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Health Care Review

HEALTH INSURANCE AND DISEASE

The concept of Health is somewhat difficult to understand. When we say a person is healthy, it means to the lay man that the person is normally doing his activities and does not outwardly show any signs of any disease in him. However , for the medical man it denotes the conformity to certain standards like physical measurements, biochemical norms and rates, physiological standards, etc . Even these principles vary with race, rest, exercise, food, habits, starvation, climate, altitude, latitude, etc . It has been extremely difficult for scientists concerned with human biology to lay definite criteria for health and define the term Health in a specific manner.

From the history of medicine we know that there have been various systems of medicine or healing arts evolved in different parts of the world during different civilizations. But in no process has there been a clear-cut definition of health.

In the oxford dictionary health means the state of being free from sickness, injury or disease, bodily conditions; something indicating good bodily condition. A few decades ago this meaning was conveyed in the definition of health but recently the World Health Organization have considered it necessary to give a direction towards the achievement of a robust and happy and additionally active bodily and mental condition capable of continuous productive ability and, therefore , have defined health as follows:

"Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity. " (WHO---1948) it will be seen that even after having this definition it will be difficult to conceptualise and standardise positive health with specific clear-cut attributes and criteria with regard to measurement. A person may be enjoying mental equanimity and enthusiasm for doing anything. He may also be physically able to do any amount of work, but he may be having some minor dysfunction or deficiency or even a mild infection causing a very minor disturbance which however does not upset his normal activities.

For example , Hyper pigmentation on the skin or lack of pigmentation on the skin; angular stomatitis as a result of B complex deficiency; a ring-worm patch on the skin, etc . In these conditions strictly speaking the person cannot be called 'health' but for outward purpose he will appear healthy and he will also be fully active. Similarly, under the mental component there are ever so many stresses and strains that an individual is exposed to and depending on his own mental make-up he is either able to overcome the strain or is suffering from worry and depression. If in spite of his worry he is able to function normally others may take him to be healthy, whereas the worry may normally be making him mentally unsound.

Social well-being is very much related to the mental adjustment of the individual to others around him in the family or in the community. Sometimes it may so happen that a person may find it had to adjust with his group and will, therefore , be under a mental strain. But he may be doing his work normally from which others would judge him to be healthy. It is only if he reaches a break-point and behaves either in a withdrawn manner or becomes aggressive that his mental condition will become manifest to be seen and experienced by others.

We have, therefore , to understand that the term health is not an subjective thing but a relative concept. In it we see a continuum of freedom from sickness to better health and positive health. When we say positive health we refer to a condition in which the body has sufficient reserve nutrition and resistant factors to prevent the invasion of the body by any micro-organism or by the deprivation of any nutritional factors causing a deficiency pathology and, therefore , completely free from condition.

Disease is a little less difficult to define than Health. It denotes the condition of the human body in which something has gone wrong and has upset the Norman functions of the body including the mind. As in health there is also a continuum from a predisposition or premonition of illness which may or may not be experienced or noticed even by the individual concerned, to a definite condition of illness manifested by signs or symptoms and impairment with body functions.

This continuum may further extend from mild sickness to severe sickness and death or recovery from sickness back to a debilitated condition and later to a normal condition.

As has been pointed out in the previous paragraphs the normally of health of person may shift towards positive health depending on the improvement of health by wholesome food, wholesome water proper living circumstances, proper work atmosphere, good personal hygiene, etc ., or the deterioration of health due to faulty or inadequate food, infection through food, water or air, skin or due to external injuries, accident etc .

For maintenance of good health the following things are essential:

1 . Adequate quantities of proper nutrition
2 . Adequate quantities of safe drinking water
3. Proper shelter with adequate ventilation in addition to lighting
4. Proper clothing
5. Proper work, exercise and rest and recreation
6. Proper social conditions for a harmonious existence and work
7. Proper security from fear of any kind
8. Proper sexual behavior
9. Personal hygiene
10. Provision and utilization of health services.

Disease can be due to say one or more of the following causes:

1 . Genetic traits
2 . Congenital deformity or malformation
3. Cancer
4. Malnutrition
5. Poisons

The above are the direct causes.

The science of epidemiology employs various methods and approaches to explore, investigate, identify and establish the cause of disease as against maintenance of health in the individual, in the community and in a geographical area. Modern epidemiology has revealed a multiple causation theory for most of the diseases. The direct or immediate causes may be congenital, traumatic, infection or cancerous growth, etc . But besides these direct causes, many indirect and predisposing causes have been described,

For example , tuberculosis is caused by the tubercule bacilli, called myco bacterium tuberculosis, this is the direct cause. The other causes which predispose a person to the infection by tubercule bacillus may be overcrowding, poor nutrition, bad ventilation, heavy work, fatigue, etc . It may be appreciated that these causes are generally socio-economic causes. The economic factors arising out of poor means of livelihood, inadequate food, etc ., are also inter-related with human and social factors like bad ways of living, customs, habits, beliefs, superstitions, etc . Taking another example, malnutrition may be due to either lack of availability of nutritious food in adequate quantities or the wrong practices of preparation of food in which nutrients may be wasted. The commercial factors may be the cause for non-accessibility and the social factors may be the cause of wastage of nutrition even after the food stuffs are available or on the contrary over eating and addiction to alcohol, etc ., causing metabolic disorder. In the rural countryside we have a lot of locally available food resources but the habits may be such that the people do not know what can be eaten and how, for deriving nutrition.

The human and social factors are predominant determinants in any society or community. In affluent countries many of the metabolic diseases like obesity, heart diseases, diseases due to air pollution, etc ., are on the increase due to social customs. In the poor countries the large number of communicable diseases and nutritional deficiencies are due to poor sanitation, poor hygiene and low and faulty intake of food. These are again in turn due to economic and social factors. Look at here chiropractic
 
Examine of human behavior is extremely important in public health and in any community oriented programme. The mere opening and establishment of hospitals or clinics or treatment centers by any government or voluntary agencies does not immediately ensure that all the people will use the facilities whenever they fall sick. For a person to seek treatment for a particular illness from a doctor or an institution the following stages of human behavior are anticipated to take place.

Communicate Health Benefits Information More Effectively

Just about all employers have responsibility of guiding their employees about the health benefit schemes offered by them. Even the employees on the other hand also have the right to receive information about the health benefit schemes offered to them. Therefore an employer has the right to inform the employees about certain information regarding the health benefit schemes. For this reason, organizations have created the position of Health Benefit Manager having communication as one of the responsibilities for health and wellbeing benefit related schemes and procedures.

Key information heads to be shared by employer

There is a plethora of information available for communication. It is the skill of the Health benefit Manager to present them in a structured manner on behalf of the employer.

- Employers need to provide a detailed list of information to the employees about what health benefit schemes are provided to them or the scheme they are entitled to.
- Providing information concerning cost sharing as well as arrangements
- To take up necessary steps to resolve problem as well as to deal with appeals.
- To provide and guide its employees about the status of accreditation, certification as well as licensure.
- Provide sufficient and necessary information about the composition of the provider network too.
- To use the emergency care services as when required by the employees of the organization.
- To obtain referrals to help specialists
- Most importantly provide all the information regarding the quality, safety of the health benefit plan and the cost of the employer sponsored plan.

Regulatory directives
According to the Employer Retirement and Income Security Act of 1974, it is necessary to provide all detailed information that the employees are entitled to that includes plan rules, covered benefits, documents about the plan management and operation as well. The employees are also entitled to receive a document along with the summary plan description, known as SPD. The SPD contains

- Information of the health care services that are covered in the plan.
- Description of what services are being provided by the plan and how these schemes function.
- It provides information also on how to calculate the benefits.
- Explanation on the cost that the plan covers and the cost that the beneficiary has to pay.

Tools and Methods for communicating
Electrical power methods by which the Health Benefit Manager, on behalf of the employers, can communicate health benefit information to the employees:

- One of the best ways is to communicate with the employees about the health coverage plan but providing too much information of it should also be avoided. The employees should be given the required time to understand the scheme and ask questions if any.

- It is best to explain the changes in simple terms to the employees to make these understand.

- Apart from the employees it is also necessary to explain the health benefit plans to the health benefit managers so that they can explain it to the employees to.

- Employers should be ready to face any questions asked by employees regarding the health benefit scheme and clear their doubts.

- It is equally important as well to be direct and honest when discussing about the coverage plan especially if employees face charge increase due to the coverage plan.

- Discussing the 5C's too is essential with the employees. This 5C's include cost, changes in plans, coverage of the plan, comparison of the previous year's plan and also the current option.

- It is necessary to provide information the employees about the health care providers that are available in the revised and new plan option.

- Providing testimonials of other employees about the changes in well being benefit plans can also be quite helpful for the present employees.

- Taking the help of various means like internet, face to face discussions, telephonic conversations, office intranet as well as printed materials can be helpful too. However it is also necessary to use materials that are easily understood by employees.

Using health communication campaigns

What are its advantages?

- It is important for the employers to conduct communication campaigns to educate the employees about the need with health benefit schemes and how they operate.

- The responsible manager's aim should be to identify the objective and aim of the health care campaign.

- To develop health care message that meets the objectives and aim of the campaign.

- Setting up the criteria for evaluation of the campaign and also the degree to which it is getting conveyed among the employees.

- To implement and the campaign and make sure that that employees understand message that is being conveyed by the employer.

- It is also necessary to make sure that the employees also to address the education need of the employees with language barrier, literacy issues etc .

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