America's Health System Wasted $750 Billion In One Year

America's health care system is inefficient, suffers from data overload, is complex and very costly, a report from the Institute of Medicine (IoM) revealed today. The authors added that too many negative factors are undermining health care quality and affecting the USA's global competitiveness and economic stability. Despite all this, there are knowhow and tools in place to correct the deep faults within the country's health system so that costs may be reduced and the quality of care improved.

The authors of the report (the Committee) estimated that $750 billion was wasted nationwide on administration costs, fraud, pointless services, and some other problems. Apart from the economic toll these deficiencies place, they also result in patients having to suffer needlessly. Some studies have indicated that in 2005, about 75,000 deaths could have been averted if each state had delivered healthcare at the quality and efficiency levels of the best performing state.

The Committee said that aiming for just incremental upgrades and alterations carried out by individual hospitals or health care providers will have little impact on improving the nation's overall health care service.

America's health care needs to transform into a "learning system"

The only way the USA's healthcare system can really improve is to transform it into a learning system that continuously improves itself by "systematically capturing and broadly disseminating lessons from every care experience and new research discovery."

Health care authorities will need to embrace and implement new technologies that gather and analyze clinical data at the point of care, encouraging patients and their loved ones to become active contributors, and working towards total transparency and teamwork within health care organizations. Financial and other types of incentives which focus on quality and results should be placed into the system.

Committee chair Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland, said:

"The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck. Our health care system lags in its ability to adapt, affordably meet patients' needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value."

Keeping up with new treatments and breakthroughs

One of the main problems today is that healthcare providers cannot keep up with the rapid pace of new research discoveries and technological breakthroughs.

In an online communiqué, the IoM wrote "How health care organizations approach care delivery and how providers are paid for their services also often lead to inefficiencies and lower effectiveness and may hinder improvement."

The Committee said for a health system to be able to continuously evolve, excellent use of data is vital. In the USA, approximately 75 million people have two or more chronic conditions - for proper treatment and control, good coordination among multiple specialists and therapies is vital. Otherwise, the risk of misdiagnoses, clashing interventions, and dangerous drug interactions grows.

Doctors and patients often do not have useful and relevant data at the point of care where decisions are made. Currently, for new breakthroughs to become widely accepted and adopted can take several years. Only after 13 years did beta blockers become standard practice for heart attack victims.

Embracing mobile technologies and electronic health records would contribute considerably to a competent capture of health data, as well as disseminating that information. They wrote that "The National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable, the report says. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care."

During the last 40 years, health care costs have increased at a higher rate than inflation or the economy as a whole for 31 of them. The main thrust has been volume rather than quality as far as reimbursements are concerned, instead of paying a flat rate or rewarding providers according to patient outcomes, the authors added.

The report urges insurance providers, professional societies, researchers, and health economists to work together to find ways of measuring quality performance and to design new payment models and incentives that reward quality rather than volume.

So far, not many health care organizations, clinics or medical practices encourage patients and their families to become engaged in care decisions and management of their conditions, even though studies and examples abroad have proven that they lead to better outcomes and value for money.

The Committee wrote:

"To facilitate these interactions, health care organizations should embrace new tools to gather and assess patients' perspectives and use the information to improve delivery of care. Health care product developers should create tools that assist people in managing their health and communicating with their providers.

Increased transparency about the costs and outcomes of care also boosts opportunities to learn and improve and should be a hallmark of institutions' organizational cultures, the committee said. Linking providers' performance to patient outcomes and measuring performance against internal and external benchmarks allows organizations to enhance their quality and become better stewards of limited resources, the report says. In addition, managers should ensure that their institutions foster teamwork, staff empowerment, and open communication."

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Essentials Of Orthopaedic Nurse Care

Orthopaedic Nursing

An orthopaedic nurse is a specialty nurse trained in orthopaedic problems such as fractures and is an expert in neurovascular status monitoring, traction, casting and continuous motion therapy. More than 350,000 hip fractures occur in the United States every year (Watters, 2006). Nurses' skills, interventions, attitudes, communication and continuity of care constitute the essential components of orthopaedic nurse care .

Patient satisfaction measures assist nurses in the evaluation of effectiveness of their practice and assist the process of improvement of established orthopaedic practice methods (Wu et.al, 2000). Technical advances in the field of orthopaedics like Radiography, Computed Tomography, and Magnetic Resonance Imaging have not only led to improved diagnosis and evaluation of orthopaedic diagnosis but also innovative treatment options like Vertebroplasty, Bupivacaine Infiltration, Total Disc Replacement Arthroplasty, Unicompartmental Knee Arthroplasty, The Titanium Rib, Toe-to-Hand Transplantation Surgery, The Scandinavian Total Ankle Replacement (STAR), Mechanical Devices for Lateral Transfers and Kyphoplasty. Thus, orthopaedic nurse should have the essential training and skills in the latest innovations in the field.

Nursing Skills and Interventions

Nursing intervention begins with the assessment of the patient after a traumatic event, determination of the mechanism of injury, assessment of the injured or fracture site, confirmation of the exact injury, identification of potential complications, and assessment of the patient's social and professional status to identify potential problems that might affect treatment and challenge and are important as a cause for morbidity and mortality (Kobziff, 2006).Fractures of the forearm in an adult may involve the ulna, the radius, or both and it is better to xray the entire upper extremity in most upper-limb injuries (Altizer, 2003).

Spinal cord injuries are devastating events, and they are particularly tragic when they affect children or adolescents (Vogel et.al, 2004).Nurses should provide interventions preoperatively, intraoperatively, and postoperatively to avoid potential complications (Harvey, 2005).Preoperative interventions include a thorough assessment of the patient history and screen for hypertension or other problems in order to avoid possible intraoperative and postoperative complications. Intraoperative interventions include insertion of a urinary catheter, prophylactic administration of antibiotics and inflammation of tourniquets. Postoperative care is equally important at the surgery itself. An effective postoperative nurse care can decrease the patient's pain and decrease vasospasm in replantation surgeries ( Michalko and Bentz, 2002 ).


Compartment syndrome is a common complication in fracture, sprain, or orthopaedic surgery. Early identification of the symptoms can prevent the loss of a limb (Altizer, 2004).Pulse oximetry provides one of the best objective ways to monitor arterial blood flow. Patient monitoring is done hourly during the first 24 hours and then every 2 hours during the second 24-hour period after a surgery. This intense monitoring frequently is done in the ICU. Antibiotic chemotherapy is usually recommended for 5 days, but is always determined by the wound intensity. Bed rest minimizes vasospasm. Intake of chocolate, caffeine, and nicotine in any form is strictly prohibited in the postoperative period to avoid induction of vasospasm that could impede blood flow. Patient-controlled analgesia (PCA) has been recommended for pain relief with relatively few side effects. But, IV PCA has been shown to cause respiratory depression (Brubakken and Shippee, 2004). Continuous low-dose infiltration of a local anesthetic into the postoperative wound incision for a 48-hour period has been shown to diminish the need for narcotics or other analgesics to reduce postoperative pain (Pulido et.al, 2002). The use of a mechanical device for the lateral transfer has been shown to give comfort to the patients (Pellino et.al, 2006).

Though most patients treated with casts do not have any significant orthopaedic problems, it is important to emphasize cast care instructions to young patients and their parents to alleviate itching, such as blowing cool air under the cast to reduce the risk of serious infectious complications (Carmichael, 2006).Tracking outcomes of interventions provides a systematic method of monitoring effectiveness and efficiency. The nurse should evaluate and choose appropriate measurement tools, and understand the clinical meaning of measurements to successfully employ these instruments (Resnik and Dobrykowski, 2005).

Nurse attitudes

Attitudes of nurses caring for orthopaedic patients affect the quality of care provided. A recent research on positive and negative attitudes of such nurses has shown that knowledge deficits shape most of the negative attitudes (Mary et.al, 2000). The cultural background of nurses also has an influence on the attitudes and there are reports of nurse's disagreements with patient's self-report, especially in pain assessment (Harper et.al, 2007).

Communication

Patient education is a critical component of orthopaedic nursing that requires nurse communication to maintain optimum independence and quality of life (Oldaker, 1992). A randomized controlled trial study with sixty six young adolescents to evaluate the effects of coping instruction and concrete-objective information on adolescents' postoperative pain and focus on potential applications of these interventions for orthopaedic nursing practice has shown that nurse interventions that direct adolescent patients' attention to learning coping strategies reduce the postoperative pain in such patients (LaMontagne et.al, 2003). The gender, age and health condition also influences the communication. For example, it is difficult to communicate to or assess an old patient whose 'hearing capacity would be at a reasonably low level or whose perception has diminished due to aging. Nonverbal verbal communications do occur in nurse-patient communication. (Wilma, 1999).

Continuity of care

It may take several months of intense physical or occupational therapy for the patients to regain optimal function, especially after complicated orthopaedic surgical procedures like toe-tohand transplants. In such surgical procedures progressive joint mobilization, usually begins on the seventh to tenth postoperative day and Progressive resistive exercises are begun 4 weeks later to increase strength.

A recent conference convened to explore the strengths and weakness of the current continuum of care, develop recommendations for addressing problems in the system, and devise strategies for implementing the recommendations has brought out recommendations in four broad categories: Communication/Continuum of Care, Reimbursement, Prevention/Education, and Research Initiatives. A study examining the risk factors for falls and the effectiveness of physical therapy interventions to decrease the risk of falls in a community dwelling population has shown that an appropriately designed physical therapy intervention in the form of an exercise program can decrease the risk for falls among a community-dwelling aging population identified as having an increased risk of falls (Robinson et.al, 2002). Massage therapy has been shown to be safe and effective for orthopaedic patients with low back problems and potentially beneficial for patients with other orthopaedic problems. Massage therapy appears to be safe, to have high patient satisfaction, and to reduce pain and dysfunction (Dryden et.al, 2004).

Conclusion

There is a critical need to incorporate the use of latest technological innovations like guided imagery (Antall and Kresevic, 2004) and bone morphogenetic proteins (Boden, 2005) into all nursing curricula to improve the skills, interventions, communication and attitudes of orthopaedic nurses so that nurses can develop the expertise to act as patient educators and advocates in the use of these interventions. Early identification of the care problem is vital in orthopaedic nursing.

References

-- Carmichael, Kelly D.; Goucher, Nicholas R. (2006). Orthopaedic Essentials. Orthopaedic Nursing. 25(2):137- 139.

-- Carol V. Harvey (2005). Spinal Surgery Patient Care. Orthopaedic Nursing. 24 (6). 426 - 440.

-- Cindy Pfeiff (2006). The Scandinavian Total Ankle Replacement (STAR). Orthopaedic Nursing.25 (1):30 - 33.

-- Courtney, Mary, Tong, Shilu, Walsh, Anne (2000). Acute-care nurses' attitudes towards older patients: A literature review. International Journal of Nursing Practice. 6(2):62-69.

-- Elwin R. Tilson et .al (2006). An Overview of Radiography, Computed Tomography, and Magnetic Resonance Imaging in the Diagnosis of Lumbar Spine Pathology. Orthopaedic Nursing.25 (6): 415 - 420

-- Gloria F. Antall (2004). The Use of Guided Imagery to Manage Pain in an Elderly Orthopaedic Population. Orthopaedic Nursing. 23(5): 335 - 340.

-- Harper, Phil, Ersser, Steven and Gobbi, Mary (2007) How military nurses rationalize their postoperative pain assessment decisions. Journal of Advanced Nursing, 59, (6), 601-611.

-- Heather Chong (2004). Innovations: The Titanium Rib: Creating Room to Grow. Orthopaedic Nursing. 23(5): 348 - 349.

-- Jim Hanna et.al (2007). Kyphoplasty: A Treatment for Osteoporotic Vertebral Compression Fractures. Orthopaedic Nursing.26 (6):342 - 346.

-- Julie Hummer-Bellmyer (2002). The Collaborative Role of the Perioperative Nurse Practitioner in Assessing Perioperative Patients. Orthopaedic Nursing. 21(1): 29- 44.

-- Kathleen A. Gross (2002). Vertebroplasty A New Therapeutic Option. Orthopaedic Nursing. 21(1): 23-29.

-- LaMontagne, Lynda; Hepworth, Joseph T.; Salisbury, Michele H.; Cohen, Frances. Effects of Coping Instruction in Reducing Young Adolescents' Pain after Major Spinal Surgery. Orthopaedic Nursing. 22(6):398- 403.

-- Linda Altizer (2003). Forearm and Humeral Fractures. Orthopaedic Nursing. 22 (4): 266 - 273. Lawrence C. Vogel et.al (2004). Unique Issues in Pediatric Spinal Cord Injury. Orthopaedic Nursing. 23(5): 300-308.

-- Lydia Kobziff (2006). Traumatic Pelvic Fractures. Orthopaedic Nursing. 25(4):235 - 241.

-- Mary E. Hagle et.al (2004). Respiratory Depression in Adult Patients with Intravenous Patient-Controlled Analgesia. Orthopaedic Nursing. 23(1): 18-27.

-- Mary Faut Rodts (2004). Total Disc Replacement Arthroplasty. Orthopaedic Nursing. 23(3): 216-219.

-- Maryann Godshall (2006). Toe-to-Hand Transplantation Surgery. Orthopaedic Nursing. 25(1):13 - 19.

-- Watters CL, Moran WP (2006). Hip fractures--a joint effort. Orthop Nurs. 25(3):157-65.

-- Wilma M.C.M et.al (1999). Non Verbal behaviour in nurse elderly patient communication. Journal of Advanced Nursing 29: 808.

-- Wu ML, Courtney M, Berger G (2000). Models of nursing care: a comparative study of patient satisfaction on two orthopaedic wards in Brisbane. Aust J Adv Nurs.; 17(4):29-34.

Journal of Nursing

Journals belonging to the American Society of Registeres Nurses

The American Society of Registered Nurses (ASRN) was founded in May 2003 for the purpose of bringing together professional nurses interested in creating a nursing "society" which is defined as "A group of humans broadly distinguished from other groups by mutual interests, participation in characteristic relationships, shared institutions, and a common culture".

This new Society brings together nurses from all fields of inquiry, regions, and specializations both inside and outside academe in order to expand the study and practice of nursing, and offer support, resources, education, and distinction to its members. The Society serves nurses in all 50 states as well as across the globe.

ASRN represents a community for all nursing voices. We invite registered nurses, international professionals, and new graduates to discover ASRN. Our goal is to advance nursing as a science and profession.

www.asrn.org

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Empire Blue Cross Blue Shield Joins Blue Plans Nationwide To Launch Largest Private Database Of Health Care Information

Empire Blue Cross Blue Shield announced today that it is collaborating with 19 other Blue Plans nationwide to launch Blue Health Intelligence (BHI), a unique resource that will help improve health care quality by providing the most detailed view available of health care trends, best practices and comparative costs through a claims database of 79 million people.

BHI, the premier health intelligence resource in the nation, will strengthen the movement toward greater health care transparency and informed decision-making by employers and, ultimately, providers and consumers.

A secure, HIPAA-compliant database, Blue Health Intelligence is significantly larger than existing health care databases. Access to the aggregate data -- containing no personal identifiers -- will be available to the Blue Cross and Blue Shield Plans currently participating in BHI.

"Our vision is for a health care system that is less complex and easier for consumers to navigate," said Larry C. Glasscock, chairman, president and chief executive officer of WellPoint, Inc., the parent company of Empire Blue Cross Blue Shield. "BHI will help transform the current health care system into a focused, knowledge-based system. Blue Health Intelligence is in direct response to employers and consumers who are interested in more precise information that is presented in a clear, understandable and useable way."

In the near term, BHI will support the efforts of employers to better manage the quality of benefits they offer their employees. In the future, BHI will provide consumers with greater access to information that will enable their ability to make informed health care decisions, and will heighten collaboration with providers as they deliver high-quality, evidence-based care to their patients.

Specifically, here are some examples of what BHI will ultimately provide:

-- information about the pros and cons of certain treatments. For example, a given medical condition could have more than one treatment option. In the long term, the database could provide consumers with information on the costs and outcomes of these options so they could have informed discussions with their physicians about which option is best for them.

-- data that would allow an employer to compare health care costs for its employees to national trends and costs for other employers in the same industry.

-- opportunities for health services research. With such a large database, BHI will be able to better track costs and outcomes for different clinical practice patterns and the experience of FDA-approved drugs and medical devices.

BHI is being pilot-tested and will be operational in 2007.

Blue Health Intelligence is part of Blue Distinction, an umbrella program for multiple initiatives that foster health information transparency by Blue Plans nationwide.

"As a leader in health care transparency, we are committed to collaborating with physicians, hospitals and other stakeholders to provide consumers with meaningful cost and quality data," Glasscock said. "We will continue to provide consumers with the information they need to make informed choices about their medical care."

In addition to Empire Blue Cross Blue Shield, the company's participating units include:

-- Anthem National Accounts
-- Anthem Blue Cross and Blue Shield in Colorado
-- Anthem Blue Cross and Blue Shield in Connecticut
-- Anthem Blue Cross and Blue Shield in Indiana
-- Anthem Blue Cross and Blue Shield in Kentucky
-- Anthem Blue Cross and Blue Shield in Maine
-- Anthem Blue Cross and Blue Shield in Missouri
-- Anthem Blue Cross and Blue Shield in Nevada
-- Anthem Blue Cross and Blue Shield in New Hampshire
-- Anthem Blue Cross and Blue Shield in Ohio
-- Anthem Blue Cross and Blue Shield in Virginia
-- Anthem Blue Cross and Blue Shield in Wisconsin
-- Blue Cross Blue Shield of Georgia
-- Blue Cross of California

About Empire Blue Cross Blue Shield

Empire Blue Cross Blue Shield, the largest health insurer in New York State, based on PPO and HMO membership, is a subsidiary of WellPoint, Inc. (NYSE: WLP). WellPoint's mission is to improve the lives of the people it serves and the health of its communities. WellPoint, Inc. is the largest health benefits company in terms of commercial membership in the United States. Through its nationwide networks, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, pharmacy benefit management, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan and surrounding counties and as Blue Cross or Blue Cross Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at http://www.wellpoint.com.

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The French Health Care System

The public health insurance program in France was established in 1945 and its coverage for its affiliates have undergone many changes since then. One of the major changes has resulted in the expansion to all legal residents, under the law of universal coverage called la couverture maladie universelle (universal health coverage). It is based on the principle of solidarity, guarantying financial protection against life´s contingencies for everyone.

Originally, professional activity (being in employment) was the basis of the funding and benefits of the French public health insurance system known as the Sécurité Sociale (social security). The main fund covers eighty percent of the population. There are two additional funds for the self-employed and agricultural workers.

Reimbursement is regulated through uniform rates. The financing is supported by employers, employee contributions, and personal income taxes. The working population has twenty percent of their gross salary deducted at source to fund the social security system.

The contribution of financing through personal income taxes has gradually increased and its purpose is to make up for the fall in remuneration, reduce price changes on the labor market and allocate the system´s financing among citizens equitably.

Employer and union federations jointly control the funds under the State´s supervision. This involves an intricate collaboration between the various entities of the system.

About seventy five percent of the total health expenditures are covered by the public health insurance system. A part of the balance is paid directly by the patients and the other part by private health insurance companies that are hired individually or in group (assurance complémentaire or mutuelle, complementary insurance or mutual fund).

The State

The State sees that the whole population has access to care; it dictates the types of care that are reimbursed, and to what degree, and what the role is of the different participating entities.

The State is in charge of protecting patient´s rights, elaborating policies and enforcing them. It is responsible for public safety.

Health authorities plan the size and numbers of hospitals. They decide on the amount and allocation of technical equipment (such as MRI, CT scans…). Through its agencies, the State organizes the supply of specialized wards and secures the provision of care at all times.

In recent years, regional authorities have taken a growing role in policy-making and negotiation.

Hospitals

There are two general categories:

• The public sector, which accounts for 65% of hospital beds. Public hospitals are responsible for supplying ongoing care, teaching and training.


• Private hospitals are profit oriented. They concentrate on surgical procedures and depend on their fee-for-service for funding.

There is no significant difference in the quality of care between public and private hospitals.

In France, there are 8.4 hospital beds per 1,000 people.

Health Professionals

Health professionals and physicians usually work in both public hospitals and private practices. About 36 percent of physicians work in public hospitals or establishments. They are in essence public servants, and the amount they are paid is determined by the government. However, 56 percent of physicians work in private practices because of the difficult working conditions in hospitals.

Experts set the relative price of procedures that are then negotiated by physicians' unions and public health insurance funds. Around ninety seven percent of practitioners conform to the Tarif de convention (tariff references) which sets prices. Tariff references are the fixed rates to be used by doctors set by the national convention for all health services. Medical practitioners and clinics/hospitals who are not conventions (complying with the tariff references) have to display their prices.

In some situations, certain medical practitioners (such as surgeons with extra qualifications or experience) can charge more than the Tarif de convention. The extra fee is called a dépassement.

There are 3.37 physicians per 1,000 people.

There was a reform in July of 2005 which put in place a process of coordinated care. The patient first visits his/her médecin traitant (general practitioner). This physician has been previously registered at the caisse d´assurance sociale as the one in charge of the coordination of care for the patient. In case the physician or his substitute is unavailable, the patient can consult another physician and inform his/her caisse d´assurance - this does not affect his/her entitlement reimbursement. The patient is free to change to another general practitioner but has to report the change.

The médecin correspondant (correspondent doctor) is the physician to whom the patient has been referred and is usually a specialist. With the authorization of the patient, this physician sends the relevant information to the médecin traitant in order to follow up and coordinate care.

Several specialists have direct authorization for passing on information relevant to care, such as gynecologists, ophthalmologists and psychiatrists.

The service of gynecologists, ophthalmologists and dentists are covered by the State without a referral by a médecin traitant (the patient does not have to go to his/her General Practitioner first).

The patient has to present his card called "Carte Vitale" which transmits all transactions to the caisse d' assurance where he/she is registered. All medical procedures (hospitalization, laboratory tests, x-rays…) have to take place in the locality of his/her caisse d´assurance. However, the patient can buy medicines anywhere in France and have the reimbursement later deposited on his/her bank account, usually within a ten-day-period.

An average of 70 percent of the cost of a visit to a family doctor or specialist is refunded. Reimbursements are on average of: 95 percent for a major surgery, 80 percent for minor surgery, 95 to 100 percent for pregnancy and childbirth, 70 percent for x-rays, routine dental care and nursing care at home. Reimbursements for prescribed medicines depend on the type of medication and range from 15 percent to 65 percent.

The percentage that is to be paid by the patient and not reimbursed by the Sécurité sociale is called ticket modérateur. This fraction varies following each individual´s obligatory regime set by the tariff references allocated to various medical treatments and associated fees encountered.

A patient can receive 100 percent coverage under certain conditions, such as having a chronic or acute medical condition (including cancer, insulin-dependent diabetes, heart disease…), requiring long-term care, having a long-standing condition, requiring a hospital stay of more than 30 days.

Beneficiaries of the RMI (revenu minimum d´insertion, minimum revenue of introduction) are automatically affiliated to the social security system. They are several requirements to qualify, but essentially every legal resident in France who earn less than a certain amount are entitled to this financial aid. As soon as they are affiliated, they also entitled to the health coverage. Those individuals are entitled to a 100 percent reimbursement of medical and hospital costs.

Complementary Insurance

Since health expenditure is growing in France, there has been ongoing concern about the deficit of the Sécurité Sociale and governments have been inclined to reduce the degree of reimbursement. As a result, more individuals are turning to l´assurance complémentaire (complementary insurance). This health insurance covers all or part of the costs not reimbursed by the health system.

The complementary insurance offers an extensive range of plans. The patient has to select the one that is best suited to his situation and needs to take into consideration his/her state of health, medical consumption, family, income and place of residence.

Expatriates in France

Since 2007, there have been some changes for EU citizens residing in France, introducing restrictions in their access to the health care system. This affects inactive individuals (not in employment) that do not have a professional activity (not working) or are looking for work, or students. The reason for those limitations is that France has to conform to the European community rules, like the other countries in the community. The new conditions of the right of stay have direct consequences on the social benefits in France.

Right of stay for inactive residence (not in employment) depends on two conditions:

• They need to have a reasonable level of income in order not to become a burden for the State.
• They need to have health coverage.

The conditions for inactive EU residents already living on France before November 2007 remain the same.

Students and retired people need to have medical coverage. Students usually have medical coverage from their country of origin or through the French Social Security for students; this applies to students under 28 years of age. Retired individuals, in most cases have health insurance from the country where they worked.

If an EU resident becomes sick and does not fulfill those two conditions and has been residing in France for less than three months, this person is entitled to dispositif soins urgent (emergency care device ). If the person has been residing for more than three months, he/she is entitled to l´Aide Médicale d´Etat (state medical aid).

Inactive EU residents can receive the couverture maladie universelle (universal health coverage) known as CMU if they are legal residents (stable and uninterrupted).

CMU de base (basic CMU)

Basic CMU helps anyone living in France who is not covered by another type of insurance get access to medical care and reimbursement of services and medication. People from all levels of income are entitled to it. The affiliation is not automatic and the person has to apply for it. It covers part of the medical services for the legal resident and the people in his/ her household. It covers typically seventy percent of a doctor's visit.

CMU complémentaire (complementary CMU)

Complementary CMU facilitates access to health care for people with low income residing in France for more than three months, in a stable and uninterrupted manner. These individuals have one hundred percent coverage without advance payment for the health services or medication (they are fully covered, no money upfront needed). The income of the individual´s household must not exceed a maximum amount. The spouse or partner of the individual, as well as the dependents under 25 years of age are also included in this coverage. It is renewable on a yearly basis.

If a person is a foreign national, outside EU member states or Switzerland, he/she must justify their right of residence in France in order to gain right to the State healthcare.

After five years of legal residence all EU nationals gain permanent right of residence and therefore become fully entitled to the CMU.

Any EU expatriate not officially retired (under retirement age), not working, and not having lived in France for more than five years will lose their right to the French state healthcare except for those who have been living in France since before November of 2007.

Life expectancy in France topped 80 years in 2004. The French health care service is certainly costly to maintain, but it remains one of the best in the world, offering a large choice of general practitioners and healthcare specialists.

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Are You Newbie in Health Club or Planning to Join. (Tips for You)

Before you can start the exercises make sure you should have at least 45 to 90 minutes for yourself. In our daily life we are thinking too much about our health but after few minutes we always forget everything. Just tight your belt and make your mind, you should do some exercise in your daily schedule. Here I am going to tell you some basic things when you join health club.

1. Choose anytime in your daily schedule, Morning or Evening and follow the same. Don’t go twice, some newbie thinking that if they are going twice a day so they can do better than others. That’s wrong for your health, your body needs rest as well so, go for once and on the same time.

2. If your health club is 500 to 2000 meter far so do some walk or light running, this way you can warm up your body and increasing your body stamina.

3. So now today is your 1st day in your health club?? If yes so after few minutes of walk and running. Your second step is, do some stretching and aerobics, this way you can make your body flexible.

Read more: Are You Newbie in Health Club or Planning to Join. (Tips for You)

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Star Family Health Optima

Today, medical costs are high and growing rapidly. If a family member is ill or injured, you should go to hospital or doctor to use medical facilities. There is no possibility of making frequent visits to medical facilities because the health care needs will always vary. It is easy to undue stress and financial focus and there is a health insurance is very important.

Optima Health is a family health insurance plan for your family is only offered by Star Health Insurance. This is a single premium contract covers your entire family needs medical care, which means they pay a premium multiple.

Covered hospital
Covers the insured for hospitalization of patients in a hospital more than 24 hours. Theses include fees such as room rental, lodging expenses, nursing costs, surgeon fees, consultant fees, expert fees, cost of anesthesia, blood money and oxygen, diagnostic expenses, cost of medicines and drugs, pacemakers, emergency ambulance fees, etc.

Pre-and post-hospitalization coverage
pre-hospital expenses are covered up to 30 days before hospitalization and after hospitalization is estimated that 7% of all hospitals, with a maximum of Rs 5000 / –

Criteria

Available for all 5 months old and 60 years living in India are eligible for this insurance.

Read more: Star Family Health Optima

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