Top 5 Risks Travellers Face in Adventure Travel

Sun basking on the beach with glass of cocktail in the hand may not be an ideal holiday style for everybody, thus a new form of holidaying – adventure sports holidays or adventure travel has become really popular. Adventure sports holidays are where travellers get an opportunity to try their hands at adrenal gushing and challenging activities such as mountain climbing, exploring caves, mountain biking, rafting, bungee jumping etc.

Because of its popularity, adventure travel coupled with adventure sports has become a part of the itinerary of almost all camping sites, resorts and hotels around the world that wish to provide their clients with something extra to do on their stay with there. Inclusion of adventure sports surely adds excitement and thrill to a traveller’s halt, but this comes with potential dangers which loom high on personal safety.

Top five risks involved in adventure travel are listed below:

1. All adventure activities and sports include dedicated gear, which is vital and should be used at all time while carrying out an activity. The gear is properly tested before use and almost all activities are carried out in a close observation of an instructor, whose main motive is to maintain your safety and make sure you adhere to all the safety requirements, but there can be a small chance that the safety equipment may fail. Therefore, safety is always an issue with adventure activities.

2. Mountain climbing can be a risky affair because as you travel uphill, the density of the oxygen in the air keeps decreasing which makes breathing difficult. If first aid is not administered, this can lead to chest pain and acute headaches, which if untreated, can lead to heart attack.

3. Mountain biking can be fun until cyclists try to do a little extra. Mountain bikers are at a risk of altitude sickness (as discussed in risk of mountain climbing above) and are also very prone to accidents because of the rough terrains selected for biking.

4. When you hit the water in a raft, you are always wearing a life jacket and are accompanied by an instructor. But the river current can flip you off the boat. Thus, while rafting you’re always at the risk of drowning or injuring yourself in the water.

5. Caving or cave exploration is one of the most thrilling adventure activities. Activity depends on the cave and how travellers negotiate squeezes, pitches, waters and rocks. Though caving has become safer with safety equipment but still travellers and adventurers are at risk of falling rocks, floods, falling, hypothermia and fatigue.

5 Tips to Adventure Travel in Small Groups

Are you planning your next vocation and thinking of taking an adventure travel tour instead of traditional beach – resort type of vocation? You are not alone, many people these days prefer active, adventurous style of travel. And the best way to have a safe adventure is to go for adventure travel in a small group.

Small group adventures travel is a fast growing industry and for a good reason. There are many definite advantages to having a guided adventure vocation in a small group:

- you can get more attention from the tour guide
- there is a great variety of small group adventures available even to rare and not tourist popular destinations
- if the group is not large the tour can be better customized to your needs
- often traveling in a small group is cheaper than participating in a conventional tour, because only a few people need accommodation, so it doesn’t have to be a big hotel
- tours are less formal and you have more freedom, yet a safety of having a guide, in case you need help

These tips will help you to get the most from your vocation

1. Decide what kind of adventure you are looking for. Adventure vocation is a broad term – for some it means exploring the wildness of Alaska or the jungles of Amazon, while others want a guided tour to Paris or Sydney. Not all adventures require you to be in a top physical shape. Some tours involve a lot of hiking, but not all – you can still see a lot of interesting and exciting things without accosting yourself. Find out in advance how difficult your tour is going to be.

2. Do you want to explore just one country in depth or would you rather see a lot of different things in different countries? This question might sound silly, but it actually is important. Since most adventure vocation tours are 7-14 days long, you can’t expect to see a lot of places and to spend a long time in each of them. More places and countries doesn’t necessarily mean better vocation, you might just become exhausted and overwhelmed by too many things to see.

3. Are you after a family adventure or you preferring only a company of adult travelers? As adventurous traveling gains its popularity, many companies offer family friendly adventure tours. These are usually light tours with many activities to interest children. So, if you plan to go with kids, search for family adventures. On the other hand, if you don’t want children as members of your group, make sure to ask your travel agent, if families with kids go for this type of tour.

4. Spend several hours researching adventure travel companies and comparing adventure tours they offer – that will save you a lot of money and frustration. If you do your research online, and you should, read what other people who took the tour you like have to say. Most traveling companies put testimonials online. You can also search adventure forums, where people share their real experiences.

5. Adventure travel doesn’t have to be very expensive, especially if we are talking about traveling in small groups. Search around and find a tour that suits your budget. In traveling industry expensive doesn’t necessarily mean the best. Compare what activities the tours offer and what kind of accommodation is included. It is possible to find great adventure tours at reasonable prices.

Seven Ways to Enrich Adventure Travel Experiences

What are the best ways to enrich Adventure Travel for you and your companions? Experienced travelers pick up tricks along the way, and I encourage you to add your own to the list. Below are seven ways that visitors to Cape Breton Island have increased their enjoyment of the journey, their stay on the Island and even the magic in their daily lives upon returning home. Notice the common ingredient is connection.

1. A Vision For Your Trip gives your adventure travel a context of what you would appreciate looking back on as a reference point of you being energized, connected with yourself and your environment, a juicy moment that can re-energize everyday life. For Aladdin, it’s a ride on a magic carpet, while for me it is taking a hike with my wife to find a waterfall.

2. A Great Destination: What place engages your sense of curiosity, your sense of where you and your companion(s) would like to explore and even settle in for a time? Many cultures call this developing a “sense of place”.

3 Knowledgeable Local Guides: By guides I mean people who know an adventure destination and are generous and passionate about sharing their knowledge and experience. They may actually escort you on a trip or simply educate you on places off the beaten track, things to do, where to eat or sleep, and where to visit in order to discover special spots mentioned above–to develop your own “sense of place”. These guides can offer a local connection embodying their passion and enthusiasm–they show an adventurous spirit which is joyful, even contagious. Guides offer a connection to local people, places and adventures. They offer you safety and useful information and recommendations.

4. Unique Gatherings The native Mi’kmaq on Cape Breton Island call gatherings “Mao I Omi” and the French call them “place de rencontre” and the Celts “Ceilidhs” (often involving music and dance). What you will find is that meeting other people and sharing your experiences, adventures and stories is a way to feel part of things, to live your adventures and enjoy others’ “magical experiences”, gifts and talents. Local gatherings, events and ceremonies are designed to create connection between people, a sense of “magic”, and the gift of good memories.

5. “An Adventure a Day (mild to wild)” By adventure, I mean something that has a degree of freshness and challenge to you even if you are accomplished at it. It does not have to be hiking up a wilderness trail or rock climbing, it can be as seemingly mild as learning a new recipe from an expert chef or discovering a blueberry patch ripe for the picking with most of the blueberries consumed on the spot and the rest put into a tasty blueberry pie! Easy as it is to overload your travel, with a list of things to do, consider focusing on “an adventure a day”, whether mild, wild or somewhere in between.

6. A Higher Purpose (Through Service and Learning) Besides recreation why travel? And is the adventure travel most significant only for you and your companion(s)? Having a Higher Purpose often adds to the experience and gets you past temporary discomfort and obstacles. One current purpose is what I call the “Green Theme” for adventure travel. Many of us experience what some call a nature deficit disorder (c/o author John Louv) and notice it in our children and others’ children. What happens when you connect with nature–trees, open space, birds and other animals–is a sense of connection not only with nature but with yourself. It gives you a different perspective and often a burst of energy, whether in a city, the country or a wilderness and unspoiled setting. Related to this “connection” with nature is an increasing desire and awareness of the fragile balance between ourselves and nature. Many volunteers and adventure travelers are seeking to stay in places that waste less and encourage use of renewable energy, as well tend to respect and preserve natural areas or at least to do no harm. For campers the expression is to “leave not a trace”. The goal increasingly becomes to be “of service” and to have a higher purpose in adventure travel: one of enjoying and preserving the green around you. The higher purpose for the trip can extend to any number of special areas of adventure and possible learning:, the arts, outdoor recreation, re-building after a hurricane,, team-building, ie is any activity for which you have a passion and can become part of your adventure travel. The goal is to create a result in you or in your environment that is useful and has significance.

7. Well-being, health and safety Find a place and be with people fostering a sense “well-being” or wellness.. After all, our normal routine is often full of work, obligations and, frankly, stress. Have you made space for “healing arts” or what some call “wellness” in your travel plan? Make sure you have enough time and knowledge to not only travel safely, but to catch your breath and to regenerate. Testing Your Brand of Magic in Adventure Travel You are the adventurer, judge and jury. The feeling and experience of the “Magic” is yours and it may be a different experience for your companion(s), but a good rule of thumb is to ask yourself if you have some stories and memories and even pictures or video that capture some of the juice, energy and enthusiasm of the magic you created during your travel. Spread this spirit of magic upon your return home and the magic will continue.

Adventure Travel From Grand Canyon Rafting to Base Jumping

Some people believe a break from work should involve more than just a holiday: it should be an adventure! Which is why adventure travel is becoming so popular. It doesn’t have to mean climbing Everest, attempting K2, or crossing a desert on the back of a camel: but it can, though it can just as easily mean a guided rafting trip in the Grand Canyon, seeing the desert from the basket of a balloon, a bungee jump like James Bond (off Switzerland’s Verzasca Dam) or a road trip somewhere literally *off the beaten track*.

Trekking in Nepal or paddling the Grand Canyon are the classic adventure travel options, and for most adventure travellers involve a bit of travel to get to, but there are travel adventure options in every country — you ‘d be surprised to see the list of where all the best paragliding destinations are, and paragliding definitely qualifies as adventure travel if it’s done right. Ice climbing, cave diving, shark diving, paddling between scenic islands, trekking overland, base jumping, or even heli-biking or heli-skiing can elevate your travels to adventure travels, and these kinds of adventure travel options can be found in some very unlikely destinations.

But the classic adventure options are still the best: New Zealand, for all the cycling and paddling options, as well as the extreme sports, is one of the best places for adventure travel, and Chile and Patagonia are popular for the same kinds of adventure travel attractions. Canada has the winter-y wilderness, and offers adventure travellers the chance to get back to nature and meet some exotic animals, while Borneo and the Galapagos, offer adventure travellers both untouched wilderness, unique animals and sunshine. Just in case you prefer your adventure travels without the adventurous weather.

Not all of us get the chance to have a real travel adventure. However, ‘adventure holidays’ are becoming ever more popular, and accessible, and not just among the young. As baby boomers mature they find they are fitter, and generally richer, than their parents were – so your 50s and 60s is a great time to take that travel adventure you never had time or money to do. Lots of adventure travel is within the realms of possibility for most people — you don’t have to be an elite athlete to cross the Sahara with a camel train, just relatively healthy and the owner of an adventurous spirit. Some adventure travel tour operators even run adventure tour options for younger explorers, and there are some gentle routes along even some of the most exciting of white water rivers, and child size mountains still worth conquering. And while once people thought of some adventure travel options as being the adventure of a life time, now a lifetime can have many travelling adventures.

Adventure Travel On The Road Less Travelled

When those of you think of adventure travel frequently it rouses pictures of mountain climbing, water activities, skydiving and many other activities both for leisure and as extreme sports.

While these certainly are associated with adventure travel, it may even include something as quiet as a horse and carriage ride through the cobbled streets of Bruges.

Your objective is to get out of your comfort zone and to start searching for encounters which are new. For adventure travel or experiences it is possible that there is even something close by to your home, or it could mean an overseas or inter-state trip.

More and more these new and fulfilling experiences are becoming popular with the majority of us needing the break from work for a holiday or just by bringing some excitement to your weekends.

Once upon a time tropical island resorts were the only way to go when travel was concerned but in these modern times many of the world’s travellers are seeking out something new. In this way we have seen a rise in adventure travel which includes popular places such as the Inca Trail, camping in the African Wilderness or climbing the summit of one of the world’s many mountain ranges.

That said even on tropical islands many will book tours to incorporate with their sun-going, relaxing trip such as island cultural tours, scenic flights, snorkelling or scuba diving trips and the like.

Adventure travel is not for everybody. It is for that type of person who needs those new experiences and someone who wants to encounter the unknown by exploring somewhere on the road less travelled.

There are of course elements of danger while on an adventure trip. Climbing Everest for example imposes a much bigger number of risky than say planting yourself under an umbrella at the beach. Use your best judgement when taking up an activity using reputable companies.

Adventure travel also does not necessarily have to be organised tour or a familiar scenario and each and every individual will have their own style, thoughts and emotions attached to each adventure trip.

One of my prime examples of adventure that I have experienced includes shark diving with Great Whites in South Africa, a school of up to 30 Galapagos Sharks in Hawaii and even swimming cage-less with grey Nurse Sharks in my home town of Sydney Australia. I’ve always been fascinated with sharks throughout my life so to experience them up close was an adventure on the road less travelled that I had to take.

On another trip I took to a small, quiet village of the Scottish Highlands known as Braemar which was the place of my ancestors which included a castle once belonging to them.

These are just some examples of adventure travel but there are so many more; sport fishing trips, caving or spelunking trips, scuba diving holidays, whale watching experiences, mountain treks, safari, wildlife tours and so many more.

The destination truly is up to you as an individual and the ideas out there are limitless. So forget about those holidays where you do nothing all week, seek out and find your most favoured adventure.

Adventure Travel Destination Marketing

There are various websites which offer great opportunities in traveling. Each and every person in this world loves to go for a holiday. It is very important to choose the right kind of place as your holiday destination. Before choosing your destination it is always very important to discuss it with your family.

When you log on to the internet and look for the travel companies you will get lots of websites. Adventure holiday marketing has become quite popular these days. Adventure travel destination.com is one of the websites which provides you proper information about the adventure travel suppliers.

This website has lots of things like information about the car rental companies which are local, various adventure activities, information about different kinds of hotels and resorts. There are lots of tourism suppliers present all over the world. These suppliers can access the marketing pages of this website directly.

They will find lots of opportunities for them in these kinds of websites. Other than the suppliers the travelers also get various benefits from the website. So whether you are interested in adventure destination marketing or in an adventure holiday you can look forward to this website.

As a traveler you can check out the website for the various specials as well as deals offered. There are lots of travelers who like to go for an adventure travel once in a year. There are certain travelers who prefer to deal directly with local hotel owners as well as tourism operators.

They want to deal directly with them because by doing this they get special rates and offers on the holiday package. Other than this, there are many more privileges that are offered by the hotel owners and operators.

When you enter into this website you will different kinds of information as well as blogs written on this topic. You will also mingle with lots of other travelers who can share their experiences as well as reviews.

This website also has a page which is called the vacation special and this page offers you with the list of travel experts. These experts can also offer you with the knowledge about the special offers and packages. Other than this, you also have the destination guide pages.

This page offers you with the opinions of the travel experts. Adventure travel destinations.com is the website which has become quite popular these days. This website is actually a part of the AXES marketing network for tourism.

If you choose the local hotel owners and contact directly with them then you can enjoy the local activities much better. You can contact with the local hotel owners and operators for destination marketing with the help of this website. There are lots of adventure travel destinations in this world.

You will get information about all these destinations from this marketing website. Online booking options are also available in this website. Other than this, there are lots of other facilities that are available with adventure marketing. So get the best deal now.

All About Affordable Health Insurance Plans

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can’t land on an affordable health plan that could cater to the medical care needs.

Let’s discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits.

• Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer’s group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer’s group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman’s Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas

While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can’t have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children’s Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent’s health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.

A Prescription For the Health Care Crisis

With all the shouting going on about America’s health care crisis, many are probably finding it difficult to concentrate, much less understand the cause of the problems confronting us. I find myself dismayed at the tone of the discussion (though I understand it—people are scared) as well as bemused that anyone would presume themselves sufficiently qualified to know how to best improve our health care system simply because they’ve encountered it, when people who’ve spent entire careers studying it (and I don’t mean politicians) aren’t sure what to do themselves.

Albert Einstein is reputed to have said that if he had an hour to save the world he’d spend 55 minutes defining the problem and only 5 minutes solving it. Our health care system is far more complex than most who are offering solutions admit or recognize, and unless we focus most of our efforts on defining its problems and thoroughly understanding their causes, any changes we make are just likely to make them worse as they are better.

Though I’ve worked in the American health care system as a physician since 1992 and have seven year’s worth of experience as an administrative director of primary care, I don’t consider myself qualified to thoroughly evaluate the viability of most of the suggestions I’ve heard for improving our health care system. I do think, however, I can at least contribute to the discussion by describing some of its troubles, taking reasonable guesses at their causes, and outlining some general principles that should be applied in attempting to solve them.

THE PROBLEM OF COST

No one disputes that health care spending in the U.S. has been rising dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is projected to reach $8,160 per person per year by the end of 2009 compared to the $356 per person per year it was in 1970. This increase occurred roughly 2.4% faster than the increase in GDP over the same period. Though GDP varies from year-to-year and is therefore an imperfect way to assess a rise in health care costs in comparison to other expenditures from one year to the next, we can still conclude from this data that over the last 40 years the percentage of our national income (personal, business, and governmental) we’ve spent on health care has been rising.

Despite what most assume, this may or may not be bad. It all depends on two things: the reasons why spending on health care has been increasing relative to our GDP and how much value we’ve been getting for each dollar we spend.

WHY HAS HEALTH CARE BECOME SO COSTLY?

This is a harder question to answer than many would believe. The rise in the cost of health care (on average 8.1% per year from 1970 to 2009, calculated from the data above) has exceeded the rise in inflation (4.4% on average over that same period), so we can’t attribute the increased cost to inflation alone. Health care expenditures are known to be closely associated with a country’s GDP (the wealthier the nation, the more it spends on health care), yet even in this the United States remains an outlier (figure 3).

Is it because of spending on health care for people over the age of 75 (five times what we spend on people between the ages of 25 and 34)? In a word, no. Studies show this demographic trend explains only a small percentage of health expenditure growth.

Is it because of monstrous profits the health insurance companies are raking in? Probably not. It’s admittedly difficult to know for certain as not all insurance companies are publicly traded and therefore have balance sheets available for public review. But Aetna, one of the largest publicly traded health insurance companies in North America, reported a 2009 second quarter profit of $346.7 million, which, if projected out, predicts a yearly profit of around $1.3 billion from the approximately 19 million people they insure. If we assume their profit margin is average for their industry (even if untrue, it’s unlikely to be orders of magnitude different from the average), the total profit for all private health insurance companies in America, which insured 202 million people (2nd bullet point) in 2007, would come to approximately $13 billion per year. Total health care expenditures in 2007 were $2.2 trillion (see Table 1, page 3), which yields a private health care industry profit approximately 0.6% of total health care costs (though this analysis mixes data from different years, it can perhaps be permitted as the numbers aren’t likely different by any order of magnitude).

Is it because of health care fraud? Estimates of losses due to fraud range as high as 10% of all health care expenditures, but it’s hard to find hard data to back this up. Though some percentage of fraud almost certainly goes undetected, perhaps the best way to estimate how much money is lost due to fraud is by looking at how much the government actually recovers. In 2006, this was $2.2 billion, only 0.1% of $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year.

Is it due to pharmaceutical costs? In 2006, total expenditures on prescription drugs was approximately $216 billion (see Table 2, page 4). Though this amounted to 10% of the $2.1 trillion (see Table 1, page 3) in total health care expenditures for that year and must therefore be considered significant, it still remains only a small percentage of total health care costs.

Is it from administrative costs? In 1999, total administrative costs were estimated to be $294 billion, a full 25% of the $1.2 trillion (Table 1) in total health care expenditures that year. This was a significant percentage in 1999 and it’s hard to imagine it’s shrunk to any significant degree since then.

In the end, though, what probably has contributed the greatest amount to the increase in health care spending in the U.S. are two things:

1. Technological innovation.

2. Overutilization of health care resources by both patients and health care providers themselves.

Technological innovation. Data that proves increasing health care costs are due mostly to technological innovation is surprisingly difficult to obtain, but estimates of the contribution to the rise in health care costs due to technological innovation range anywhere from 40% to 65% (Table 2, page 8). Though we mostly only have empirical data for this, several examples illustrate the principle. Heart attacks used to be treated with aspirin and prayer. Now they’re treated with drugs to control shock, pulmonary edema, and arrhythmias as well as thrombolytic therapy, cardiac catheterization with angioplasty or stenting, and coronary artery bypass grafting. You don’t have to be an economist to figure out which scenario ends up being more expensive. We may learn to perform these same procedures more cheaply over time (the same way we’ve figured out how to make computers cheaper) but as the cost per procedure decreases, the total amount spent on each procedure goes up because the number of procedures performed goes up. Laparoscopic cholecystectomy is 25% less than the price of an open cholecystectomy, but the rates of both have increased by 60%. As technological advances become more widely available they become more widely used, and one thing we’re great at doing in the United States is making technology available.

Overutilization of health care resources by both patients and health care providers themselves. We can easily define overutilization as the unnecessary consumption of health care resources. What’s not so easy is recognizing it. Every year from October through February the majority of patients who come into the Urgent Care Clinic at my hospital are, in my view, doing so unnecessarily. What are they coming in for? Colds. I can offer support, reassurance that nothing is seriously wrong, and advice about over-the-counter remedies—but none of these things will make them better faster (though I often am able to reduce their level of concern). Further, patients have a hard time believing the key to arriving at a correct diagnosis lies in history gathering and careful physical examination rather than technologically-based testing (not that the latter isn’t important—just less so than most patients believe). Just how much patient-driven overutilization costs the health care system is hard to pin down as we have mostly only anecdotal evidence as above.

Further, doctors often disagree among themselves about what constitutes unnecessary health care consumption. In his excellent article, “The Cost Conundrum,” Atul Gawande argues that regional variation in overutilization of health care resources by doctors best accounts for the regional variation in Medicare spending per person. He goes on to argue that if doctors could be motivated to rein in their overutilization in high-cost areas of the country, it would save Medicare enough money to keep it solvent for 50 years.

A reasonable approach. To get that to happen, however, we need to understand why doctors are overutilizing health care resources in the first place:

1. Judgment varies in cases where the medical literature is vague or unhelpful. When faced with diagnostic dilemmas or diseases for which standard treatments haven’t been established, a variation in practice invariably occurs. If a primary care doctor suspects her patient has an ulcer, does she treat herself empirically or refer to a gastroenterologist for an endoscopy? If certain “red flag” symptoms are present, most doctors would refer. If not, some would and some wouldn’t depending on their training and the intangible exercise of judgment.

2. Inexperience or poor judgment. More experienced physicians tend to rely on histories and physicals more than less experienced physicians and consequently order fewer and less expensive tests. Studies suggest primary care physicians spend less money on tests and procedures than their sub-specialty colleagues but obtain similar and sometimes even better outcomes.

3. Fear of being sued. This is especially common in Emergency Room settings, but extends to almost every area of medicine.

4. Patients tend to demand more testing rather than less. As noted above. And physicians often have difficulty refusing patient requests for many reasons (eg, wanting to please them, fear of missing a diagnosis and being sued, etc).

5. In many settings, overutilization makes doctors more money. There exists no reliable incentive for doctors to limit their spending unless their pay is capitated or they’re receiving a straight salary.

Gawande’s article implies there exists some level of utilization of health care resources that’s optimal: use too little and you get mistakes and missed diagnoses; use too much and excess money gets spent without improving outcomes, paradoxically sometimes resulting in outcomes that are actually worse (likely as a result of complications from all the extra testing and treatments).

How then can we get doctors to employ uniformly good judgment to order the right number of tests and treatments for each patient—the “sweet spot”—in order to yield the best outcomes with the lowest risk of complications? Not easily. There is, fortunately or unfortunately, an art to good health care resource utilization. Some doctors are more gifted at it than others. Some are more diligent about keeping current. Some care more about their patients. An explosion of studies of medical tests and treatments has occurred in the last several decades to help guide doctors in choosing the most effective, safest, and even cheapest ways to practice medicine, but the diffusion of this evidence-based medicine is a tricky business. Just because beta blockers, for example, have been shown to improve survival after heart attacks doesn’t mean every physician knows it or provides them. Data clearly show many don’t. How information spreads from the medical literature into medical practice is a subject worthy of an entire post unto itself. Getting it to happen uniformly has proven extremely difficult.

In summary, then, most of the increase in spending on health care seems to have come from technological innovation coupled with its overuse by doctors working in systems that motivate them to practice more medicine rather than better medicine, as well as patients who demand the former thinking it yields the latter.

But even if we could snap our fingers and magically eliminate all overutilization today, health care in the U.S. would still remain among the most expensive in the world, requiring us to ask next—

WHAT VALUE ARE WE GETTING FOR THE DOLLARS WE SPEND?

According to an article in the New England Journal of Medicine titled The Burden of Health Care Costs for Working Families—Implications for Reform, growth in health care spending “can be defined as affordable as long as the rising percentage of income devoted to health care does not reduce standards of living. When absolute increases in income cannot keep up with absolute increases in health care spending, health care growth can be paid for only by sacrificing consumption of goods and services not related to health care.” When would this ever be an acceptable state of affairs? Only when the incremental cost of health care buys equal or greater incremental value. If, for example, you were told that in the near future you’d be spending 60% of your income on health care but that as a result you’d enjoy, say, a 30% chance of living to the age of 250, perhaps you’d judge that 60% a small price to pay.

This, it seems to me, is what the debate on health care spending really needs to be about. Certainly we should work on ways to eliminate overutilization. But the real question isn’t what absolute amount of money is too much to spend on health care. The real question is what are we getting for the money we spend and is it worth what we have to give up?

People alarmed by the notion that as health care costs increase policymakers may decide to ration health care don’t realize that we’re already rationing at least some of it. It just doesn’t appear as if we are because we’re rationing it on a first-come-first-serve basis—leaving it at least partially up to chance rather than to policy, which we’re uncomfortable defining and enforcing. Thus we don’t realize the reason our 90 year-old father in Illinois can’t have the liver he needs is because a 14 year-old girl in Alaska got in line first (or maybe our father was in line first and gets it while the 14 year-old girl doesn’t). Given that most of us remain uncomfortable with the notion of rationing health care based on criteria like age or utility to society, as technological innovation continues to drive up health care spending, we very well may at some point have to make critical judgments about which medical innovations are worth our entire society sacrificing access to other goods and services (unless we’re so foolish as to repeat the critical mistake of believing we can keep borrowing money forever without ever having to pay it back).

So what value are we getting? It varies. The risk of dying from a heart attack has declined by 66% since 1950 as a result of technological innovation. Because cardiovascular disease ranks as the number one cause of death in the U.S. this would seem to rank high on the scale of value as it benefits a huge proportion of the population in an important way. As a result of advances in pharmacology, we can now treat depression, anxiety, and even psychosis far better than anyone could have imagined even as recently as the mid-1980′s (when Prozac was first released). Clearly, then, some increases in health care costs have yielded enormous value we wouldn’t want to give up.

But how do we decide whether we’re getting good value from new innovations? Scientific studies must prove the innovation (whether a new test or treatment) actually provides clinically significant benefit (Aricept is a good example of a drug that works but doesn’t provide great clinical benefit—demented patients score higher on tests of cognitive ability while on it but probably aren’t significantly more functional or significantly better able to remember their children compared to when they’re not). But comparative effectiveness studies are extremely costly, take a long time to complete, and can never be perfectly applied to every individual patient, all of which means some health care provider always has to apply good medical judgment to every patient problem.

Who’s best positioned to judge the value to society of the benefit of an innovation—that is, to decide if an innovation’s benefit justifies its cost? I would argue the group that ultimately pays for it: the American public. How the public’s views could be reconciled and then effectively communicated to policy makers efficiently enough to affect actual policy, however, lies far beyond the scope of this post (and perhaps anyone’s imagination).

THE PROBLEM OF ACCESS

A significant proportion of the population is uninsured or underinsured, limiting or eliminating their access to health care. As a result, this group finds the path of least (and cheapest) resistance—emergency rooms—which has significantly impaired the ability of our nation’s ER physicians to actually render timely emergency care. In addition, surveys suggest a looming primary care physician shortage relative to the demand for their services. In my view, this imbalance between supply and demand explains most of the poor customer service patients face in our system every day: long wait times for doctors’ appointments, long wait times in doctors’ offices once their appointment day arrives, then short times spent with doctors inside exam rooms, followed by difficulty reaching their doctors in between office visits, and finally delays in getting test results. This imbalance would likely only partially be alleviated by less health care overutilization by patients.

GUIDELINES FOR SOLUTIONS

As Freaknomics authors Steven Levitt and Stephen Dubner state, “If morality represents how people would like the world to work, then economics represents how it actually does work.” Capitalism is based on the principle of enlightened self-interest, a system that creates incentives to yield behavior that benefits both suppliers and consumers and thus society as a whole. But when incentives get out of whack, people begin to behave in ways that continue to benefit them often at the expense of others or even at their own expense down the road. Whatever changes we make to our health care system (and there’s always more than one way to skin a cat), we must be sure to align incentives so that the behavior that results in each part of the system contributes to its sustainability rather than its ruin.

Here then is a summary of what I consider the best recommendations I’ve come across to address the problems I’ve outlined above:

1. Change the way insurance companies think about doing business. Insurance companies have the same goal as all other businesses: maximize profits. And if a health insurance company is publicly traded and in your 401k portfolio, you want them to maximize profits, too. Unfortunately, the best way for them to do this is to deny their services to the very customers who pay for them. It’s harder for them to spread risk (the function of any insurance company) relative to say, a car insurance company, because far more people make health insurance claims than car insurance claims. It would seem, therefore, from a consumer perspective, the private health insurance model is fundamentally flawed. We need to create a disincentive for health insurance companies to deny claims (or, conversely, an extra incentive for them to pay them). Allowing and encouraging aross-state insurance competition would at least partially engage free market forces to drive down insurance premiums as well as open up new markets to local insurance companies, benefiting both insurance consumers and providers. With their customers now armed with the all-important power to go elsewhere, health insurance companies might come to view the quality with which they actually provide service to their customers (ie, the paying out of claims) as a way to retain and grow their business. For this to work, monopolies or near-monopolies must be disbanded or at the very least discouraged. Even if it does work, however, government will probably still have to tighten regulation of the health insurance industry to ensure some of the heinous abuses that are going on now stop (for example, insurance companies shouldn’t be allowed to stratify consumers into sub-groups based on age and increase premiums based on an older group’s higher average risk of illness because healthy older consumers then end up being penalized for their age rather than their behaviors). Karl Denninger suggests some intriguing ideas in a post on his blog about requiring insurance companies to offer identical rates to businesses and individuals as well as creating a mandatory “open enrollment” period in which participants could only opt in or out of a plan on a yearly basis. This would prevent individuals from only buying insurance when they got sick, eliminating the adverse selection problem that’s driven insurance companies to deny payment for pre-existing conditions. I would add that, however reimbursement rates to health care providers are determined in the future (again, an entire post unto itself), all health insurance plans, whether private or public, must reimburse health care providers by an equal percentage to eliminate the existence of “good” and “bad” insurance that’s currently responsible for motivating hospitals and doctors to limit or even deny service to the poor and which may be responsible for the same thing occurring to the elderly in the future (Medicare reimburses only slightly better than Medicaid). Finally, regarding the idea of a “public option” insurance plan open to all, I worry that if it’s significantly cheaper than private options while providing near-equal benefits the entire country will rush to it en masse, driving private insurance companies out of business and forcing us all to subsidize one another’s health care with higher taxes and fewer choices; yet at the same time if the cost to the consumer of a “public option” remains comparable to private options, the very people it’s meant to help won’t be able to afford it.

2. Motivate the population to engage in healthier lifestyles that have been proven to prevent disease. Prevention of disease probably saves money, though some have argued that living longer increases the likelihood of developing diseases that wouldn’t have otherwise occurred, leading to the overall consumption of more health care dollars (though even if that’s true, those extra years of life would be judged by most valuable enough to justify the extra cost. After all, the whole purpose of health care is to improve the quality and quantity of life, not save society money. Let’s not put the cart before the horse). However, the idea of preventing a potentially bad outcome sometime in the future is only weakly motivating psychologically, explaining why so many people have so much trouble getting themselves to exercise, eat right, lose weight, stop smoking, etc. The idea of financially rewarding desirable behavior and/or financially punishing undesirable behavior is highly controversial. Though I worry this kind of strategy risks the enacting of policies that may impinge on basic freedoms if taken too far, I’m not against thinking creatively about how we could leverage stronger motivational forces to help people achieve health goals they themselves want to achieve. After all, most obese people want to lose weight. Most smokers want to quit. They might be more successful if they could find more powerful motivation.

3. Decrease overutilization of health care resources by doctors. I’m in agreement with Gawande that finding ways to get doctors to stop overutilizing health care resources is a worthy goal that will significantly rein in costs, that it will require a willingness to experiment, and that it will take time. Further, I agree that focusing only on who pays for our health care (whether the public or private sectors) will fail to address the issue adequately. But how exactly can we motivate doctors, whose pens are responsible for most of the money spent on health care in this country, to focus on what’s truly best for their patients? The idea that external bodies—whether insurance companies or government panels—could be used to set standards of care doctors must follow in order to control costs strikes me as ludicrous. Such bodies have neither the training nor overriding concern for patients’ welfare to be trusted to make those judgments. Why else do we have doctors if not to employ their expertise to apply nuanced approaches to complex situations? As long as they work in a system free of incentives that compete with their duty to their patients, they remain in the best position to make decisions about what tests and treatments are worth a given patient’s consideration, as long as they’re careful to avoid overconfident paternalism (refusing to obtain a head CT for a headache might be overconfidently paternalistic; refusing to offer chemotherapy for a cold isn’t). So perhaps we should eliminate any financial incentive doctors have to care about anything but their patients’ welfare, meaning doctors’ salaries should be disconnected from the number of surgeries they perform and the number of tests they order, and should instead be set by market forces. This model already exists in academic health care centers and hasn’t seemed to promote shoddy care when doctors feel they’re being paid fairly. Doctors need to earn a good living to compensate for the years of training and massive amounts of debt they amass, but no financial incentive for practicing more medicine should be allowed to attach itself to that good living.

4. Decrease overutilization of health care resources by patients. This, it seems to me, requires at least three interventions:

* Making available the right resources for the right problems (so that patients aren’t going to the ER for colds, for example, but rather to their primary care physicians). This would require hitting the “sweet spot” with respect to the number of primary care physicians, best at front-line gatekeeping, not of health care spending as in the old HMO model, but of triage and treatment. It would also require a recalculating of reimbursement levels for primary care services relative to specialty services to encourage more medical students to go into primary care (the reverse of the alarming trend we’ve been seeing for the last decade).

* A massive effort to increase the health literacy of the general public to improve its ability to triage its own complaints (so patients don’t actually go anywhere for colds or demand MRIs of their backs when their trusted physicians tells them it’s just a strain). This might be best accomplished through a series of educational programs (though given that no one in the private sector has an incentive to fund such programs, it might actually be one of the few things the government should—we’d just need to study and compare different educational programs and methods to see which, if any, reduce unnecessary patient utilization without worsening outcomes and result in more health care savings than they cost).

* Redesigning insurance plans to make patients in some way more financially liable for their health care choices. We can’t have people going bankrupt due to illness, nor do we want people to underutilize health care resources (avoiding the ER when they have chest pain, for example), but neither can we continue to support a system in which patients are actually motivated to overutilize resources, as the current “pre-pay for everything” model does.

Florida Health Insurance Rate Hikes and Quotes

Florida Health Insurance Rate Hike

Florida Health insurance premiums have touched new heights! Every Floridian has the common knowledge that most annual health insurance contracts will endure a rate increase at the end of the year. This trend is not new and should be expected. Every time this issue pops up it seems as though the blame game starts. Floridians blame Health insurance companies; Health insurance companies blame Hospitals, Doctors and other medical care providers, Medical care providers blame inflation and politicians, well, we really don’t know what they do to help the issue… No one seems to be interested in finding the real cause of the health insurance premium rate increase. Most individuals, self employed, and small business owners have taken Florida Health Insurance Rate Hikes as the inevitable evil.

Hard Facts

What are various reports telling us? Why do Health insurance premium have annual rate increases?

Rate of inflation and heath insurance premium rate increase.

America’s health expenditure in the year 2004 has increased dramatically, it has increased more than three time the inflation rate. In this year the inflation rate was around 2.5% while the national health expenses were around 7.9%. The employer health insurance or group health insurance premium had increased approximately 7.8% in the year 2006, which is almost double the rate of inflation. In short, last year in 2006, the annual premiums of group health plan sponsored by an employer was around $4,250 for a single premium plan, while the average family premium was around $ 11,250 per year. This indicates that in the year 2006 the employer sponsored health insurance premium increased 7.7 percent. Taking the biggest hit were small businesses that had 0-24 employees. There health insurance premiums increased by nearly 10.4%

Employees are also not spared, in the year 2006 the employee also had to pay around $ 3,000 more in their contribution to employer’s sponsored health insurance plan in comparison to the previous year, 2005. Rate hikes have been in existence since the “Florida Health Insurance” plan started. In covering an entire family of four, a person will experience an increase in premium rate at every annual renewal. If they would have kept the record of their health insurance premium payments they will find that they are now paying around $ 1,100 more than they paid in the year 2000 for the same coverage and with the same company. The same item was found by the Health Research Educational Trust and the Kaiser Family Foundation in their survey report of the year 2000. They found out that the premiums of health insurance that is sponsored by the employer increases by around 4 times than the employee’s salary. This report also stated that since 2000 the contribution of employees in group health insurance sponsored by employer was increased by more than 143 percent.

One business man predicts that if nothing is done and the Health insurance premiums keep increasing that in the year 2008, the amount of health premium contribution to employer will surpass their profit. Professionals within and outside the field of Florida health insurance, think that the reason for increase in Florida health insurance premium rates are due to many factors, such as high administration expenditure, inflation, poor or bad management, increase in the cost of medical care, waste etc.

Florida health insurance rate hikes affect whom?

Rising rates of Florida health insurance generally affects most of the Floridians who live in our beautiful state. The highest affected individudals are the minimum wage and low wage workers. Recent drops in the renewal of health insurance are mostly from this low income group. They just can’t afford the high premiums of Florida health insurance. They are in the situation where they can not afford the medical care and they can not afford the medical insurance premiums that are assosiated with adequate coverage. Almost half of all Americans are of the opinion that they are more worried about the high health insurance rate and high cost of health care, over any other bill they have on a monthly basis. A survey also finds that around 42% of Americans can not afford the high cost of health care services. There is one very interesting study conducted by Harvard University researchers. They found out that 68% of people who filed bankruptcy covered themselves and their family by health insurance. Average out-of-pocket deductibles for people filed bankruptcy were around $ 12,000 per year. They also found some co-relation between medical expenditure and bankruptcy. A national survey also reports that main reason for people not to take health insurance is the high premium rate of health insurance.

How to reduce Florida’s high health insurance cost? Nobody knows for sure. There are different opinions and experts are not agreeing with each other. Health professionals believe that if we can raise the number of healthy people by improving the lifestyle and regular exercise, good diets etc. than naturally they will need less medical care services which decreases the demands of health care and hence the cost.( This year in Florida the smoking rate has increased by 21.7 percent) One Floridian sarcastically suggested that there are ‘highs’ and ‘lows’ in health care that are needed to reversed. That the state of Florida is to ‘high’ in cost of medical care compare to other States and ‘low’ in the quality of health care.

Florida Health insurance rate hike has attracted many frauds. These frauds float many bogus insurance companies and offer cheap health insurance rate which attract many people to them. These companies usually through assosiations that are based in other states.

Meanwhile reputable Florida health insurance companies provide different types of health insurance like employer sponsored group health insurance, small business health insurance, individual health insurance etc. to vast number of employees and their families. Still there are many people in Florida that lack any health coverage. Today the employer also has found it challenging to decide how to offer employer sponsored group health insurance to their employees, so that both of them arrive at some point of agreement.

Community Needs Health Assessment

In 2012 the Internal Revenue Service mandated that all non-profit hospitals undertake a community health needs assessment (CHNA) that year and every three years thereafter. Further, these hospitals need to file a report every year thereafter detailing the progress that the community is making towards meeting the indicated needs. This type of assessment is a prime example of primary prevention strategy in population health management. Primary prevention strategies focus on preventing the occurrence of diseases or strengthen the resistance to diseases by focusing on environmental factors generally.

I believe that it is very fortunate that non-profit hospitals are carrying out this activity in their communities. By assessing the needs of the community and by working with community groups to improve the health of the community great strides can be made in improving public health, a key determinant of one’s overall health. As stated on the Institute for Healthcare Improvement’s Blue Shirt Blog (CHNAs and Beyond: Hospitals and Community Health Improvement), “There is growing recognition that the social determinants of health – where we live, work, and play, the food we eat, the opportunities we have to work and exercise and live in safety – drive health outcomes. Of course, there is a large role for health care to play in delivering health care services, but it is indisputable that the foundation of a healthy life lies within the community. To manage true population health – that is, the health of a community – hospitals and health systems must partner with a broad spectrum of stakeholders who share ownership for improving health in our communities.” I believe that these types of community involvement will become increasingly important as reimbursement is driven by value.

Historically, healthcare providers have managed the health of individuals and local health departments have managed the community environment to promote healthy lives. Now, with the IRS requirement, the work of the two are beginning to overlap. Added to the recent connection of the two are local coalitions and community organizations, such as religious organizations.

The community in which I live provides an excellent example of the new interconnections of various organizations to collectively improve the health of the community. In 2014 nine non-profits, including three hospitals, in Kent County, Michigan conducted a CHNA of the county to assess the strengths and weaknesses of health in the county and to assess the community’s perceptions of the pressing health needs. The assessment concluded that the key areas of focus for improving the health of the community are:

· Mental health issues

· Poor nutrition and obesity

· Substance abuse

· Violence and safety

At this time the Kent County Health Department has begun developing a strategic plan for the community to address these issues. A wide variety of community groups have begun meeting monthly to form this strategic plan. There are four work groups, one for each of the key areas of focus. I am involved in the Substance Abuse workgroup as a representative of one of my clients, Kent Intermediate School District. Other members include a substance abuse prevention coalition, a Federally qualified health center, a substance abuse treatment center and the local YMCA, among others. The local hospitals are involved in other workgroups. One of the treatment group representatives is a co-chair of our group. The health department wants to be sure that the strategic plan is community driven.

At the first meeting the health department leadership stated that the strategic plan must be community driven. This is so in order that the various agencies in the community will buy into the strategic plan and will work cooperatively to provide the most effective prevention and treatment services without overlap. The dollars spent on services will be more effective if the various agencies work to enhance each others’ work, to the extent possible.

At this time the Substance Abuse work group is examining relevant data from the 2014 CHNA survey and from other local resources. The epidemiologist at the health department is reviewing relevant data with the group so that any decisions about the goals of the strategic plan will be data driven. Using data to make decisions is one of the keystones of the group’s operating principles. All objectives in the strategic plan will be specific, measurable, achievable, realistic and time-bound (SMART).

Once the strategic plan is finished, the groups will continue with implementation of the plan, evaluating the outcomes of the implementation and adjusting the plan as needed in light of evaluation. As one can see, the workgroups of the CHNA are following the classic Plan-Do-Check-Act process. This process has been shown time and again in many settings-healthcare, business, manufacturing, et al-to produce excellent outcomes when properly followed.

As noted above I recommend that healthcare providers become involved with community groups to apply population level health management strategies to improve the overall health of the community. One good area of involvement is the Community Health Needs Assessment project being implemented through the local health department and non-profit hospitals.