As healthcare costs continues to rise, a recent NY Times article describes the growing trend of underinsured Americans. This group now numbering 25 million people includes those who have health insurance coverage that may not adequately cover them in a healthcare crisis or have high out of pocket expenses and deductibles.

“The rates of underinsurance among families earning more than $40,000 a year nearly tripled from 2003 to 2007. Most worked for small businesses with poor coverage or had to buy costly, bare-bones individual policies on the private market. A typical family might have to cope with rising premiums, high deductibles, benefit limits that exclude or cap treatments and substantial co-payments for each service.”

As costs continue to rise it becomes more  important than ever for healthcare consumers to become better educated about not only their health but also what insurance plans are available and how they work. Websites are available to assist you. MostChoice (www.mostchoice.com) serves as an insurance broker. You can also check the quality of a healthplan at Consumer Assessment of Healthcare Providers and Systems (www.cahps.ahrq.gov) and National Committee on Quality Assurance (www.ncqa.org).

Question: What happens if you fall sick outside the USA?
From: See L. of Forest Hills, New York

Answer: What a practical question! I must admit, it made me stop and think and consider my actions when I next travel outside of the U.S. For those with private health insurance plans, it is important to check with your health insurance plan to learn if benefits are available when traveling to other countries. Even if your plan does, the problem remains whether that health plan is accepted by the country you are traveling to. Medicare and Medicaid do not provide coverage in other countries. You may want to consider purchasing a short-term supplemental health insurance plan that is specifically designed to cover international travel. For options, check the Bureau of Consular Affairs. Make sure the plan covers care as well as medical evacuation back to the U.S. as evacuation may exceed $50,000. Most of these policies can begin right away.

There are some other practical tips provided by the State Department when traveling. Register your plans with the State Department (free online at https://travelregistration.state.gov) so the State Department can better assist in case of emergency, whether the crisis is with family in the U.S. or where you are. Make sure to complete emergency information when applying for travel permits. Leave copies of the itinerary with family or friends. Familiarize yourself with services and environment where you plan to be-medical facilities, immunization needs, pollution, etc. If you are being treated for a medical condition, take along a letter from your physician describing the condition and the medications you are taking. You may want to check with that country’s foreign embassy (again through the State Department site at www.state.gov) to make sure the medications are not considered illegal narcotics. If you are injured or become ill abroad, the U.S. consular officer can assist in locating medical services, inform family members, and assist in the transfer of funds from the U.S. Remember that payment of hospitals and expenses are the responsibility of the traveler.

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Question: Why does one have to wait months for a mammogram?
From: Diane W. of Oreland, PA

Answer: I’m not sure that there is one answer for every mammography center. I would hope that the main reason is that more and more women are scheduling their mammograms and heeding the recommendations for early detection. Please note that there are regular screening mammograms as well as diagnostic mammograms being done. The regular screening is usually done annually to ensure that there are no irregularities. A diagnostic mammogram is performed to evaluate a new abnormality or in follow-up for a past abnormality. I have had a few friends and relatives who had diagnostic mammograms and the radiologist was able to interpret the study immediately. Since 10/94, mammography centers must be certified by the U.S. FDA in order to perform, interpret, and develop the studies. They may be located in hospitals, outpatient clinics, or physicians’ offices. Many facilities accept self-referral (but not all). If your facility does, you do not need a physician’s referral. Remember to check with your insurance company, however, as some insurance plans do require a physician’s prescription to cover the mammogram. Medicare covers an annual screening for all women age 40 and over who have Medicare. Medicare pays for one baseline study for women between 35 and 39 who have Medicare. Medicare also covers digital technologies for screening mammograms. There is no Part B deductible but the 20% coinsurance or co-pay applies.

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Question: Is there some sort of easily available rating system that can help one choose a good hospital?
From: Steve W. of Rahway, NJ

Answer: This question comes up fairly often and I am always happy to respond. It pleases me that consumers are actively looking into the best resources available for their needs, including the best healthcare. It is important, however, to do a self survey. What qualities are important to you? Is it the nurse to patient ratio and the hospitals current staffing? Is it cleanliness, friendliness of the staff, explanations of treatment and medications, written instructions, specialty physicians on staff, technology? There are many resources available to research hospital ratings so I will recommend what I consider to be the top sites. Check whether the hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) which sets the gold standard for care. Other sites are U.S.News & World Reports annual list of the best hospitals by specialties, the Leapfrog Group (www.leapfroggroup.org), HealthGrades (www.healthgrades.com), VIMO (www.vimo.com), the Commonwealth Fund (wwwcmwf.org). Study what quality indicators these sites use (e.g., mortality, reputation, patient volume, advanced technology, professional credentialing, cost) and then compare to your expectations.

In my book, 7 Steps to Your Best Possible Healthcare, I address these issues in great detail. I also provide some practical tips to look for and questions to ask.

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Question: How can I make better use of a Flexible Spending Account?
From: Virginia G. of Santa Cruz, CA

Answer: A Flexible Spending Account (FSA) is essentially a cafeteria plan offered through an employer. It provides a tax advantage by allowing the employee to designate a non-taxable amount to be set aside from earnings to pay for qualified expenses within the cafeteria plan. The employee then submits for reimbursement from the FSA. It is more often used for medical expenses but may allow for dependent care. Medical expenses not paid by the health insurance plan, such as deductibles, co-insurance, dental, vision, over-the-counter medicine and mileage reimbursement for medical visits, are eligible for reimbursement. Items reimbursed must be to treat or prevent a specific medical condition. Ineligible items include health insurance premiums, cosmetic items, and cosmetic surgery (non-elective cosmetic surgery is eligible). Money not reimbursed to the employee is forfeited.

There are several steps to take to make sure you are reimbursed appropriately. Keep all medical receipts/statement from the provider for which you want to be reimbursed. Make sure they show the provider’s name, reason for treatment or visit, date of service, charge for the service, and amount paid by patient. The plan will define the time frame during which services rendered may be reimbursed and will also define the time frame by which application for reimbursement must be made so be sure to submit within the allowable time frame. In 2005, the IRS authorized employers to allow a 2 ½ month grace period after the plan date to seek reimbursement. You may seek reimbursement at one time or periodically throughout the time period. You may also seek full reimbursement from the plan if you have spent the complete amount of your projected deductions but you will continue to have the money withheld from your pay. Deciding how much to have deducted from your earnings should be done carefully. Make a list of out-of-pocket expenses for yourself and your dependents. Remember that unused money is forfeited. Lastly, effective 1/1/08, approved merchants (grocery stores and discount stores) are required to have inventory systems which can identify healthcare purchases and over-the-counter items each time you use a health care debit card.

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Question: I would like to know more about alternative health
From: Alla R. of Cordova, MD

Answer: Conventional medicine (allopathic medicine) is medicine as practiced by MDs or Dos and their allied health professionals. Complementary and Alternative Medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not currently considered part of conventional medicine. Complementary medicine blends conventional and alternative treatments. For example, aromatherapy may be used to alleviate a patient’s discomfort following surgery. Alternative medicine is used in place of conventional medicine. An example of alternative medicine is using a special diet to treat cancer instead of surgery, chemotherapy, or radiation. Some examples of current mainstream practices that began as CAM are acupuncture for headache pain, glucosamine to assist in treating arthritis, and fish oil to help treat heart disease. The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government’s lead agency for scientific research on CAM and has been moved within the National Institutes of Health. You can explore CAM further by going to the NCCAM’s website, www.nccam.nih.gov. In my book 7 Steps to Your Best Possible Healthcare, I describe the approaches, publications, and teachings of several physicians.

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If you are in the position of shopping for a private health plan the options may seem overwhelming. To get you started, you first have to decide what is most important to you. Factors to consider include services, choice, location, and costs. All plans have tradeoffs. Here is place where you need to apply your individual goals and values for your personal healthcare plan. You may want to ask yourself the following questions in deciding what plan is best for you and your family.

Services

• How comprehensive do you want coverage of healthcare services to be?
• What services are limited or not covered?
• Is there a good match between what the plan provides and what you think you will need? For example, if you have a chronic disease, is there a special program for that illness?
• Will the plan provide the medication and equipment you need?
• Does the plan pay for preventive care?
• If alternative or holistic treatment options are important to you, does your plan cover them?

In his book, Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self, Peter Kramer, MD, refers to one component of the “medicalization” of mental health as “cosmetic psychopharmacology.” In particular, he addresses the ability of Prozac to alter patients’ personalities. Even when a patient is no longer depressed, he could use Prozac to sustain the personality change. Dr. Kramer describes the phenomenon as patients becoming “better than well. . . . patients acquiring extra energy and becoming socially attractive, through the continued use of Prozac when they may no longer have needed it to treat depression.”

Medicalization speaks to an issue of fear—fear that society continues to “lower the bar” in defining what is a disease in need of medical treatment. The following are some common conditions that may be life consequences and may receive treatment as medical diagnoses:

• Menopause
• Mood disorder
• Dyslexia
• Attention deficit hyperactivity disorder (ADHD)
• Hair loss
• Insomnia
• Obesity
• Restless leg syndrome
• Acne
• Sleep disorder
• Wrinkles
• Depression
• Yellow teeth
• Anxiety
• Headaches
• Sexual dysfunction
• Everyday unhappiness

While you are the quarterback for your healthcare team, your primary care physician is your coach – without him or her – you wade aimlessly around the healthcare maze. Your primary care physician should work to keep you healthy, refer you to specialists and basically make sure nothing slips through the cracks.  Problem is, the number of medical school students going into primary care continues to decrease each year.  Worse yet, the number of primary care physicians leaving the practice of medicine is increasing.  The main reason for this defection is the reimbursement rates for primary care physicians compared to specialists. It could take decades before some of the government and medical school programs incentivizing more grads to enter primary care actually have an impact – if ever. In the meantime, what’s a patient to do?

After my daughter Emmalea had her first seizure and was diagnosed with epilepsy, she was treated by a neurologist at our local medical center, who I will call Dr. Smith. To be sure we were on the right path with such a serious diagnosis, we sought out a second opinion from Dr. Carl Bazil, a nationally known neurologist at Columbia Presbyterian Medical Center in New York City. Dr. Bazil, who agreed with the local neurologist’s treatment, sent Dr. Smith a letter describing his visit with Emmalea and documenting his suggestions.  This is standard practice, and basic etiquette, for consulting physicians to inform the primary physician about their visit with the patient.

After her second seizure, frantic, I called Dr. Smith.  When I asked him what we should do, he responded, “Why don’t you ask your fancy New York City doctor......”   I immediately hung up the phone and called Dr. Bazil who provided guidance and counseling to us immediately. Our next step was to find another primary neurologist.  

People share their healthcare experiences with Dr. Ruthann Russo and how they overcame significant challenges from within the healthcare system.

The phrase, medicalization of life refers to "society’s growing trend to classify more and more life problems as medical problems" and treating those problems with pharmaceutical or surgical intervention.There is a spectrum of medicalization issues that includes those a physician may treat with prescription medication and surgery to those that are cosmetic in nature. Many advertisements describe how to treat problems like restless leg syndrome, sexual dysfunction, and insomnia with a prescription drug and physician visit. These are examples of the medicalization of life today that 20 years ago we did not even have a medical diagnosis for. At the extreme, medicalization involves treating natural life consequences, such as minor body image issues, being slightly overweight, or experiencing hair loss as diseases that must be eradicated.

Medicalization involves asking questions, such as:

• When does a deviation from normal need medical intervention?
• Does every episode of depression or attention deficit require a medical intervention?
• What are appropriate alternative treatments?

On one end of the medicalization spectrum, an individual may be experiencing anxiety or depression. To the extent that any condition interferes with a person's ability to function effectively on a day-to-day basis, it is important to treat it. Physicians have professional judgment parameters in applying clinical criteria. If you choose to seek medical intervention for such a condition, your physician may recommend treatment with prescription drugs. You make the decision.

At the other end of the medicalization spectrum are conditions like wrinkles, hair loss or yellow, crooked teeth. If you have any of these conditions, you need to discern for yourself whether you need, want, or can afford medical or surgical intervention for problems like these. Whether you choose to seek medical intervention for a natural consequence of living may not be as important as how you do it. We count on our physicians to act ethically and in our best interests when making decision about when and if to treat a symptom, a condition or a "common life consequence."

The Happy Times in Healthcare Podcast is here to help healthcare consumers become better educated in order to receive the best possible healthcare available to them. This podcast series covers a wide variety of topics including paying for healthcare - when you are insured and when you are not insured, selecting a new physician, using healthcare quality rating tools, and understanding your medical record. In this episode:

Ed on Selecting a Primary Care Practitioner - In an excerpt from her upcoming release of The Stories Behind the Steps, Dr. Russo is joined by Ed who discusses how he mapped out a strategy to research, interview and select a new doctor to serve as his primary care practitioner. For a free sample chapter of 7 Steps to Your Best Possible Healthcare or to purchase a copy of the book please visit http://www.7stepshealth.com.

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The government recognizes the individuality of nutritional needs. They changed the structured food pyramid to one that is now called My Pyramid. MyPyramid.gov is the website that contains nutritional resources for each of us to build our own personalized food pyramid. The site allows you to design your own plan using steps to a healthier you criteria and guidance. Just like with any resource, you need to analyze the credibility and appropriateness of the information for you. One thing you need to be aware of is the influence behind this site. The web site contains valuable information and useful tools. However, don’t take everything on face value. The government, by necessity, is influenced by every industry that affects the food market. They even acknowledge this in the statements about one size doesn’t fit all and personalization and even gradual improvement.

Creating a personal medical record may sound like an unnecessary step to you. After all, your physician maintains records in his office and, if you’ve ever been hospitalized, the hospital has a record. But what if you have more than one doctor or have been in more than one hospital? Can you be sure that the doctor’s information is available to the hospital? Are you sure events that occurred in one hospital or facility are passed along to another? Do your children know all of your medical conditions? There are many “ifs” and chances to be taken.

The Happy Times in Healthcare Podcast is here to help healthcare consumers become better educated in order to receive the best possible healthcare available to them. This podcast series covers a wide variety of topics including paying for healthcare - when you are insured and when you are not insured, selecting a new physician, using healthcare quality rating tools, and understanding your medical record. In this episode:

Jay and Christine on Selecting a Specialist - In an excerpt from her upcoming release of The Stories Behind the Steps, Dr. Russo is joined by Jay and Christine who discuss the successes and challenges they have faced with the healthcare system. As a long time sufferer from Type I diabetes Jay shares his story of finding a specialist when faced with diabetic retinothopy.  For a free sample chapter of 7 Steps to Your Best Possible Healthcare or to purchase a copy of the book please visit http://www.7stepshealth.com.

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Question: How to choose the best healthcare plan for myself and my family?
From: Virginia G. of Santa Cruz, CA

Answer: This is an area that I devote a chapter to in my book, 7 Steps to Your Best Possible Healthcare. You do not say whether you are choosing through your employer’s options, purchasing it yourself, or choosing a Medicare or Medicaid option. I will try to provide basic information but strongly suggest you read the book for details.

The Happy Times in Healthcare Podcast is here to help healthcare consumers become better educated in order to receive the best possible healthcare available to them. This podcast series covers a wide variety of topics including paying for healthcare - when you are insured and when you are not insured, selecting a new physician , using healthcare quality rating tools, and understanding your medical record. In this episode:

Stories Behind the Steps Excerpt - Dr Diener Part 2 - In an excerpt from my upcoming release of The Stories Behind the Steps, I am joined by Dr. Ian Diener to discuss medical records and how they have evolved into a crucial aspect of your personal health planning. For a free sample chapter of 7 Steps to Your Best Possible Healthcare please visit http://www.7stepshealth.com.

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The Happy Times in Healthcare Podcast is here to help healthcare consumers become better educated in order to receive the best possible healthcare available to them. This podcast series covers a wide variety of topics including paying for healthcare - when you are insured and when you are not insured, selecting a new physician , using healthcare quality rating tools, and understanding your medical record. In this episode:

Stories Behind the Steps Excerpt - Dr Diener Part 1 - In an excerpt from my upcoming release of The Stories Behind the Steps, I am joined by Dr. Ian Diener to discuss some of the issues to keep in mind while selecting a new primary care physician. For a free sample chapter of 7 Steps to Your Best Possible Healthcare please visit http://www.7stepshealth.com.

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With more and more hospitals shifting debt to third party financing companies, uninsured patients are frequently turning to healthcare credit cards to pay for healthcare services. This can quickly lead to large high interest debt that can financially cripple a consumer.

As healthcare costs continue to rise and many people are paying higher out-of-pocket expenses, shopping for healthcare is becoming more and more important. By using the freely available web-based tools from Vimo.com, the savvy healthcare consumer can maximize the value of the healthcare dollar.

Vimo shows consumers exactly what each hospital charges for a particular surgery. The pricing information includes a list price as well as a negotiated price for each surgery. The negotiated price is the amount insurance companies pay. In some cases, the insurance company pays as little as 30 percent of the provider’s charge. The norm is about 50 to 60 percent. Vimo also provides national averages and information for individual hospitals.

Vimo (http://www.vimo.com/hospital/cost.php ) provides resources that allow you to take charge of your healthcare spending. It compares pricing information for every procedure by the hospital. Since most pricing information is not shared openly by the hospital with patients, this is a novel idea in healthcare. As we begin to assume more of a burden for increased deductibles and hospital and doctor fees, cost will become an even more important component of quality.

I have a new 31 page eBook available entitled the Economics of Healthcare, Why Buying Healthcare Isn’t Like Buying Anything Else is now available online from djiberstore.com for purchase and immediate download.

Buying healthcare is different from buying anything else for several reasons, including: information, unpredictability, payment, emotion, and responsibility. You can use this book to help you understand why healthcare is different as well as what you can do to improve your actions as a healthcare consumer.

As a benefit for readers of this site you can enter the code ruthannrusso.com at checkout to save 10% on any order from djiberstore.com.

Here are a few reasons you may want to obtain and maintain your own health information:,

1. To provide continuity of care

2. For your own reference

3. For future generations

4. To gain a greater understanding of the healthcare system

5. To increase efficiency and reliability of health information

6. To increase our own responsibility for our health

7. To increase the accountability of healthcare providers

The 2007 Quality Report from HealthGrades.com was released yesterday and among other issues demonstrates the varying level of care provided at hospitals throughout the country. The study found that on average there is a 71% lower chance of a patient dying at the top-rated hospitals as compared to the lowest rated hospitals for comparable patient stays on a risk adjusted basis. This study highlights the need for the individual healthcare consumer to assess the quality of the health providers available to them in order to get the best possible healthcare.

Physician fees, prescriptions, and other non-covered costs can be significant if you have a catastrophic illness. Depending on your situation, you may want to purchase a secondary health insurance policy. Commercial insurance companies offer secondary insurance for anyone with a specific type of disease or healthcare need.