In recent months, there has been a renewed initiative by most governments to make it costlier to light up a cigarette. In Australia, not only has excise duties increased, cigarettes can only be sold at designated areas and, since December 2011, they have to come in plain packaging, forcing all cigarette manufacturers to present their goods in khaki boxes with shrunken logos and a graphic health message.
The argument whether increasing taxes do significantly reduce the incidence of smoking has been with us for ages. Some have not been convinced, but irrefutable data has just been released which showed that in the US, when President Obama signed the tax hike — the biggest to take effect in his first term — on his 16th day in office, reversing two vetoes by the previous President Bush (causing the federal cigarette tax to jump from 39 cents to $1.01 per pack on April 1, 2009) the net result was, as reported by USA Today, a historic drop in smoking, especially among teens, poor people and those dependent on government health insurance.
Most impressively, about 3 million fewer people smoked last year than in 2009, despite a larger population, according to surveys by the Centers for Disease Control and Prevention.
These data are most certainly going to spur more countries to implement this form of social engineering via taxation, what with the economic recession resulting in declining revenues for the tax-man.
However, while most of us acknowledge the health hazards of smoking, increasing taxes may lead to newer problems. Increased smuggling, tax evasion, counterfeiting are challenges that law enforcement agencies have to handle effectively so that the ultimate objective is achieved. The tendency for smokers to downgrade to cigars (not necessarily more cost-efficient!) or cheaper brands will not reduce the incidence of smoking. Hence the necessity of concurrent health education campaigns.
The last-mentioned is an often under-estimated weapon, particularly when the stand of most cigarette companies is “We don’t build our business on persuading people to smoke or trying to stop people from quitting. We believe that if you want to quit, you should.”
Obamacare, aka Healthcare for America aka Affordable Care Act are one and the same. It was upheld legally by the US Supreme Court on 28 June 2012. Some facts of Obamacare can be found here.
Never gave a thought to this before, but with the advent of synthetic joints, titanium plates, heart pacemakers, heart valves and other surgical implants, there must be an increasing number of dead bodies with non-human parts.. so what happens to them?
In the case of body burials, quite often these parts remain unretrieved. Such would be the case in artificial hips and other difficult-to-remove surgical implants. I do know that a serious attempt attempt is made to remove cardiac pacemakers from a dead patient in some hospitals.
In the case of cremated bodies, such parts are retrievable among the ashes. In fact, there are companies which recycle metal implants from cremated human bodies. That’s everything from steel pins to titanium hips and cobalt-chrome knees. In the US alone, there are quite a few companies which even use magnets to sort out the metallic parts from the cremated remains.
One such company, Orthometals, has been in the business for 15 years and recycles 250 tons of body parts annually. The company works by collecting the metal implants for nothing, sorting them and then selling them – taking care to see that they are melted down, rather than reused.
Now, with the rising trend in cremation, largely to save space and cost (in the US 40% of bodies are cremated, but the figure is going up), The retrieval of body-parts is also increasing. Another reason given for the increase in cremation is socio-cultural. More and more families feel that, instead of visiting deceased relatives year after year, they would rather scatter the ashes and be left with no obligations after that.
- Ultimate recycling: Artificial joints after cremation (philly.com)
- Recycling Surgical Implants (business-opportunities.biz)
With unsolicited offers of credit cards coming ‘free-for-life’, its not surprising that many consumers will find that, with easy credit in hand amounting to a few extra thousand dollars, there’s a tendency to treat it as extra spending money and over-indulge with bliss..till the end of the month, that is.
The real danger is when credit card usage passes the barrier of overspending and enters the realm of addiction. Yes, there are increasing numbers who will treat cards as extra spending money and go on a splurge , thereby forgetting about the liabilities of spending beyond their means and ending up with huge balances at the end of the month, leading to, in extreme cases, financial ruin.
Credit card addiction (I call it credit carditis) strikes when you least expect it. As with most addictions, the person with the problem is often the last one to realize that they have a problem.
How do you spot the warning signs of credit card addiction?
According to financial planner Julie Casserly, you’re there if you have 3 or more of the following features:
- You never have cash in your wallet
- When you do have cash, it burns a hole in your pocket.
You buy things just because they’re on sale, or because they make you feel better if you’re upset.
You have more than two “branded” or store credit cards.
You and your spouse or partner argue over money.
Credit cards balances are growing — and not being paid down — each month.
Your cards are all maxed out. But instead of paying them off, you open new ones in order to have additional credit.
You don’t know how much you owe on the cards you have.
You own several things you’ve never worn, used, etc.
- You hide your credit card statements from your spouse.
How do you cure this addiction?
- Spend cash – this reduces the risk of impulse purchases.
- Hide the card – out of sight, out of mind.
- Set your short-term and long-term financial goals.
- If all else fails, seek counselling. There’s some websites worth looking -Debtors Anonymous,
Some governments feel that by imposing an annual surcharge/fee for using each credit card, this will help reduce the number of cards and help solve the addiction. As one can see from the experience of taxing cigarettes, this method is highly ineffective!
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In what may be a trend of the future, Denmark has decided to impose a tax based on the amount of fats in a particular food. The basis behind this is apparently to make the population eat less fatty foods, in an attempt to increase the life expectancy of Danes.
How it works is that a surcharge(“Fat Tax“) is placed on foods high in saturated fat. Butter, milk, cheese, pizza, meat, oil and processed food will all be subject to the levy. The tax amounts to 16 kroner (about USD 3 ) per kilogram of saturated fat in a product.
“Higher fees on sugar, fat and tobacco is an important step on the way toward a higher average life expectancy in Denmark,” health minister Jakob Axel Nielsen said when he introduced the idea in 2009, because “saturated fats can cause cardiovascular disease and cancer.”
The idea isn’t that original really – last month, Hungary introduced a new tax popularly known as the “Hamburger Law,” but that only involves higher taxes on soft drinks, pastries, salty snacks and food flavorings.In the UK last year, news reports raised the possibility of inposing VAT (currently 17.5%) on foods high in fat(currently there is no VAT on foods).
My view on this is that, as far as foods are concerned, it is equally important to cut down on salt and sugar as well, so does that mean taxes need to be imposed on food in general? The other point is whether the sole objective of prolonging life alone is adequate when many agree quality of life is just as important.
There may be economic recession, but healthcare inflation goes on unbridled, with annual inflationary rates in excess of 10%! Often, I’ve been asked how to reduce medical bills once they are incurred. Of course, the best method is prevention. The next? Getting a good healthcare insurance cover (click here to know more).
But what happens when you’ve already incurred the bills? Here’s some pointers:
1.Choose when to be hospitalised – emergencies aside, its better to be admitted during office-hours and during weekdays. Why? Because many hospitals cut off ‘non-essential services’ after office-hours. You’ll be hard-pressed to find dieticians , physiotherapists and some specialists on weekends. It may seem unfair, but hospitals do charge an ‘overtime fee’ or surcharge if services are provided after office-hours.
2. Review the bill – go through the charges. Are they accurate? Extra charges and miscoding can occur, intentional or otherwise. If there are disputes, hospitals have standard grievance procedures (more of this in a future blog article) where such disputes may be resolved.
3. Negotiate – everything is negotiable. Talk to the service provider to see if they will offer a discount for the various items charged on the bill, especially if you’re paying out of pocket. Some hospitals have provision for a discount – if you ask for it.
4. Ask for a payment plan – if you cannot pay in a lump sum, ask for instalments. Some hospitals will allow this, at no interest charge. Put it in writing and if you cannot keep to the schedule, re-negotiate.
5. Charity begins not at home – many not-for-profit hospitals have a subsidy program or a foundation which will pay or subsidise for deserving cases. You will be interviewed by a financial counsellor who willmassess whether you deserve one. Such programs are understandably poorly publicised, so do not be afraid to ask.
6. Seek out support groups – especially cancer support groups. They will be well-placed to advise on charities or foundations who might be able to access funds.
7. Government assistance programs – many pension or annuity schemes will allow withdrawal for payments of critical illnesses. Yes, it will dwindle your savings, but at least you will not be deprived of adequate medical care.
- Personal Health: Put Your Hospital Bills Under a Microscope (nytimes.com)
- Six Ways to Save Money on Your Health Care Costs (socyberty.com)
- Finding Errors in the Hospital Bill (well.blogs.nytimes.com)
Enter a new phenomenon – the growth of medical credit cards designed for consumers to help them pay their medical bills. With such enticements as a discount on their medical bills, they have proven attractive for those not covered by health insurance or for those who have lost their jobs or faced with declining employer benefits in healthcare.
But really, the consumer has to be on top of the game; otherwise these credit cards can really hurt your financial health by crippling you with the payment of the hospital bills at the end of the month plus the potentially high finance charges, should you defer paying completely. These medical cards are designed to cover only health-related spending, but for all intents and purposes, behave like ordinary credit cards. That means enormously high interest rates on balances, late payment charges and other fees that you would find in any credit card.
Already, in New York, some of these cards have come under fire. Some of the reasons:
-claiming to charge no interest when in reality carrying interest rates as high as 25%.
-retrograde charges if the balance was not paid in full.
-’kickbacks’ received by hospitals or doctors for every card issued to patients.
-abuse by clinics and hospitals, like charging on these cards for non-existent services.
Consumers need to be informed on what getting a medical credit card entails. Here are some useful tips:
- A medical card is essentially a credit card and behaves like one.
- Its important to understand the terms and conditions, often buried in small print. Look for the pitfall of a low introductory interest rate which can skyrocket upon a single late payment. Some card issuers have been known to shorten payment cycles without warning, causing the card-holder to be caught unawares.
- Do not pay for services in advance by allowing the provider to swipe your card before receiving the service. Often, its a big hill to climb to get the charges reversed should the service be annulled for whatever reason.
- Avoid signing up when under duress. Notice how medical card companies set up counters in hospitals aiming to prey on those suddenly in need of emergency medical services for which they would normally not be able to afford.
- Sometimes, despite the hassle of filling innumerable claim forms to claim health insurance, they are usually more cost-effective than simply swiping a medical card. Better still, pay cash if you can and ask for a discount or deferred payment plan from the hospital or clinic.
A recent study on medical errors committed in the US in 2008 showed that it cost $19.5 million, the loss of more than 2,500 potentially preventable deaths and more than 10 million lost days of work. The study, published in July 2010, put in stark perspective the tremendous cost that errors made by medical personnel can entail, despite attempts by health-related agencies to work towards zero-tolerance in the last decade or so.
Let me clarify that medical errors are best defined as a preventable adverse event of medical care that is the result of improper medical management, ie an error of commission, rather than the progression of medical illness due to lack of care, ie an error of omission.
Definitions aside, the cost of such errors are sometimes not measurable, such as pain & suffering and malpractice costs.
Given the above figures, one can imagine that medical errors can be somewhat frequent. Indeed, the Annals of Surgery reported that 9% of surgeons in the US admitted they had made a “major medical error” in the preceding three months.
So how do you avoid mistakes when going for surgery ?
Some pointers include looking for a hospital with a good safety record as well as those possessing a recognised accreditation standard (such hospitals voluntarily undergo screening by a recognised review body, such as the JCI, in order to provide services of a certain minimum quality).
Find out from your doctor where he sends his relative to. What’s good enough for a doctor is usually a stamp of approval. Why, even nurses in the hospital may provide the right doctor if one cares to ask.
Look for a doctor who’s busy. Sure, it means long waiting times, but this might be worth it in the long run.
Finally, some health department websites do provide statistics on how many specific operations are done in a year and what the complication rates are. This way one can opt for the best hospitals for a particular procedure.
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Mention stress-tests to healthcare workers..and it can only mean one thing - jogging patients on the treadmill to ascertain their cardiovascular fitness. But in the world of finance and global economics, this term takes a different meaning.
Recently, banks in Europe were subject to stress-testing to ascertain their ‘fitness’ to carry on their business. In banking, this is not a new term and came into prominence in the US last year when the major banks were put to the test by forward-looking economic assessments of themselves. In essence, projections are done into the future (usually 2 years) to see, in the event of a worse-scene scenario, whether the banks will have enough money to survive.
Take the case of the stress tests conducted on 19 of the top banks in the US last year. The projected worse-scene scenario for 2009 & 2010 was put in place: the economy was to shrink 3.3% in 2009, the unemployment at 8.9% and home-prices to drop 22%. Based on this scenario, 10 of the banks failed, some of which are household names (see diagram below). They were required to raise their capital to maintain solvency.
In the case of Europe, stress-test results on 91 banks released on 23 July 2010 showed that 7 failed (5 of which were from Spain). The prescription? They were asked to raise new capital in order to meet the ‘normal’ values.
Critics of these tests say these tests are badly flawed. They allege the assumptions themselves should be given a failing grade, while others decry the influence of politicians who want to ensure the results are not too damaging to the nation. Others say the tests are not ‘stressful’ enough..its like a doctor trying to gauge the health of one’s heart by setting the treadmill at a leisurely pace!
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If there’s any lesson to show that healthcare today is an industry, take a look at Greece. With the economy heading south, even healthcare is affected just like any of the other industries in Greece – production problems, delivery issues and lack of supplies are for real. What with the current economic turmoil, a leading global pharma company has even decided to pull the rug and stop supplying a state-of-the-art medication to the beleaguered country.
Novo Nordisk, a Danish company and the world’s leading supplier of insulin (a drug used for treating diabetes) is withdrawing the Novopen from Greece as it objects to a government decree ordering a 25% price cut in all medicines (see here).A spokesman for the Danish pharmaceutical company said it was withdrawing the product from the Greek market because the price cut would force its business in Greece to run at a loss.
This has resulted in local action groups condemning the move as brutal, bad timing and a neglect of corporate social responsibility. Novo Nordisc on the other hand claims that it is owed $36m (£24.9m) dollars already by the Greek state, whose coffers are now empty.
Most likely, many other big pharmas will follow suit soon and is likely going to cause a crisis within a crisis soon. (Doctor2008: its now reported that another firm, Leo Pharma is also withdrawing sales). Which is a shame, because Greece in recent times ensured everyone of its citizens received free healthcare services and at the same time had one of the most admired private healthcare services in Europe, the so-called “Greek Paradox”.
Back to my opening sentence – its all very well for some activist groups to proclaim universal healthcare rights for all, but this has to be tempered with the realities of the economics of modern healthcare delivery. No country in the world can afford a liver transplant for every patient with advanced cirrhosis of the liver; so I beg to differ with those who say healthcare is a basic human right…I would amend it to say that basic healthcare is a basic human right.
Developing countries like Malaysia could do well looking at what’s happening to Greece, because when push comes to shove, healthcare, like any other industry, will be subject to ups and downs of economic forces and suffer the same consequences as any other industry.
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