This article is focused on describing what is wrong with the United States Health Care system and how it can best be reformed. The current system is described as being inefficient and expensive, with poor outcomes and many people who are denied access. The authors advocate a health trust system that would provide core medical benefits to every American, while improving efficiency and reducing redundancy. In this country we have the most technologically intensive medical practice in the world, yet our country also spends more money than any other nation on medical care, with outcomes inferior to those in other developed nations. Lack of access to health care leads to major disparities in health. A fragmented delivery system also leads to cost shifting, which is the practice of insurer's transferring costs to other payers, administrative waste, and an imbalance between spending on medical care and spending on population health initiatives. Most proposals for reforming the health care system call for universal coverage independent of employment status, disability status, or age. Also essential to integrate is personal prevention programs and therapeutic care with public health. A reformed system should also be organized and funded to take advantage of new knowledge about medical and nonmedical determinants of health. This new health trust system, would assess the cost of health care insurance equitably, promote efficiency by reducing fragmentation and relying on competitive markets, allow coordination of spending on population health and personal medical care, accommodate heterogenous preferences, and build on existing American health insurance and provider institutions, informed by international experience. The current financing structure and organization of care in the U.S. provide strong incentives to treat illness after it occurs rather than focus on preventative care. This is extremely troublesome because it would be a great way to reduce costs by preventing illnesses before they happen. But since our system is more concerned about treating visible illnesses, physicians and other health care professionals may be likely to just let a disease come about so they can make money by treating the disease or condition. According the authors of the article, a reformed health care system would also foster coordination of public, population, and private health care at the local level, impose financial discipline and encourage choice for and responsiveness to, clients. The first level would be the national health trust, which would use risk-adjusted capitations to allocate funding to regional health trusts, which would direct funding to the appropriate areas in their regions. Doing this would ensure that funding for health services would be responsive to the needs of the different populations in different locations. Also needed to be taken into account is the costs of delivering medical care in various areas throughout the country, through mechanisms similar to Centers for Medicare and Medicaid services developed for Medicare inpatient and outpatient services. Another responsibility of the NHT is developing uniform national policies to promote information technology, define criteria for high-quality care for particular diseases, conduct comparative effectiveness analyses, and forecast future health manpower needs. The Regional Health Trusts would be responsible for the organizing, managing, and overseeing the delivery of the core benefits: personal care combined with population health interventions. Something important to remember is that RHT's would not directly provide care, they would contract for services either directly with providers or indirectly through integrated plans and would also finance population and public health initiatives. RHT's would employ quality standards developed by the NHT to evaluate the quality of care and make this information available to consumers to facilitate the selection of providers or care plans. They could also monitor quality of care at the patient level, tracking patients by their unique insurance identifier.
This plan sounds good on paper, but I am questioning its practicality, even though I believe that a change in the health care system has been long overdue. I am of the opinion that perhaps this method could be proposed to Congress, and perhaps they would be able to make a working model of the plan that would be better suited to dealing with the problems that we face in this country. One problem I have with this article is that it seems to be biased towards those who favor health care reform. I feel that the authors of this paper may not have looked carefully enough at the other side of the debate before they wrote their article. Even so, they still have some very good points that I feel warrant a closer look at by the National government as they attempt to determine the best way to go about reforming the health care system, because it is inevitable that change will happen, what will be variable in the equation is how much change do we want? That's that most important question that we all have to ask ourselves before we form our own opinions about what should be done.
http://web.ebscohost.com/ehost/delivery?sid=cbd20c6f-c07e-4bc1-a8de-c9ca62d2086b%40sessionmgr12&vid=7&hid=19
Tuesday, October 18, 2011
Tuesday, October 11, 2011
Childhood Obesity
In the United States, childhood obesity is a problem that has continued to increase in prevalence over the past thirty years. Obesity contributes to a long list of health concerns and diseases, including hypertension, dyslipidemia, chronic inflammation, asthma, endothelial dsyfunction, hyperinsulinemia, diabetes, cardiovascular disease, certain cancers,w and premature death. While there has been an increase in the amount of fast food consumed, and growing trends toward eating away from home, two-thirds of the foods children consume are in the home. Childhood obesity is a problem that stems for several sources, and in order to deal with the problem, several areas need to be examined for what can be done to create a better lifestyle for children. The authors of this article propose a model that divides the home food environment into three different domains, each one with macro and micro level implications. Micro refers to areas closer to the child's home life, whereas macro refers to existing in the greater community. The three domains include political and economic environments, socio-cultural environments, and built and natural environments.
Political and economic environments are composed of financial resources, policies, and laws. The macro level includes food prices, which determine the likelihood of what kinds of foods families will purchase, and government and business policies. Businesses will make use of inexpensive commodities by processing and adding value to create and market profitable, palatable, energy rich food. The availability of federal and community food programs such as food stamps for the poor and the WIC ( women, infants, and children) program are designed to improve the eating habits of the disadvantaged or vulnerable. The last macro influence is the link between economic conditions and healthy eating. The less money people have, the less willing they will be to spending more money to eat healthier foods. On the micro level, lower family socio-economic status has a wide variety of effects on families, including: eating fewer family meals, having parents with less authoritative feeding practices, eat less fruits and vegetables, are more likely to skip breakfast, watch more television, are more likely to be overweight, and are more likely to eat fast food, just to name a few. Another micro level effect is family food insecurity, which is defined as the limited or uncertain availability of nutritionally adequate foods, and has strong links to poverty and financial insecurity. In the United States, more than fourteen million children under the age of 18 live in a home where they sometimes do not get enough to eat. Therefore these children are less likely to eat fruits and vegetables and more likely to eat energy dense foods when they are available. The third and final micro level structure is the lack of use of federal assistance programs by those who qualify for them. The reasons that less than seventy-five percent of those eligible sign up for a food program includes the fear of stigma for being poor, the lack of funds to afford the food, or being ignorant of what programs are available.
In terms of socio-cultural environments, there are several macro and micro influences on eating behaviors. On the macro level, race, ethnicity, and cultural identity all have an influence on children becoming obese. Children from ethnically diverse groups are at an increased risk of obesity. In a study of adolescent meal patterns, blacks were four times as likely as whites to eat less that two meals a day, skip meals, or snack frequently. Similarly, Mexican American children may be help to culturally specific standards where there parents expect them to have hearty appetites. Advertisers will also target their ads toward specific ethnic groups. Another macro level change is in the consumption trends changing to favor greater consumption of soda and snacks. In the micro level, it has been shown that cultural inheritance accounted for thirty to forty percent of the dietary intake variance for children. Also, changes in family structure have led to less meals eaten together as a family, which has the risk of having children live on convenience diets, which are not healthy. Other influences include family eating habits, parental eating habits, and educational and nutritional knowledge of the parents.
Lastly, the built and natural environments have an impact on children's eating habits. On the macro level, the food landscape, which refers to the production of food and its availability and accessibility. Studies show that lower income neighborhoods are less likely to have grocery stores, whereas wealthier areas are more likely to have more supermarkets. Television has a major impact on eating habits, especially in permissive environments. It leads to sedentary behavior, which leads to low energy expenditure, which leads to obesity. People are also more likely to eat while watching the television, which leads to mindless eating, a high energy intake, and then obesity. Children see adversing through the television, which leads to either the child or the parent making food purchases that are not nutritionally beneficial. In conclusion, all three of these domains need to be examined in order to find a way to reduce the levels of childhood obesity in this country.
http://web.ebscohost.com/ehost/detail?vid=4&hid=12&sid=ef60a2df-625b-4b25-8ac5-7a1be9c065ae%40sessionmgr10&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=hxh&AN=33538028
Political and economic environments are composed of financial resources, policies, and laws. The macro level includes food prices, which determine the likelihood of what kinds of foods families will purchase, and government and business policies. Businesses will make use of inexpensive commodities by processing and adding value to create and market profitable, palatable, energy rich food. The availability of federal and community food programs such as food stamps for the poor and the WIC ( women, infants, and children) program are designed to improve the eating habits of the disadvantaged or vulnerable. The last macro influence is the link between economic conditions and healthy eating. The less money people have, the less willing they will be to spending more money to eat healthier foods. On the micro level, lower family socio-economic status has a wide variety of effects on families, including: eating fewer family meals, having parents with less authoritative feeding practices, eat less fruits and vegetables, are more likely to skip breakfast, watch more television, are more likely to be overweight, and are more likely to eat fast food, just to name a few. Another micro level effect is family food insecurity, which is defined as the limited or uncertain availability of nutritionally adequate foods, and has strong links to poverty and financial insecurity. In the United States, more than fourteen million children under the age of 18 live in a home where they sometimes do not get enough to eat. Therefore these children are less likely to eat fruits and vegetables and more likely to eat energy dense foods when they are available. The third and final micro level structure is the lack of use of federal assistance programs by those who qualify for them. The reasons that less than seventy-five percent of those eligible sign up for a food program includes the fear of stigma for being poor, the lack of funds to afford the food, or being ignorant of what programs are available.
In terms of socio-cultural environments, there are several macro and micro influences on eating behaviors. On the macro level, race, ethnicity, and cultural identity all have an influence on children becoming obese. Children from ethnically diverse groups are at an increased risk of obesity. In a study of adolescent meal patterns, blacks were four times as likely as whites to eat less that two meals a day, skip meals, or snack frequently. Similarly, Mexican American children may be help to culturally specific standards where there parents expect them to have hearty appetites. Advertisers will also target their ads toward specific ethnic groups. Another macro level change is in the consumption trends changing to favor greater consumption of soda and snacks. In the micro level, it has been shown that cultural inheritance accounted for thirty to forty percent of the dietary intake variance for children. Also, changes in family structure have led to less meals eaten together as a family, which has the risk of having children live on convenience diets, which are not healthy. Other influences include family eating habits, parental eating habits, and educational and nutritional knowledge of the parents.
Lastly, the built and natural environments have an impact on children's eating habits. On the macro level, the food landscape, which refers to the production of food and its availability and accessibility. Studies show that lower income neighborhoods are less likely to have grocery stores, whereas wealthier areas are more likely to have more supermarkets. Television has a major impact on eating habits, especially in permissive environments. It leads to sedentary behavior, which leads to low energy expenditure, which leads to obesity. People are also more likely to eat while watching the television, which leads to mindless eating, a high energy intake, and then obesity. Children see adversing through the television, which leads to either the child or the parent making food purchases that are not nutritionally beneficial. In conclusion, all three of these domains need to be examined in order to find a way to reduce the levels of childhood obesity in this country.
http://web.ebscohost.com/ehost/detail?vid=4&hid=12&sid=ef60a2df-625b-4b25-8ac5-7a1be9c065ae%40sessionmgr10&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=hxh&AN=33538028
Friday, October 7, 2011
The Influence of the FDA
The FDA is an organization that the evidence-based review process for evaluating the evidence for health claims and qualified health claims. A health claim is any claim that is made on a label, food, or dietary supplements. All health claims and qualified health claims need to be reviewed and evaluated by the FDA. Evidenced based reviews in the field of nutrition have become more common in evaluating the strength of the scientific evidence on a nutritional statement. The FDA seeks to by objective by relying on verified evidence, being flexible in the levels of data needed to support the validity of the different substance/ disease relationships, and by being responsive to the need to re-evaluate the data as experimentation are refined. Substances are defined as being a food such as tomatoes, or a food component like lycopene. A disease is defined as damage to an organ, part, structure, or system of the body that has not been properly functioning. There are several health claims that have been shown to meet the standards of significant scientific agreement. In regards to cancer, dietary lipids, fiber-containing grain products,fruits and vegetables have been shown to have effects on the body. In terms of coronary heart disease, dietary saturated fat and cholesterol, products containing soluble fiber, soy protein, and plant sterol. Sodium is proven to have an effect in hypertension, folate is know to stop neural tube defects, dietary noncarciogenic carbohydrate sweeteners in dental carries, and calcium and vitamin D are shown to have benefits for osteoporosis. Qualified health claims subject to enforcement discretion include the effect of tomatoes on prostate, ovarian, gastric, and pancreatic cancers, calcium in colon/rectal cancer, green tea in breast and prostate cancer, selenium in bladder, prostate and thyroid cancer, walnuts in coronary heart disease, and phosphatidylserine in insulin resistance and dementia.
Basically, the purpose of the FDA is to evaluate the health claims made in regard to food, medication, nutritional supplements, and basically any kind of things that may have an impact on one's health. The FDA is shown to be an organization that works to make sure that people are not being taken advantage of by it's makers. Of course, the every day person needs to be able to distinguish how the FDA is involved in establishing the rules that are enforced in the market places. I am of the opinion that the FDA's influence is not that significant because the majority of the population is not as well informed about the way that the FDA determines what is safe to consume.
Basically, the purpose of the FDA is to evaluate the health claims made in regard to food, medication, nutritional supplements, and basically any kind of things that may have an impact on one's health. The FDA is shown to be an organization that works to make sure that people are not being taken advantage of by it's makers. Of course, the every day person needs to be able to distinguish how the FDA is involved in establishing the rules that are enforced in the market places. I am of the opinion that the FDA's influence is not that significant because the majority of the population is not as well informed about the way that the FDA determines what is safe to consume.
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