Monday, May 26, 2008

Presidental Fitness Test - How Good Are You?

Remember the Presidential Fitness Test we had to go through while in middle school? Get ready for the latest test, except it is for adults. The Presidental Fitness Test for Adults was unveiled in May and covers the following:

  • The test involves three basic components: aerobic fitness, muscular strength and flexibility. The test is for people 18 and older who are in good health.
  • The aerobic component of the tests consists of a one-mile walk or 1.5-mile run. The run is not recommended for those who don't run for at least 20 minutes, three times a week.
    Push-ups and half sit-ups make up the strength test. The push-ups are done until failure. The sit-ups are done for one minute.
  • A stretching exercise called the "sit-and-reach" is used to measure flexibility.
    The scores from all four of the fitness tests can be entered online. Other information, such as age, gender, height and weight are also part of the equation.
  • You won't get a presidential certificate, but the results will then show where you rank among people of the same age. For example, if someone scores in the 75th percentile for push-ups, that means 75 percent of the scores fall below your score.
How healthy do you think you are?

Wednesday, May 21, 2008

Health Savings Accounts - A New Way of Paying for Medical Care

The Wall Street Journal reported about a report from the General Accounting Office that found those individuals who purchased health savings accounts tended to be wealthier. Health savings accounts (HSAs), which must be coupled with a health insurance plan with a high-deductible, has been the cornerstone of the Republican plan to improve healthcare inflation. Certainly the premiums for a high-deductible plan are significantly cheaper than traditional plans by up to 50 percent and the rate of health care costs slowed to about 3.6 percent as compared to 7 percent for companies that adopted HSAs. The concern among some is that those with HSAs are getting less medical care and services.

Is this a bad thing? It depends. If individuals decreasing unnecessary care because now they are responsible for the deductible then less consumption of healthcare is a good thing. If, however, people are putting off or delaying important preventive care this could be more costly and detrimental in the future. Preventive care can often find problems before they become expensive debilitating problems.

For example, would you delay getting your car maintenance if you had a high deductible? It depends. If you could not afford to have your car breakdown at the most inopportune times, then you might get routine regular preventive care. You might even do it yourself and change the oil and rotate the tires if you knew how to and had the time. If, however, you didn't know what to do, then you might not do it or figure it is unnecessary and take your chances. The difference between our bodies and our cars is you can always buy a new car.

From the article:
  • Some analysts say much of those employer savings come because many HSA participants tend to forgo care. "There is a lot of evidence that suggests that when patients pay a higher percentage of the cost of their care they get less of it," says Michael Thompson, a principal at PricewaterhouseCoopers, which advises employers on health plans.
  • Self-employed attorney Jonathan Stein, 34, of Elk Grove, Calif., got an HSA in 2005. Because he is responsible for paying the entire bill, he didn't go to the doctor for a recent bout of flu and doesn't get annual physicals despite a family history of heart disease and cancer. "My doctor and I fight about that when I do see her because she wants me to come in every year," Mr. Stein says. "If it was covered by insurance I'd probably go."
  • Watson Wyatt expects 54% of big companies next year to offer high-deductible health plans, many of which are HSA eligible, up from 39% in 2007. Since the plans were introduced in 2004, more than six million Americans have enrolled in HSA-eligible plans, although that represents a small percentage of the more than 200 million people with private health coverage.
HSAs make sense for individuals who know when to get care and when to safely skip care. Having less medical care isn't a bad thing as long as it makes sense and won't cause problems in the future. Who best to figure that out? Empowered and educated patients. If you don't feel like you have the knowledge or expertise to figure it out, then who next? A primary care doctor. After all, if you are like many people, you don't do the actual car maintenance yourself, you have a trusted mechanic tell you what needs to be done. The same applies to your health. The difference is that your health advisor is your doctor.

Monday, May 19, 2008

How Your Car Purchase Impacts Your Health

How to select a safe car is an important skill many people may not know. People often don’t realize how this simple decision can affect their health and future healthcare costs. Unintentional injuries are the leading cause of death among people age one to thirty-four and the third leading cause among forty-five to fifty-four-year-olds. The most common cause of unintentional injuries is motor vehicle accidents. In 2002, the death rate for motor vehicle accidents was triple the HIV death rate and 60 percent of the breast cancer death rate.

Clearly all vehicles are not created equal. I know this from personal experience having simply walked away from a serious accident. The car I was riding in was my soon to be father-in-law’s prized Mercedes-Benz. The car skidded on an oil patch on a very busy LA freeway, ran up a hillside, and flipped on its side. The car was a total loss. What was clear to me was that the engineering made a difference between my financee and I walking away, very shaken, but not injured, as opposed to being seriously injured or killed. The passenger compartment, while it gave slightly, stay intact protecting us. We’ve all see horrific pictures of motor vehicle accidents and often this compartment is obliterated. Was it because no amount of engineering could have overcome the tremendous forces involved in an accident or simply because safety wasn’t paramount to the design?

Although all vehicles seem strong with their metal frames, there are tangible engineering and design differences in motor vehicles. The outcome could be life or death. The result could be walking away from an accident or a life filled with disability.

Thinking critically about what you drive can impact your health. In fact, one study showed that the declining death rate in motor vehicle accidents over the past decade was not due to better drivers or improved roads, but to safer cars.

Where to look? Start with the Insurance Institute of Highway Safety. Be sure to check the model year of the vehicle you are interested in. Surprisingly, the safety of a particular make can vary annually.

Once you've found the vehicle that fits your criteria of safety, then you can move on and focus on how to improve the rest of your health by exercising, maintaining a healthy weight, not smoking, and only drinking alcohol is moderation.

Monday, May 12, 2008

Invest In Your Most Important Financial Asset - Your Health

The most important financial asset each of us owns is our ability to earn money. Specifically our earning power. But we can only work if we are of sound mind and body - i.e. we need to be healthy. Staying healthy and being able to work is a more powerful financial asset than our investment portfolio and our real estate holdings, particularly in today's market.

Yet most of us don't take the same level of care managing our health the same way we do our mutual funds. We spend more time evaluating the performance of the stock funds rather than how well our health insurance plan does to keep us healthy. Many of us sit down in front of our computers watching our bank account fluctuations rather than actively exercising and eating well to ensure we have the opportunity to make more money by staying healthy.

If we valued our health as much as we did our other financial assets, then we would take better care of it by quitting smoking, limiting alcohol intake, and getting adequate sleep. We would only seek out insurance plans that were best at promoting our health much the same way we would select mutual funds with a high rating by Morningstar and a solid ten year return. Instead of being distracted by the latest me too drug and newest medical malady, we would be focused on getting the boring hardly sexy preventive tests done like mammograms, colon cancer screenings, and cholesterol, much the same way we've been taught to save money early and often into financial investments we understand and are familiar with.

Too many of us treat our health the same way we do our retirement planning. We don't take the time and effort to do the little things that matter and then when we want to retire we find out we didn't do enough and can't. With health, many ignore the important preventive interventions only to develop a more complicated and expensive medical condition that should have been easily addressed had it been given priority. Instead of having a long productive and high quality of life, the individual now faces costly medical bills and often lost income because of the illness. People don't realize how fragile good health can be for if they did they would be much more careful with it.

A RAND study found that during a ten year period for individuals between the age 25 to 54, those in very good health who then described their health as excellent a decade later doubled their net worth. Those, however, that identified themselves as being in poor health saw their net worth shrink by half.

As your stocks and real estate holdings become less valuable, be sure to keep your most important financial asset in tip top shape. On average our healthcare system makes sure that you get the right preventive care only 55 percent of the time so like any of your other investments, take the time to educate yourself and then act on the information. Maintain a healthy weight, ask for the preventive tests shown to save lives, and partner with a primary care doctor, who is your advocate in keeping you well. Once you protect your most important financial asset, then any downturn in the market can be managed because as long as you are healthy, you can make more money. Having more money, however, doesn't necessarily mean one can acquire good health.

Sunday, May 11, 2008

Medical Students Beware - Jobs Might Be Outsourced

The current generation of newly minted doctors are choosing lifestyle over career. Indeed the top students are choosing radiology, ophthalmology, anesthesiology, and dermatology. This is the trend of generation X and Y, who value time.

But will it continue? Healthcare is extremely expensive and each of these specialties not only pay top dollar, but also have great hours. Each of these specialties can be outsourced which is a concept foreign to medicine, but not to other industries.

Already some insurers are sending patients overseas for elective cases like heart surgery and joint replacements in well-run high quality hospitals for one-sixth the cost. Many of the doctors are US-trained. This trend can only continue as many of the insurers are giving patients a strong financial incentive, i.e. cash, to go overseas.

What does this mean? Already many radiological practices outsource their overnight call to other doctors to read at a fraction of the cost to have someone cover nights. Many Americans are having plastic surgery in South Africa, where not only do they recover at a five star resort, but also participate in a safari before they go home, which is still cheaper than staying in the States. With elective procedures in eyes and skin potentially going overseas, why wouldn't a smart consumer decide to get it done? In San Francisco, one company offers just that.

What does this mean for future doctors. Don't think your future will be so easy. It is very likely it will be much harder as much of the lucrative and easier procedures move overseas and the more complex cases can't be done because of medical complications barring travel. Medicine and healthcare may be the last industry to discover the devasting power of outsourcing businesses. Will patients opt for it? They have a very strong financial reason to do so and will.

Monday, May 5, 2008

Parents Don't Know Their Babies

A paper found that about one in three parents don't know the basics about child development. About 10,000 parents were surveyed about their 9 month old babies. Nearly 99 percent of the parents were mothers. One in three answered four or more questions incorrectly. From the article:

  • the study found that many parents don't know that 1-year-olds can't tell the difference between right and wrong, and often don't cooperate or share when playing with other children.
  • A lack of proper understanding of a child's development can cause assorted problems... For example... a mother might expect an 18-month-old child to sit still for a doctor's appointment, even though children that age are normally curious and like to wander around.
  • "A mom could misinterpret a child's normal curiosity as intentionally being defiant, and could respond with harsh discipline, withdrawal of affection and repetition of that pattern over time," ... "That could hinder the child's potential for full growth and development."
Surprising? Perhaps no. Parents are increasingly busy with often more than one job. Society is more fast and intense with 24/7 communications, fast food, and seemingly a long list of things to do to keep up with the neighbors. Can pediatricians close the knowledge gap by informing parents at well child checks? Certainly that is only part of the solution.

If I hadn't gone to medical school, I would be completely clueless about my children's development. Although I'm still hardly an expert, at least I have some basic information even though it took four years and tens of thousands of dollars in tuition. Despite this "advanced training", I find that books by Dr. Spock and What To Expect in the First Year extremely valuable and worth a read. Being a doctor and being a parent are two different things.

Raising our children is our most important job. The information is out there. You need to find some time in your day and get educated. It might make the job a little easier.

Thursday, May 1, 2008

Current Doctors Want Work-Life Balance

A Wall Street Journal article noted that the current generation of doctors want to have a balanced professional career and family life. This belief is far different than in the past when doctors essentially did nothing else except practice medicine. The implications for patients are that the doctors you like may only work part-time and when you wish to see them that they might not be available. It doesn't necessarily mean that the care you receive is any worse but that it might be different that what we are used to.

What is fascinating is that many older doctors view this new generation of doctors' work ethic (or lack thereof in the former group's eyes) as (a) a reflection of a group that feels entitled or (b) as not good enough because the high costs of education and relatively low return in compensation relative to other more lucrative careers, like business, are attracting the best and brightest. Many of those doctors simply feel that increasing doctor compensation or making medical education less expensive would simply result in the return of doctors who do nothing else but see the practice of medicine as a calling. Anything less is viewed as inferior medical care.

Unfortunately, they are completely mistaken. The trend of the current generation of doctors merely indicates this cohort’s desire for work-life balance. It isn’t limited to just medicine as all businesses and organizations have noticed the same thing. Certainly medical care has gotten much more complicated with patients living longer with more complex problems. The answer isn’t simply increasing compensation or decreasing medical school loans (although either would be helpful), but rather how do we develop programs and systems that make the practice of medicine sustainable. Institutions and medical groups that do so will be rewarded with new doctors. Those that fail will find it increasingly more difficult to hire colleagues. There is no reason to believe that this generation of doctors can’t meet the challenges of medical care the same way other groups have done before them. There is no reason to expect that medical care will suffer simply because one generation views the world differently than previous groups.


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