

- What are the current costs to the government, brought on by the uninsured?

cc_rider

cc_rider Avatar

Location: Bastrop
Gender: Male


Posted: Aug 4, 2008 - 11:28am

sherbeari wrote:


There is very select list of generic prescription drugs that you may be able to fill at Walmart and Target for $4 each. If you have trouble paying, "needy meds" may be able to help. If you live in CA, you can also get a "California Rx card" .

Just thought I would throw that out there for you.

{#Hug}



Thanks. My pharmacy checks for generic substitutes already. Of course none of mine are generic yet. I'm not hurting THAT bad yet, it's just one more straw, y'know?

c.

sherbeari

sherbeari Avatar

Location: Oak Park, CA
Gender: Female


Posted: Aug 4, 2008 - 9:55am

 cc_rider wrote:
I am planning to leave my current employer in a few months, maybe less. It is very likely I will just go 'bare' for the foreseeable future. I will TRY to put money aside, maybe create another account for the purpose, but I will have $200-$300/month prescription expenses without insurance. Still, it'll be a fraction of what health insurance would cost. My employer pays all of it right now, which is a huge reason I have not had a raise as long as I can remember.

I have arrived at the conclusion health insurers are some of the worst bunch of crooks ever to come down the pike. Besides the brain trusts in Washington, of course.

c.


 

There is very select list of generic prescription drugs that you may be able to fill at Walmart and Target for $4 each. If you have trouble paying, "needy meds" may be able to help. If you live in CA, you can also get a "California Rx card" .

Just thought I would throw that out there for you.

{#Hug}
bokey

bokey Avatar

Gender: Male


Posted: Aug 4, 2008 - 9:51am

 cc_rider wrote:

I am planning to leave my current employer in a few months, maybe less. It is very likely I will just go 'bare' for the foreseeable future. I will TRY to put money aside, maybe create another account for the purpose, but I will have $200-$300/month prescription expenses without insurance. Still, it'll be a fraction of what health insurance would cost. My employer pays all of it right now, which is a huge reason I have not had a raise as long as I can remember.

I have arrived at the conclusion health insurers are some of the worst bunch of crooks ever to come down the pike. Besides the brain trusts in Washington, of course.

c.



 
 It's a great system they have.  " They" add the shit to our food that clogs our arteries and pollutes our bodies, then "they" charge us astronomical amounts to fix (or better yet, control) the damage  if we want to live .

cc_rider

cc_rider Avatar

Location: Bastrop
Gender: Male


Posted: Aug 4, 2008 - 9:47am

bokey wrote:
Health care just keeps getting more and more out of reach for average Americans{#Fire}.
.

Prescription Data Used To Assess Consumers
Records Aid Insurers but Prompt Privacy Concerns
By Ellen Nakashima
Washington Post Staff Writer
Monday, August 4, 2008


"When an insurer makes an online query about an applicant, Ingenix or Milliman's servers scour the data and within minutes or less return reports to a central server at the company. The server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor.

Then comes the analysis.

Ingenix's MedPoint tool provides insurers a "pharmacy risk score," or a number that represents an "expected risk" for a group of people, such as 30- to 35-year-old women who have taken prescription drugs, Stenson said. Higher scores imply higher medical costs."
(click here)


I am planning to leave my current employer in a few months, maybe less. It is very likely I will just go 'bare' for the foreseeable future. I will TRY to put money aside, maybe create another account for the purpose, but I will have $200-$300/month prescription expenses without insurance. Still, it'll be a fraction of what health insurance would cost. My employer pays all of it right now, which is a huge reason I have not had a raise as long as I can remember.

I have arrived at the conclusion health insurers are some of the worst bunch of crooks ever to come down the pike. Besides the brain trusts in Washington, of course.

c.


bokey

bokey Avatar

Gender: Male


Posted: Aug 4, 2008 - 9:13am

Health care just keeps getting more and more out of reach for average Americans{#Fire}.
.

Prescription Data Used To Assess Consumers
Records Aid Insurers but Prompt Privacy Concerns
By Ellen Nakashima
Washington Post Staff Writer
Monday, August 4, 2008


  "When an insurer makes an online query about an applicant, Ingenix or Milliman's servers scour the data and within minutes or less return reports to a central server at the company. The server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor.

Then comes the analysis.

Ingenix's MedPoint tool provides insurers a "pharmacy risk score, " or a number that represents an "expected risk" for a group of people, such as 30- to 35-year-old women who have taken prescription drugs, Stenson said. Higher scores imply higher medical costs. "
  (click here)


Zukiwi

Zukiwi Avatar

Location: Montreal's suburb
Gender: Female


Posted: Apr 7, 2008 - 5:20am


France best, US worst in preventable death ranking
By Will Dunham

WASHINGTON, Jan 8 (Reuters) - France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday.

If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.

Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine tracked deaths that they deemed could have been prevented by access to timely and effective health care, and ranked nations on how they did.

They called such deaths an important way to gauge the performance of a country's health care system.

Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study.

"I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview.

In establishing their rankings, the researchers considered deaths before age 75 from numerous causes, including heart disease, stroke, certain cancers, diabetes, certain bacterial infections and complications of common surgical procedures.

Such deaths accounted for 23 percent of overall deaths in men and 32 percent of deaths in women, the researchers said.

France did best -- with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people, in the study period of 2002 and 2003. Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people, the researchers said.

After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last.

PREVIOUS RANKINGS

The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. France and Japan also were first and second in those rankings, while the United States was 15th, meaning it fell four places in the latest rankings.

All the countries made progress in reducing preventable deaths from these earlier rankings, the researchers said. These types of deaths dropped by an average of 16 percent for the nations in the study, but the U.S. decline was only 4 percent.

The research was backed by the Commonwealth Fund, a private New York-based health policy foundation.

"It is startling to see the U.S. falling even farther behind on this crucial indicator of health system performance," Commonwealth Fund Senior Vice President Cathy Schoen said.

"The fact that other countries are reducing these preventable deaths more rapidly, yet spending far less, indicates that policy, goals and efforts to improve health systems make a difference," Schoen added in a statement.

laozilover

laozilover Avatar

Location: K Town (Kenosha, Wisconsin)
Gender: Male


Posted: Jun 9, 2007 - 10:49am


EXPERIENCING HEALTHCARE AS A HUMAN RIGHT IN VENEZUELA

May 27, 2007 | filed under bakers-blog | printer-friendly


Cuban Doctors and author In Front of Venezuelan Hospital

Reprinted from UPSIDE DOWN WORLD

Misión Barrio Adentro: Experiencing Health Care as a Human Right in Venezuela
Written by Rebecca Trotzky Sirr
Thursday, 24 May 2007

For once in my career as a medical student, I have absolute faith that my patients will be taken care of regardless of how much money they have in their pocket. Entering the Misión Barrio Adentro clinic in San Rafael de Tabay, a town in Merida, Venezuela amazes even the most jaded visitor. The local community hospital, Centro de Diagnostico Integral (CDI) brings alive Venezuela’s social revolution in health care.

The premise of Misión Barrio Adentro is simple: doctors live and work in communities providing health services free of charge to anyone.(1) In the span of four years, Barrio Adentro added 1612 modules (with 4618 under construction) to the 4,800 existing public ambulatory clinics.(2) The national goal is to have one primary care doctor for every 1250 to 2500 habitants. While Cuban doctors currently cover a large portion of this health need, new medical schools are training over 17,000 Venezuelan youth to become doctors. A corollary training program has around 3,000 Venezuelan doctors in a postgraduate residency community medicine. It’s one thing to look at the numbers, but does this massive expansion of primary health through Misión Barrio Adentro actually work? To gain perspective, I have been studying as a medical student under Venezuelan and Cuban physicians in both the traditional and revolutionary Barrio Adentro public health clinics. Beyond the reports and statistics, I carry back with me the experience of participating in egalitarian medicine, a goal I can keep in my mind's eye.

Many who view the new health care programs as a radical departure, may not know that even before the Chavez government, all people had a right to health care, education, social protection provided free from the state. However, access was limited. A report of the Panamerican Health Organization and World Health Organization, "Barrio Adentro: the right to health and social inclusion in Venezuela" documents the history of health care in Venezuela. Before Chavez, there was an underinvestment in social programs, increased orientation to the private sector. When Chavez was first elected president in 1998, over 35 percent of the poorest 20 percent of the population indicated that they didn’t go to see a medical for their health problem because they didn’t have the money to pay for a consult, medicine, or exam.(3)

Since the 1970s until Chavez’s Administration, investment in public health did not match the expanding population’s needs. During the 80s and 90s, only 50 new public clinics were built. Meanwhile, 400 new private clinics were constructed. From the 70s to Chavez’s election, there was only one public hospital built. A 1985 study revealed that Venezuelans had trouble getting care in Caracas, even in spite of the fact that the capital had disproportionately more physicians than the rest of the country. This is for many reasons. Clinics were too far away and badly organized for the communities needs. They also lacked appropriate referral systems, and were focused on curing instead of preventing disease. In poor and rural communities, care was provided by recently graduated inexperienced physicians.(4) These results match the stories I am told by my patients.

Misión Barrio Adentro was founded in 2003 as a part of 17 Misións, or comprehensive national social service programs, that together have similar explicit objectives to overturn decades of growing social inequalities. By recognizing the social rights of health, education, nutrition, housing, and employment, the Misións create sustainable new power relations based on democratic and participative ideals.

How does a country with a per-capita gross domestic product 1/6th that of the United States fund this massive expansion of primary clinics? In an example of South-South economic cooperation, bypassing neoliberal economic trade models, Venezuela sends up to 50 thousand barrels of oil per day in exchange for the services of Cuban health workers and related medical supplies. A ‘petrol for physicians’ trade agreement brings over 23,500 Cuban health professionals including nearly 15,500 doctors to serve the community. Importantly, new medical schools led by these doctors are training Venezuelan medical students, youth who would never otherwise have had access to advanced formal education.(5)

Like their counterparts in Cuba, doctors spend mornings attending to patients in neighborhood walk-in clinics. In the afternoon, doctors walk "terreno" where they make house calls and facilitate community classes. Doctors census person by person, family by family, recording the prevalence of disease and issues like lack of housing or clean water. Initially, the most frequent problems that doctors encountered were malnutrition and illiteracy.(6)

Entering the Community Hospital

The intelligent and friendly Cuban hospital director, Doctora Jaquiline greets me at the CDI’s door. She is interested in letting the world in to see the successes of her hospital. While she readily acknowledges that, like any hospital, there is room for improvement at the CDI, she says in general things are going well. I concur.

Doctora Jaquiline and her advisor, Julio Sanchez, introduced me to patients and the community. The atmosphere was honest and frank; I felt no guardedness on the part of families, staff or patients. Patients were told they were free to answer positively or negatively about any topic, to raise any of their concerns, and it would not change the level of services they are receiving. Additionally, we let patients know that they can share opinions away from hospital staff, allowing private discussion. All patients agreed to be interviewed.

Some articles about Misión Barrio Adentro, written by leaders of the Venezuelan Medical Federation (the AMA of Venezuela,) state that doctors "give health care to those with red shirts," imply that political allegiance to the Chavez administration is a requisite to access health care.(7) In my months as a participant observer of the Misión, I have never heard any worker ask any patient about partisan politics. Moreover, a Cuban medical journal publishes that the goal of Cuban doctors working abroad is to provide "attention to all of the population without distinction to race, creed, ideology without mixing in internal politics and respecting the law and customs of the countries where they work."(8)

A Venezuelan doctor working in the Misión, who did not identify as Chavista, explained to me, "I serve everyone regardless of their politics, if I agree with them, if I disagree, if I like them, if I don’t like them, I doctor everyone. Above everything, I am a doctor. We don’t wear political colors in my clinic." This was reflected in my conversations at the CDI. People shared negatives and positives of the programs openly, and discussions were more health care based than overtly political.

Patient Experiences

Gregorio Sulbaran, a much loved grandfather from the pueblo of Pedgregal high in the Andes Mountains, came to the hospital. He felt very weak, dizzy, and had trouble breathing: an exacerbation of his chronic heart failure made worse by pneumonia. Before Chavez administration, Mr Sulbaran "never" had received medical attention because it was "impossible" for him to pay for medical services. His first encounter with a thorough medical exam occurred during a Misión campaign in which patients from his community were brought to the CDI for EKGs, Chest X Rays, ultrasounds, dentist and eye exams, as well as a complete blood tests. These exams, as well as transportation, are provided for free to all. The goal of this health campaign is to create a health census, in which 100% of the community receives preventive health work up, diagnosis and referrals to services if needed.

Mr Sulbaran’s enlargement of his heart was first identified during this initial community health screening. Also this screen diagnosed his chronic obstructive lung disease and chronic heart failure. He says that in this hospital there has been "enormous attention" to his health. He says here, the doctors treat wealthy and poor patients equally. He has had continuous access to health services. The food is good, too. Everything-- from his initial health check up, to his now-three day hospitalization (including medications) to treat his acute bout of pneumonia, to the plate of spaghetti with meat sauce for lunch—is free of charge.

I see Mr Sulbaran’s family waiting in the hallway, and stop to talk. They explain there was nothing in the way of accessible health services before Misión Barrio Adentro. If the CDI were not present, they would have brought Mr Sulbaran to an academic hospital an hour and half away where the family believes that "the staff would send us away with an appointment for next week or next month." Jose Gorns, Gregorio’s son in-law, believes that "in the time and money spent coming and going to the academic hospital, my father in law would have died before receiving care."

"Some people are political," continues Jose, "but not here." The politicization of missions has been hotly debated. Some believe that the Chavez’s Misións were strategically located to "buy votes" from poor communities. Other people believe that the evaluation of the Misións impacts or outcomes have not been completely or transparently reported, due to of political reasons. Those claims look dubious here. "If things were going badly, I would say that. But things are good here," Jose concludes.

Participation of the Community in Health

Ender Quintero, a local community activist and member of "Comite de Salud," meets me in the hallway of the CDI. The "Comite de Salud" a participatory local health committee identifies and priorities community health needs. They also donate space for clinics and lunches for doctors and us medical students. (Thanks for the rice and chicken today!) Ender describes the origin and history of the CDI. "During the 90s, the population of this municipality grew greatly. We only had three public ambulatory clinics to serve the entire region. These saw about 15-20 patients a day. There weren’t enough resources, and I’m talking about both technology and doctors." He recounts that previously, for example, there was only one functioning X ray machine for the entire municipality, and no overnight hospitalization capabilities.

For these reasons, two years ago Ender Quintero began to meet with nearly two dozen other community members to help coordinate the planning of a local hospital. Today he is proud of the CDI, and knows its capacity off the top of his head. It has a "24 hour laboratory, 2 overnight doctors, 2 overnight nurses, an observation room and trauma room, rehabilitation center, EKG machine, and X ray machine" he recounts accurately. "Now, we serve around 250 patients a day." Not only does this improve trauma care, but it increases the preventive services available to the community. There are now 600 CDIs built across Venezuela. For every 10 to 15 neighborhood walk-in clinics, there is one local hospital CDI providing a more intense level of health care.

Before the Misión, there were preventive community health services but the schedule was arraigned by centralized health workers, resulting in top-down single issue projects like a vaccination campaign. Ender is excited that health information at the Misión is now better organized, so that the community can be sure that everyone is receiving appropriate care.

More Than A Treatment: Holistic Rehabilitation

After meeting with Ender, I pass the free dental clinic, speech therapists, and physical therapists to enter the rehabilitation room. Perhaps the most impressive and emotionally charged part of health care, rehabilitation services are often first service to be slashed in budget cuts. Rehabilitation is a key part of any recovery process, often ignored by physicians in the United States. Inside we find Idalba Castillo who is struggling to stand from a sitting position. At her side is her son, Richard Rangel Castillo, who brings her to rehabilitation 90 minutes every day Monday through Friday.

Richard is a bright industrial design student in his early twenties. His family’s life changed suddenly when his mother fell from a motorcycle the day following Chavez’s electoral victory. She suffered a blunt force injury to the right temporal lobe of her brain, and spent 10 days in a coma. Surgeons thought she would never regain the ability to communicate or walk. Richard says that his mother was the "heart of the family," and the whole family has suffered tremendously from her injury. However, he believes that she has much improved thanks to the CDI rehabilitation program.

At first the family attempted to bring Ms Castillo to the distant IVSS (social security) hospital for physical therapy, but they were sorely disappointed when therapists implemented a ‘one size fits all’ generic program for their mother. The hospital "couldn’t provide a therapy program in the way she needed it" reported her son. Additionally, the family preferred that she receive daily services instead of every-other-day therapy, and the hour and a half commute made it difficult to transport her to the clinic. The family decided to give the CDI a try. Now, after months of daily sessions, Idalba can raise herself from her wheelchair to a standing position, far surpassing her original surgical team’s assessment.

Impressions and a look to the future

As I said goodbye, I was impressed by the dedication of the staff to the program. From my perspective working within the program, I find an atmosphere that is open to continual growth. Mostly things are going well, but critiques aren’t ignored or brushed under the rug. For example at times we lack certain medications and ask our patients to buy them at local pharmacies or go to another clinic site. But, mechanisms are in place to figure out what medications we are running out of faster than initially planned.

On a broader level, both Cubans and Venezuelans alike are excited for the day when the Misión becomes operated and fully run by Venezuelans. Doctors are doctors regardless of nationality, but there is well deserved pride when a clinic staffed and run by doctors from the community they serve. Many Cuban doctors have been separated from their families for a few years while working in Venezuela. On the whole, Cuban and Venezuelan doctors work well together. But, both groups do things slightly differently, having subtle management and educational style variations. The heavy reliance on Cubans is seen as a short term solution.

Misión Barrio Adentro is currently run in parallel to the traditional ambulatory clinics, under both Cuban and Venezuelan administration. In the long run, there are plans to create a unified Venezuelan public health system bringing the management of older public clinics together with the new clinics. However each public health system (military hospitals, social security hospitals, older public health clinics from the 70s, Misión Barrio Adentro clinics) has its own style of management and independent administration. The logistics to unify will be challenging, even though well intentioned.

If the clinics appear to fail, it will be a blow against Chavez. Though the opposition bemoans quality of care in Barrio Adentro, going so far as to claim that the Cubans are not ‘real’ doctors, this is not my experience. I see the positive results of well qualified physicians working long hours on behalf of our patients. It is unfortunate that some want to discredit the clinics and doctors for political motivations.

I am heartened to see an ethic of continual improvement being built into this Misión Barrio Adentro’s infrastructure. Hot off the press monograph, "Consultorio por la salud del barrio: moviemento por la excelencia de los servicios de salud en el consultorio popular" ("Clinics for the health of the barrio: a movement for the excellence in health services in the popular clinics"), confirms the attention to quality health services by giving health workers specific survey tools to measure their impact and evaluate patient satisfaction. Instead of being satisfied with merely expanding services, seeing more patients, there is an active effort to make sure quality of care remains high.

I leave the hospital energized. Though I have been a participant-observer in the local consultarios for a while, at the end of the day I remain unable to sufficiently describe the emotional impact of seeing the national transformation of health care from a commodity to a human right.

Rebecca Trotzky Sirr is a 3rd year medical student at the University of Minnesota. She is a 2006/07 Fulbright Scholar studying the impact of Misión Barrio Adentro in Venezuela. Rebecca also studies in the postgraduate public health program at the Universidad de Los Andes through the Departmento de Medicina Preventiva y Social. She is a single mom to her Zev, who studies 2nd grade at the Escuela Bolivariana de la Mucuy Alta. He asks that you send him macaroni and cheese.

Notes:

1. República Bolivariana de Venezuela (2004) Decreto Presidencial de creación

de la Misión Barrio Adentro. Gaceta Oficial No. 37.865, de 26 de Enero de 2004.

2. Misión Médica Cubana (2006) Información Semanal del 21 al 27 de mayo.

Caracas: Ministerio de Salud.

3. Instituto Nacional de Estadística (1998) Encuesta Social. Disponible en internet



4. Rakowski CA, Kastner G Dificultéis envolved in taking health services to the people: The example of a public health care center in a poor Caracas barrio. Social Science & Medicine 21:67-75



5. CONVENIO INTEGRAL DE COOPERACIÓN ENTRE LA REPÚBLICA DE CUBA Y LA REPÚBLICA BOLIVARIANA DE VENEZUELA

6. Misión Médica Cubana (2006) Informe Misión Médica Cubana. Caracas:

Misión Médica Cubana.

7. 2005 Que Tal.

8. "La colaboracion Medica Cubana en el siglo XXI: Una propuesta para la sostenibilidad en Guiea Bissau" trabajo para optar por el titulo de master en salud publica en Haban 2006 autor Dr Nestor Marimon Torres

laozilover

laozilover Avatar

Location: K Town (Kenosha, Wisconsin)
Gender: Male


Posted: May 14, 2007 - 9:26am


Free Market Fundamentalism Is Killing Us

Posted by Barbara O'Brien at 5:00 AM on May 12, 2007.


Barbara O'Brien: Our private, profit-based health care system is grand at creating and marketing innovative health care products. But at delivering some essential medical services, it's poor and getting worse.
By many tangible measures, the U.S. health care system isn't much to brag about. For example, the World Health Organization reported that in 2000 the U.S. ranked 24th in the world in "healthy life expectancy."

"Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries," said Christopher Murray (M.D., Ph.D.), Director of WHO's Global Programme on Evidence for Health Policy.

In life expectancy, infant mortality, and number of practicing physicians per capita, the U.S. long has ranked near the bottom among the 30 or so wealthiest industrialized nations. And this is in spite of the fact that we spend nearly twice as much per capita on health care as nations that get much better results than we do. We don't even have as many hospital beds per capita as most other industrialized nations.

But worry no more, children. I learned yesterday that "US Health Care Saves More Lives Than Socialized Medicine"! Keep reading to learn more!

I learned about the triumph of the U.S. health care system from rightie blogger Captain Ed , who wrote,
Captain Ed wrote:
A new study by the Karolinska Institute in Sweden shows that the American health care system outperforms the socialized systems in Europe in getting new medicines to cancer patients.
According to the document linked by Captain Ed, "The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average." In other words, if you are a colorectal cancer patient lucky enough to have health insurance and get diagnostic tests in time, you are far better off in the U.S. than anywhere else.

What more do you need to know? That proves the U.S. has The Best Health Care in the World™, right? ...
More...
coding_to_music

coding_to_music Avatar

Location: Beantown
Gender: Male


Posted: Nov 28, 2006 - 3:23pm

In Houston, an immigrant janitor's moment of truth shocks management negotiators -- and sets the stage for a health care breakthrough.
Inamorato

Inamorato Avatar

Location: Twin Cities
Gender: Male


Posted: Oct 16, 2006 - 10:13am

UnitedHealth Group CEO leaving over stock scandal.

Accused of backdating stock options, apparently the $124 million earned in 2004 and the $1.6 billion in unexercised options weren't enough.

BY JULIE FORSTER
Pioneer Press

William McGuire, who built a fortune guiding the meteoric rise of UnitedHealth Group, is leaving the company after an independent review found evidence that millions of stock options had been backdated.

Stephen Hemsley, the company's No. 2 executive, will replace McGuire as CEO on or before Dec. 1, the company said. Richard Burke, a former top company executive and director since 1977, was named chairman.

The overhaul announced Sunday includes resignations of the company's general counsel and a board member who played a direct role in compensation decisions. It calls for major changes in the structure of its board of directors and creates a high-ranking job to monitor ethics.

More changes could be coming: Hemsley has been ordered to review the conduct of senior executives in key areas of the company and recommend further action. The company will learn today whether its changes fly with investors when trading opens on Wall Street.

(more)


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