-Why American healthcare is so expensive?

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drneelesh@Raksha: -Why American healthcare is so expensive?
That the American healthcare delivery system is out of control and wasteful is a no-brainer.

Needless battery of investigations and over diagnosis, branded drugs, impractical insurance laws, free-markets approach to health care and sedentary lifestyle are all major factors in creating the current scenario.Its like a bad spiraling black hole which only sucks you into unnecessary and wasteful consumption of health services.

Keeping the whole machinery ticking seems to be the raison d'itre de patient existence.

This video below touches on a few reasons on why health care is so expensive in America. Features like this convince that India must be doing something right in its public health policy. I have been a member of Public health delivery system for about 10 years, in a wide range of positions and institutions. I fully appreciate Indian obstacles (population) and limitations (poverty) in public health delivery. A good step has been taken with the Swasthya bima (govt. sponsored health insurance with private partners). This Indian central govt scheme for BPL (Below poverty line) families is built on sound understanding of indian conditions and mindset. Eighteen states, including Rajasthan, have already launched this scheme. What is needed now is to make sure ALL BPL families OBTAIN an insurance smartcard. NGOs need to come forward to ensure all BPL families get their smartcards. The cost of the insurance is Ruppees 750/- annualy, 75% paid by central govt. and 25% state govt. The consumer would have to pay an annual Ruppees (Thirty) 30/- as registration/renewal fees. Then they would be able to use services at all public hospitals, many private hospitals and most specialist health care institutions all over the country with the help of a single smartcard!! The claims section of the scheme still has to show efficiency. But all in all, its a very well thought out scheme and should work wonders in more ways than one.

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Evangelizing Swathya Beema Yogana in Rajasthan

RAKSHA (Registered society for knowledge and health activities) is a Rajasthan based non-profit organization working for democratization of knowledge and health. It is headed by 1)Dr.Neelesh Bhandari, a Armed forces Medical College passout, a pathologist, post graduate in Human Rights and a medical multimedia consultant. Dr.Neelesh has more than ten years of experience in public health administration, of which about Eight years is in Rajasthan Public service commission. 2) Dr. Preeti Lodha, a psychiatrist and health rights activist with more than ten years of experience in public health administration, of which about Eight years is in Rajasthan Public service commission. Additionally, Dr. Preeti has previous experience of One year as a Project Manager in Operation Veerni. ( A maternal and child health project run by Apollo Rajdadiji Hospital, Jodhpur with international assistance).

The Swasthya Beema Yogana is an ambitious programme meant to provide cashless health care services to the poor in Rajasthan and India.

-Health Raksha Campaign, Rajasthan-

• The main aims of the Project-

1) Creating New multimedia/video content for public awareness
2) Displaying multimedia content at important rural junctions using Audio-visual equipment and via local cable and news channels.Permanent IEC Boards ( 4 feet by 2 feet) to be erected at more than one thousand sites.
3) Explaining the benefits of the scheme to Doctors and health workers.
4) Screening BPL families and referring appropriate cases to public hospitals.
5) Collect data on baseline health status and scheme usage trends amongst the BPL families.

• Broadly, the project would consist of

1) Four vehicles, armed with Audio-visual equipment ( Television and CD player) to be leased for One year.
2) Each vehicle manned by one driver, one paramedical staff and one Technician, ie 3 personnel.( Total Twelve employees in four vehicles). Supervision over Four vehicles by Two doctors ( Dr.Neelesh Bhandari,Pathologist and Dr.Preeti Lodha, Psychiatrist).
3) Each vehicle entrusted with carrying out IEC activities in Six ( or seven) Districts.( Total 25 districts)
4) Each vehicle makes a minimum of twenty (20) visits per month.( Total approx. One thousand visits over 25 districts in one year) These visits would be prefixed in consultation with local authorities and would consist of rural junctions with high BPL population/attendees ( like Tehsil offices, hospitals, panchayat bhawan, Bus stops, subordinate courts etc.)
5) Dr.Neelesh Bhandari and Dr.Preeti Lodha to make regular monthly visits to various district hospitals, CHCs etc. to give multimedia presentations on the Scheme to the medical and paramedical staff. These visits shall coincide with monthly block/CHC meetings and achieve the dual purpose of training and sensitization of health workers and Doctors. All District hospitals and medical staff at CHCs in all 25 districts to be covered over one year.

• Creating New Multimedia

1) For this campaign original video content shall be produced . Promotional content shot in TV studios ( Surya Cine vision, Mumbai and MEdRC, Hyderabad), Interviews with BPL families and officials on site, health education videos and other such content shall be produced. RAKSHA expects to produce original video content of Tens of hours over One year. All intellectual property rights to the multimedia content will be equally shared between RAKSHA and Controlling agency / ICICI Lombard.All the content shall be branded and provided to local cable channels, TV stations and also published on our youtube channel on medical education.
2) Each visit shall be recorded via Still photographs which shall be posted on a dedicated Flickr channel created for this purpose.Copies of photographs shall be distributed to all the local newspapers. Close to five thousand photographs ( Five photographs per visit X approx. 1000 visits) shall be published on the internet.
3) All the events shall be chronicled ( updated every three days) on a new blogspot/wordpress blog created for this purpose.
Such extensive self publication via youtube, blogs and Flickr.com shall also assist in Remote Monitoring of the campaign by state and central authorities at ICICI Lombard.

• During each visit by the mobile team, the activities carried out would include

1) Set up the TV and the CD player
2) Give short talks on the Bima Yojana to the gathering
3) Distribute pamphlets and other brochures.
4) Provide OTC medication only to BPL families. This will be done primarily to attract the Target audience.The seriously ill amongst these families to be referred to nearby hospitals with instructions to avail the Bima Yojana. Data regarding total number of patients seen and referred to be conveyed monthly to ICICI Lombard.

This is the skeleton sketch of the proposed Project to conduct IEC and other Promotional activities in the state of Rajasthan over one year. Initially, the four vehicles shall concentrate on the four districts of Jhalawad, Rajsamand, Barmer and Bikaner ( as recommended by you). Later, all the remaining districts shall be covered in equal proportions during the year. RAKSHA shall operate locally in conjunction with public health authorities and local NGOs like Bharat Vikas Parishad., Manav sewa sansthan and others.RAKSHA shall strive to create new partnerships with national and international organizations by using United Nations platforms like solution exchange.to furthur extend the reach of this campaign.

Copies of all the multimedia content along with analysis of before-after data accumulated over the year shall be handed over to Controlling agency / ICICI Lombard at the end of the year.

Kindly email me for receiving a detailed project report. If approved, RAKSHA can initiate the project from the First of January, 2009.

Dr. Neelesh Bhandari
MBBS(AFMC), MD(Path.)
P.G.P. in Human Rights
www.geocities.com/neeleshbhandari

i

My blogs and original widgets ecosystem
www.neeleshbhandari.blogspot.com
www.netvibes.com/drneelesh
My slides
www.slideshare.net/drneelesh
My presentations
www.authorstream.com/User-Presentations/drneelesh/
My videos
www.youtube.com/medicaleducation

Chief Mentor- RAKSHA
Registered society for knowledge and health activities.
c/o Suncity Hospital and Research Center, Paota, Jodhpur 342006
Phone- 02912701970

Email- neeleshbhandari@gmail.com, onlineraksha@gmail.com

-Non existent healthcare facilities in Jalpaiguri-

The Statesman
JALPAIGURI, West Bengal, India
 
The State Legislative
Assembly’s health standing committee has expressed dissatisfaction
today over the dismal heath service of the Jalpaiguri Sadar Hospital.


After visiting the hospital today, Mrs. Tapati Saha, the chairman of
the committee said that the service seemed to have broken down in spite
of several lakhs of rupees having been sanctioned for the
infrastructure development for the district hospital. “We are wondering
how the sanctioned amount has been spent. No initiative to improve the
health infrastructure is in sight. There is no burn unit. Besides, the
condition of the other wards in the hospital is very bad. The seem not
to care and indifferent to the multitude of patients coming from far
and near for treatment,” she said adding that the team would submit a
special report on the fast worsening condition in the hospital on the
floor of the Assembly in the coming session.


The chairman also expressed concern over the plight of the HIV positive
patients of the district. “The doctors are not following the special
counseling programme for the HIV patients as ordered by the state
government.” Mrs. Saha said. '


Commenting on the charge the medical superintendent of the Jalpaiguri
Sadar Hospital, Mr.Suresh Chandra Bhoumick, said that the separate burn
unit proposal was yet to be sanctioned by the state government.
“Besides, we are under staffed. The special counseling program for the
HIV positive patients would start soon in our district,” he said.

- Preventing Mother-to-Child transmission of HIV-

Guidelines Address HIV Testing, Prophylaxis to Mother-to-Child Transmission

Below I am quoting some of the guidelines for dealing with Pregnancy in High HIV risk pregnancies, during and after labour.
You can view all the guidelines here

• When the mother's HIV serostatus is unknown, the newborn infant's healthcare professional should order rapid HIV antibody testing for the mother or the newborn, with appropriate consent as required by state or local law.
• To facilitate appropriate care and testing of the newborn infant, maternal HIV serostatus should promptly be disclosed to the healthcare professional for that infant.
• When results of HIV rapid antibody test are positive, the mother and newborn infant should receive antiretroviral prophylaxis without waiting for results of confirmatory HIV testing.
• Although women with positive results of HIV rapid antibody test should not breast-feed, they should be offered assistance with immediate initiation of hand and pump expression to stimulate milk production, in the event that confirmatory test results may be negative. If this proves to be the case, prophylaxis should be stopped and breast-feeding may be started.
• All facilities with an obstetric unit and/or newborn nursery of any level should have rapid HIV antibody testing available on a 24-hour basis.
• Infant medical records should document maternal HIV-infection status, and this documentation should be a standard measure of the adequacy of hospital care for the mother and infant.
• Although prophylaxis is most effective within 12 hours of birth, it may still be effective when started as late as 48 hours of life.
• Before hospital discharge, the full 6-week course of infant antiretroviral prophylaxis should be arranged and the family should be carefully instructed regarding administration. All third-party payers should pay for the prophylaxis.
• Infants should not breast-feed if either the mother or the infant has a positive test result for HIV antibody.
• The newborn infant should be tested for HIV antibody, preferably within the first 12 hours of life, in the absence of parental availability for consent. State and local jurisdictions should develop policies to ensure rapid assessment and testing of the infant.
• To guide appropriate care and follow-up testing if indicated, infants of unknown HIV exposure status at the first health supervision visit should undergo HIV antibody testing with appropriate consent.
• Specialists in obstetric and pediatric HIV infection should be consulted regarding care of the mother, fetus, newborn, and child with perinatal exposure to HIV.

-Achieving Millennium Development Goals, India-

India forms parliamentary panel to meet MDGs : iGovernment ( 22nd October,2008)
New Delhi: A parliamentary committee comprising 30 MPs was formed on Wednesday to ensure that the Millennium Development Goals (MDG), which India aims to achieve along with the rest of the world, are met by 2015, reports IANS.

"The main aim behind formation of the Parliamentary Group on the MDGs (PG-MDGs) is to sensitise the MPs about the MDGs and the issues that plague India, and indeed the rest of the world today," Lok Sabha MP and a core member of the committee on MDGs Raman Senthil said.

"Only when they are aware, will the various government policies be influenced in the direction of realisation of the goals," Senthil said on the sidelines of a meet on MDGs in the capital on Wednesday.

In 2000, leaders of 189 countries including India signed the Millennium Declaration, agreeing to do everything in their power to end poverty. They promised to do this by achieving the MDGs, a roadmap set by the UN to end extreme poverty by 2015.

"To begin with we are launching the committee with 30 MPs including a bright and upcoming woman MP, Supriya Sule, who is the chairperson of the group. There maybe more members in the future," Senthil said.

Two handbooks were also released for the benefit of the MPs on this occasion. "The handbooks give details about the eight MDGs, what our present government programmes are doing to achieve these and recommendations about what else needs to be done," he said.

For instance, the first goal is eradication of poverty. The current policies towards this common goal include the National Rural Employment Guarantee Scheme (NREGS) and the Public Distribution System (PDS).

Policy recommendations state that NREGS should be made more mission focussed, wage payments should be made on time and transportation to the area of work and child care should be included.

To achieve the MDG of universal primary education, the policy recommendations include more public investment in education, making education a justifiable right and making it more relevant to the present times.

Besides these two, the other six MDGs are promotion of gender equality and women's empowerment, reduction of child mortality, improvement of maternal health, combating HIV/malaria and other diseases, ensuring environmental sustainability and development of global partnership.

HMIS for India

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Proper Health management requires the monitoring of the health status of the population, the provision of services as to the coverage and utility, drugs stocks and consumption patterns, equipment status and availability, Finances, personnel on a regular basis.India has a large population living in widespread far flung areas. Because of  this, Data collection and streamlining of public health services has always been a very tough task.

http://www.nrhm-mis.nic.in/ 

The Government of India has launched the Health Management Information System (HMIS) portal to convert local health data into real time useful information, management indicators and trends which could be displayed graphically in the reports.The new system envisages enhancing the information flow at various levels and providing useful and timely inputs for programme development, monitoring and midcourse interventions in the policies.

The HMIS portal captures data to be collected as per the revised HMIS formats on a web-based system at the District level so that the primary data can be easily aggregated and the information and reports flow quickly to the state head quarters and the Ministry.

The application has been developed by the Ministry in technical collaboration with iBILT Technologies who will also be providing maintenance and support to the application for the next five years.

The portal will be generating unique intelligence reports using the advanced SAS Data Warehousing platform and explore and establish new linkages and advanced analysis for policy initiatives.

Related articles

• Using Computer assisted health risk assessment tools (neeleshbhandari.blogspot.com)
• Thinking out of the box - Portable OR (neeleshbhandari.blogspot.com)
• The hidden influence of social networks on Health (medical-communication.blogspot.com)

`-Radio for health education-

The Hindu : Kerala / Thiruvananthapuram News : Health capsules on the air

THIRUVANANTHAPURAM: A major campaign utilising the mass media to disseminate health education and public health messages took off here on Monday with the launch of Radio Health, an initiative by the National Rural Health Mission (NRHM-Arogyakeralam).

Inaugurating the campaign at a function here, Health Minister P.K. Sreemathy said Radio Health would make it possible to disseminate information about the increasing incidence of lifestyle- induced diseases and the importance of health in everyday life.

She said the project, to be aired on the Ananthapuri FM platform initially, would be extended to other parts of the State soon.

NRHM Director Dinesh Arora, who participated in the function, said moves were afoot to utilise Ham radio operators for the network.

Radio Health is envisaged as a vehicle for providing information on health-related activities in the State and for giving health education to the community, especially rural women.

-No passive smoking for Indians-

INDIA BUSINESS WORLD - SUPREME COURT APPROVES SMOKING BAN IN PUBLIC PLACES

THE Supreme Court has refused to stay the Central government's notification imposing a ban on smoking in public places from October 2. A bench headed by Justice B N Agarwal, while refusing to stay the notification dated May 30, 2008, also transferred the four petitions, including one each filed by the ITC and the Indian Hotels Association, against it in the Delhi High Court.

�We are of the view that it is not a fit case for grant of interim relief. The prayer staying implementation of prohibition of smoking in public places is rejected...let transfer cases be heard on November 18", court said. The court also clarified that �no court in the country shall pass any order in derogation of this order." The Centre's plea seeking permission to implement a ban on smoking in public places from October 2�the birth anniversary of Mahatma Gandhi�was part of an application seeking transfer of all the petitions, challenging the ban on smoking in private offices, pending before various high courts. Additional Solicitor Generals Gopal Subramanium and Mohan Prasaran, on behalf of the centre, sought stay on Madras high court order. The high court, in its interim order, had put on hold the centre�s law banning smoking in public places. The people would suffer immensely and an irreparable loss and injury would be caused in case the notification was not implemented, said government's law officer. "The Act would not only discourage smoking in public places but would curtail passive smoking, which is the cause of lung cancer...around one billion deaths are reported every year due to smoking," said centre's law officers. Supporting him, Indra Jaisingh, appearing for health organisations, said that the petitioners should comply with the ban as such rules were being followed all over the world in public interest. However, the tobacco manufacturers and hoteliers earlier strongly opposed the notification saying such a ban on smoking at workplace was unjustified as it would include private offices. Stating that "the Rules go way beyond the Act," senior counsel Harish Salve, appearing for ITC, said that the hotels were already complying with the earlier rules that made it mandatory for the hotels, having a seating capacity of 30 or more, should have separate smoking zones. While partially supporting the ban, Salve said that the petitioners don't have any objection to such ban but the same should be applied discreetly. They alleged that the notification made no distinction between private space and public space and the �Inspector Raj� is what that may create the problem. However, he objected to the enforcement of such ban in private offices like that of lawyers, architects, private clinics, etc and the imposition of fine on persons in charge of these offices. Pointing out that the present Rules amounted to "Inspector Raj,, Salve said that now the hotels and restaurants cannot have any service in the smoking area. "Such place without any service can�t function as a restaurant. No ashtray (can be provided) or a candle can be lit in a restaurant," he added. When the court pointed out that why it took petitioners so much time to approach the court against the ban, Salve said that the petitioners had made various representations to the government and had received a reply only on September 22. �We were trying to evolve a method by which we are able to resolve the problem rather than fighting in court,� The ITC counsel said. Telling the court about the places where such a ban would be imposed, he said that not only work places, shopping malls, cinema halls, airports, hotels and restaurants�which have public access�will have to abide by the notification but a public place would also include open space surrounding such premises such as refreshment rooms, discotheques, canteen etc. It also says that smoking areas or spaces should be used only for the purpose of smoking and that too, at the entrance or exits and no other service shall be allowed. The notification also stipulates that the owner, proprietor, manager, supervisor or incharge of the affairs of a public place shall ensure that no person smokes in the public place and no ashtrays, match boxes, lighters or any other thing designed to facilitate smoking should be kept. Besides, if the owner or any incharge or authorised officer of a public place fails to act on the report of such violation, he shall be liable to pay fine.

- Hindi video for sanitation-

A hindi language video to promote hand washing.

New tools in public health

New tool to analyse maternal mortality in India : iGovernment

The United Nations Children's Fund (Unicef) has unveiled a new tool that is designed to help health-care experts, policymakers and local communities across India understand the root causes of its high rates of maternal mortality.

The tool—Maternal and Perinatal Death Inquiry and Response (MAPEDIR)—has collected data and analysed the cases of some 1,600 women across six states within India to show the underlying medical and social reasons behind maternal deaths, a Unicef release said.

An estimated 80,000 Indian women, either pregnant or new mothers, die each year from preventable causes, including haemorrhage, eclampsia, sepsis and anaemia, according to MAPEDIR.

Haemorrhage after delivery is the most common cause of death, the new tool pointed out.

Many other deaths go unrecorded because they occur in the anonymity of a women's homes or when the woman is on the way to seek help at a medical facility. In total, an average of 301 women die annually for every one lakh live births across India.

Chris Hirabayashi, the Deputy Director of Unicef's programmes in India, said the agency was working with health authorities in selected districts in the six states—Bihar, Jharkhand, Madhya Pradesh, Orissa, Rajasthan and West Bengal—to promote surveillance as a crucial strategy to cut both maternal and child mortality.

"The tragic reality is that too often maternal deaths are not visible. They don't leave any trace behind, and their deaths are not accounted for," Hirabayashi said

"If India is to achieve the Millennium Development Goal (MDG) of slashing maternal mortality figures by three quarters by 2015, it must tackle critical social and economic factors, such as the low status of women, the poor understanding of many families about health care, the cost of such care, and also the low standard of roads and other forms of transport," Unicef said.

Last month a broader UNICEF report found that at least five women die unnecessarily around the world each year because of complications from pregnancy or childbirth, with the vast majority occurring in the developing world.

MAPEDIR is being funded by the United Kingdom's Department of International Development, and Unicef is providing technical support to the initiative.
—iGovernment Bureau

Mistakes that kill !

AdelaideNow... Seven die from health system 'mistakes'

SEVEN people have died and dozens more have been left disabled or traumatised by mistakes within the health system, a survey has found.

A consumer watchdog group's snapshot of the public and private health systems also found only six in 10 people affected had filed official complaints, with people citing a fear of retribution and a lack of trust in the system as reasons for staying silent.

Of those surveyed by Health Rights and Community Action, few complainants received apologies and only one respondent felt the system had subsequently changed.

HRCA spokeswoman Pam Moore said the results pointed to the need for an urgent overhaul of complaints processes, with changes to the Health and Community Services Complaints Act and the resourcing of an independent consumer advocacy organisation.

"We are of the strong belief that sweeping changes are needed to health complaints processes generally, within SA, and nationally," she said. Most of the 70 respondents were unhappy with the standard of care, communication, misdiagnoses or waiting times.

In one example, a man's aorta was fatally severed during a triple bypass and when they told his wife, she had a heart attack and died three days later. In another case a GP ignored a woman's complaint of breast pain. She had an independent scan and two days later had to have a total mastectomy.

Other respondents told of threats, bullying and abuse when they tried to complain about their treatment.

Health Minister John Hill said some of the complaints referred to were 30 years old and most were about the private sector. Private hospitals and GPs have separate complaints processes, but unhappy patients can still complain to the HCSC commissioner.

"The State Government has set up a clear process which lets people make complaints about public health services (and) we established the HCSC commissioner to investigate complaints about all health and community services - private and public," he said.

What are health rights?

A short power point presentation by me trying to explain the basic concepts of health rights.

Uploaded on authorSTREAM by drneelesh

Health rights unit launched

Health rights unit launched
Tuesday, 30th September, 2008
By Conan Businge THE Uganda Human Rights Commission (UHRC) has set up an office to sensitise and offer legal aid to citizens whose rights to health are abused. UHRC launched the health rights unit on Monday at its head office in Kampala. “The right to health should not be understood as the right to be healthy. It simply contains both freedoms and entitlements to health. The freedom includes the right to control one’s health and body, including sexual and reproductive issues,” an official said. It also includes the right to conditions vital to being healthy, she added. The unit has been operational since 2006. It is funded by the United Nations Development Programme (UNDP), under its country programme, Action Plan. According to the UHRC chairperson, Margaret Sekaggya, one has a right to be free from torture, non-consensual medical treatment and experimentation. “This right stipulates that every human being is entitled to the enjoyment of the highest attainable standard of physical and mental health conducive to living a life of dignity,” Sekaggya explained. She was flanked by Sam Ibanda of UNDP and the assistant commissioner for planning in the ministry of health, Dr. John Bagambisa. The right to health is contained in the Universal Declaration of Human Rights promulgated in 1948. Bagambisa said the unit would help “people realise what they are entitled to in the health units and empower them to demand for the services.” He added that they were planning to secure $100m (about sh1.7b) to support the health sector next year.

Innovative uses of easy-to-use technology

YouTube - Assignment Rwanda: Using Mobiles to Combat AIDS

Google.org's new initiative, Predict and Prevent.

Its goal is to identify "hot spots" and enable rapid response to emerging threats, such as infectious disease and climate risk.

Internet audio broadcasting free.

Juice, the cross-platform podcast receiver.
Want to listen to internet audio programs (podcasts), music and shows but can't when they are scheduled? Juice is for you.

Juice lets users select and download shows and music and play whenever they want on their iPods, portable digital media players, or computers automatically.

I like the idea of democratization of knowledge by widely distributed audio and video snippets. Short, sweet and sticky knols.

Miro - free, open source internet tv and video player

Dance for health rights- This i must share :)

VietNamNet - Dance for Life to come in November2008

Dance4Life
will attract the attention of youth and encourage them to learn about
HIV/AIDS, productive health rights through dance, music and messages
sent through their idols.

Dance4life
is held every two years globally when participating countries hold the
same event, at the same moment, and is aired globally.

In
Vietnam, the programme is being conducted by the World Population Fund
(WPF), the Vietnamese HIV/AIDS Prevention Agency, the Ministry of
Health, the Hanoi Department of Education and Training, Hands in Hands,
and the Central Ho Chi Minh Communist Youth Union. Vietnam is the second Asian country taking part in this global project.

Dance4Life
will take place on November 29, 2008, with the presence of famous
artists, 3,000 students and representatives of donors and international
non-governmental organisations.

Students and HIV carriers will gather in groups to deliver the message: We are the same, no discrimination.

Dance4Life was founded
in 2003 by Dennis Karpes and Ilco van der Linde in Amsterdam, the
Netherlands, with the message: Start Dancing, Stop Aids. Dance4Life.

Search for any human rights document

Neccesary Drug information for all!

RxList - The Internet Drug Index for prescription drugs and medications